Part 48

#State the prognosis.#

The disease is readily curable, disappearing upon the removal of the predisposing cause and the employment of local antiseptic applications.

#What treatment is to be advised?#

Good food, proper hygiene and tonic remedies; and, locally, removal of the crusts and stimulation of the underlying surface with an ointment of ammoniated mercury, ten to thirty grains to the ounce.

The following mild antiseptic lotion, which materially lessens the tendency to the formation of new lesions, may be applied to the affected region two or three times daily:--

Acidi borici, ........................ iv Resorcini, ........................... ij Glycerinæ, ........................... fij Alcoholis, ........................... fj Aquæ, ........... q.s. ad ............ Oj. M.

A weak lotion of thymol, corrosive sublimate or ichthyol would doubtless be equally effectual.

#Pemphigus.#

#What do you understand by pemphigus?#

Pemphigus is an acute or chronic disease characterized by the successive formation of irregularly-scattered, variously-sized blebs.

#Name the varieties met with.#

Two varieties are usually described--pemphigus vulgaris and pemphigus foliaceus.

#Describe the symptoms and course of pemphigus vulgaris.#

With or without precursory symptoms of systemic disturbance, irregularly scattered blebs, few or in numbers, make their appearance, arising from erythematous spots or from apparently normal skin. They vary in size from a pea to a large egg, are rounded or ovalish, usually distended, and contain a yellowish fluid which, later, becomes cloudy or puriform. If ruptured, the rete is exposed, but the skin soon regains its normal condition; if undisturbed, the fluid usually disappears by absorption. Each lesion runs its course in several days or a week.

A grave type of pemphigus is exceptionally observed in the newborn--pemphigus neonatorum.

#What course does pemphigus vulgaris pursue?#

Usually chronic. The disease may subside in several months and the process come to an end, constituting the acute type. As a rule, however, the disease is chronic, new blebs continuing to appear from time to time for an indefinite period.

#In what respects does the severe form of pemphigus vulgaris differ from the ordinary type?#

In the severe or malignant type the eruption is more profuse; there is marked, and often grave, systemic depression, and the lesions are attended with ulcerative action.

#Describe the symptoms and course of pemphigus foliaceus.#

In this, the grave type of the disease, the blebs are loose and flaccid, with milky or puriform contents, rupturing and drying to crusts, which are cast off, disclosing the reddened corium. New blebs appear on the sites of disappearing or half-ruptured lesions, and the whole surface may be thus involved and the disease continue for years, compromising the general health and eventually ending fatally.

In some cases of pemphigus (pemphigus vegetans) a vegetating or papillomatous condition develops from the base of the lesion, with an offensive discharge; it is usually a grave type of the malady.

Exceptionally cases (dermatitis vegetans) are met with which have a close similarity in their symptoms to pemphigus vegetans, but in which the eruption is more or less limited to the genitocrural region. The disorder is not malignant and usually yields to cleanliness and antiseptics.

#What is the character of the subjective symptoms in pemphigus?#

The subjective symptoms consist variously of heat, tenderness, pain, burning and itching, and may be slight or troublesome.

#What is known in regard to the etiology of pemphigus?#

The causes are obscure; general debility, overwork, shock, nervous exhaustion, and septic conditions (microörganisms) are thought to be of influence. There seems no doubt that those who have to do with cattle products, especially butchers, are subjects of acute and usually grave pemphigus. Vaccination has exceptionally been responsible for the disease, probably through some coincidental infection. The disease is not contagious, nor is it due to syphilis. It may occur at any age.

It is a rare disease, especially in this country. Most of the cases diagnosed as pemphigus by the inexperienced are examples of bullous urticaria, bullous erythema multiforme, and impetigo contagiosa.