Part 58

No.

#What course does ichthyosis pursue?#

Chronic. Beginning in early infancy or childhood, it usually becomes gradually more marked until adult age, after which time it, as a rule, remains stationary.

#What is the etiology?#

Beyond a hereditary influence, which is often a positive factor, the causes are obscure. It is not a common disease.

#State the pathology.#

Anatomically the essential feature is epidermic hypertrophy, with usually a varying degree of papillary hypertrophy also.

#Mention the diagnostic features of ichthyosis.#

The harsh, dry skin, epidermic and papillary hypertrophy, the furfuraceous or plate-like scaliness, the greater development upon the extensor surfaces, a history of the affection dating from early childhood, and the absence of inflammatory symptoms.

#How is ichthyosis to be distinguished from eczema, psoriasis, and other scaly inflammatory diseases?#

By the absence of the inflammatory element.

#What is the outlook for a case of ichthyosis?#

The prognosis is unfavorable as regards a cure, but the process may usually be kept in abeyance or rendered endurable by proper measures.

#What treatment would you prescribe for ichthyosis?#

Treatment that has in view removal of the scaliness and the maintenance of a soft and flexible condition of the skin.

In mild cases frequent warm baths, simple or alkaline, will suffice; in others an application of an oily or fatty substance, such as the ordinary oils or ointments, made several hours or immediately before the bath may be necessary. In moderately developed cases the skin is to be washed energetically with sapo viridis and hot water, followed by a warm bath, after which an oily or fatty application is made. In some of the more severe cases the following plan is often useful: The parts are first rubbed with a soapy ointment consisting of one part of precipitated sulphur and seven parts of sapo viridis; a bath is then taken, the skin wiped dry, and a one to five per cent. ointment of salicylic acid gently rubbed in.

Glycerine lotions, one or two drachms to the ounce of water, are also beneficial; as also the following:--

Ac. salicylici, ...................... gr. x-xl Glycerini, ........................... ss-j Lanolin, Petrolati, .................. [=a][=a] ss

In severe cases of ichthyosis hystrix it may be necessary, also, to employ caustics or the knife.

#What systemic treatment would you prescribe?#

Constitutional remedies are practically powerless; occasionally some good is accomplished by the internal administration of linseed oil and jaborandi.

#Onychauxis.# (Synonym: Hypertrophy of the Nail.)

#Describe onychauxis.#

Onychauxis, or hypertrophy of the nail, may take place in one or all directions, and this increase may be, and often is, accompanied by changes in shape, color, and direction of growth. One or all the nails may share in the process. As the result of lateral deviation of growth, the nail presses upon the surrounding tissues, producing a varying degree of inflammation--paronychia.

#What is the etiology of hypertrophy of the nail?#

The condition may be either congenital or acquired. In the latter instances it is usually the result of the extension to the matrix of such cutaneous diseases as psoriasis and eczema; or it is produced by constitutional maladies, such as syphilis.

#Give the treatment of hypertrophy of the nail.#

Treatment consists in the removal of the redundant nail-tissue by means of the knife or scissors; and, when dependent upon eczema or psoriasis, the employment of remedies suitable for these diseases. When it is the result of syphilis, the medication appropriate to this disease is to be employed.