Part 26

The subjective symptoms consist of a feeling of tension, burning and tenderness, and sometimes itching. Not infrequently, also there is neuralgic pain.

#What is the cause of pompholyx?#

The eruption is thought to be due to a depressed state of the nervous system. It is more common in women, and is met with chiefly in adult and middle life.

#What is the pathology?#

Opinion is divided; some considering it a disease of the sweat-glands and others an inflammatory disease independent of these structures.

#State the diagnostic features of pompholyx.#

The distribution and the peculiar characters and course of the eruption.

It is to be differentiated from eczema.

#What is the prognosis?#

For the immediate attack, favorable, recovery taking place in several weeks or a few months. Recurrences at irregular intervals are not uncommon.

#What is the treatment of pompholyx?#

The general health is to be looked after, and the patient placed under good hygienic conditions. Remedies of a tonic nature, directed especially toward improving the state of the nervous system, are to be prescribed. Locally, soothing and anodyne applications, such as lead-water and laudanum, boric-acid lotion, oxide-of-zinc, boric-acid and diachylon ointments, are most suitable; or the parts may be enveloped with the following:--

Pulv. ac. salicylici, ................ gr. x Pulv. ac. borici, Pulv. amyli, .......... [=a][=a] ..... ij Petrolati, ........................... iv. M.

In fact, the external treatment is similar to that employed in acute eczema.

#Herpes Simplex.# (Synonym: Fever Blisters.)

#What is herpes simplex?#

An acute inflammatory disease, characterized by the formation of pin-head to pea-sized vesicles, arranged in groups, and occurring for the most part about the face and genitalia.

#Describe the symptoms of herpes simplex.#

In severe cases, malaise and pyrexia may precede the eruption, but usually it appears without any precursory or constitutional symptoms. A feeling of heat and burning in the parts is often complained of. The vesicles, which are commonly pin-head in size, are usually upon a hyperæmic or inflammatory base, and tend to occur in groups or clusters. Their contents are usually clear, subsequently becoming more or less milky or puriform. There is no tendency to spontaneous rupture, but should they be broken a superficial excoriation results. In a short time they dry to crusts which soon fall off, leaving no permanent trace.

#Is the eruption in herpes simplex abundant?#

No. As a rule not more than one or two clusters or groups are observed.

#Upon what parts does the eruption occur?#

Usually about the face (herpes facialis), and most frequently about the lips (herpes labialis); on the genitalia (herpes progenitalis), the lesions are commonly found on the prepuce (herpes præputialis) in the male, and on the labia minora and labia majora in the female.

#State the causes of herpes simplex.#

Herpes facialis is often observed in association with colds and febrile and lung diseases. Malaria, digestive disturbance, and nervous disorders are not infrequently predisposing factors. Herpes progenitalis is said to occur more frequently in those who have previously had some venereal disease, especially gonorrha, but this is questionable. It is probably often purely neurotic.

#What are the diagnostic points?#

The appearance of one or several vesicular groups or clusters about the face, and especially about the lips, is usually sufficiently characteristic. The same holds true ordinarily when the eruption is seen on the prepuce or other parts of the genitalia; it is only when the vesicles become rubbed or abraded and irritated that it might be mistaken for a venereal sore, but the history, course and duration will usually serve to differentiate.

#Give the prognosis.#