Part 67

#Describe general idiopathic atrophy of the skin, and give the treatment.#

General idiopathic atrophy of the skin is extremely rare, and is characterized by a gradual, more or less general, degenerative and quantitative atrophy of the skin structures, accompanied usually with more or less discoloration and pigmentation.

Treatment is palliative and based upon indications.

#Describe parchment skin, and state the treatment.#

Parchment skin (xeroderma pigmentosum, angioma pigmentosum et atrophicum) is a rare disease, the exact nature of which is not understood. It is characterized by the appearance of numerous disseminated, freckle-like pigment-spots, telangiectases, atrophied muscles, more or less shrinking and contraction of the integument, and followed, in most instances, by epitheliomatous tumors and ulceration, and finally death. It is usually slow in its course, beginning in childhood and lasting for years. It is not infrequently seen in several children of the same family.

Treatment is palliative, consisting, if necessary, of the use of protective applications and of the administration of tonics and nutrients.

#Describe atrophic lines and spots.#

Atrophic lines and spots (striæ et maculæ atrophicæ) may be idiopathic or symptomatic, the lesions consisting of scar-like or atrophic-looking, whitish lines and macules, most commonly seen on the trunk. They are smooth and glistening. Slight hyperæmia usually precedes their formation. As an idiopathic disease its course is insidious and slow, and its progress eventually stayed. The so-called lineæ albicantes, resulting from the stretching of the skin produced by pregnancy or tumors, and from rapid development of fat, may be mentioned as illustrating the symptomatic variety.

In course of time the atrophy becomes less conspicuous.

#Describe senile atrophy.#

Senile atrophy is not uncommon, the atrophy resulting, as the name inferentially implies, from advancing age. It is characterized by thinning and wasting, dryness, and a wrinkled condition, with more or less pigmentation and loss of hair. Circumscribed pigmentary deposits and seborrha, with degeneration, are also noted.

#What several diseases of the skin are commonly followed by atrophic changes?#

Favus, lupus, syphilis, leprosy, scleroderma and morpha.

#CLASS VI.--NEW GROWTHS.#

#Keloid.# (Synonyms: Keloid of Alibert; Cheloid.)

#Give a descriptive definition of keloid.#

Keloid is a fibro-cellular new growth of the corium appearing as one or several variously-sized, irregularly-shaped, elevated, smooth, firm, pinkish or pale-reddish cicatriform lesions.

#Describe the clinical appearance of keloid.#

The growth begins as a small, hard, elevated, pinkish or reddish tubercle, increasing gradually, several months or years usually elapsing before the tumor reaches conspicuous size. When developed, it is one or more inches in diameter, is sharply defined, elevated, hard, rounded or oval, fungoid or crab-shaped, and firmly implanted in the skin. It is usually pinkish, pearl-white, or reddish, commonly devoid of hair, with no tendency to scaliness, and with, usually, several vessels coursing over it. In some instances it is tender, and it may be spontaneously painful.

The breast, especially over the sternal region, is a favorite site for its appearance. One, several or more may be present in the single case.

#What course does keloid pursue?#

Chronic; usually lasting throughout life. In rare instances spontaneous involution takes place.

#State the etiology of keloid.#

The causes are obscure. The growth usually takes its start from some injury or lesion of continuity; for instance, at the site of burns, cuts, acne and smallpox scars, etc.--cicatricial keloid, false keloid; or it may also, so it is thought, originate in normal skin--spontaneous keloid, true keloid.

#What is the pathology of keloid?#

The lesion is a connective-tissue new growth having its seat in the corium.

#Is there any difficulty in the diagnosis of keloid?#

No. It resembles hypertrophic scar; but this latter, which is essentially keloidal, never extends beyond the line of injury.