Diseases Of The Skin

a. General. Diseases of the skin make up a large portion of the physician's practice, whether in civilian life or in the Army. A specialist in diseases of the skin is called a dermatologist. Descriptive terms used in dermatology are:

(1) Bulla--large blister filled with serous fluid.

(2) Excoriation--superficial discontinuity or scratch.

(3) Induration--hardness.

(4) Lesion--any localized abnormality.

(5) Macula--small, flat discoloration or freckle.

Papule-small, elevated lesion.

(7) Pruritis--intense itching.

(8) Pustule--vesicle containing pus.

(9) Squamous--scaly. (10) Vesicle--small blister.

b. Virus Infections. Virus infections of the skin include the follows:

(1) Verruca vulparis. Verruca vulparis is the common wart.

(2) Herpes simplex. This is often called a fever blister, or cold sore.

(3) Herpes zoster. Herpes zoster is a painful infection commonly known as shingles.

c. Bacterial Infections. Bacterial infections of the skin include the following:

(1) Furuncle (also called "boil.") This is an acute, inflammatory lesion produced by the infection of a hair follicle or a skin gland by staphylococci bacteria. The lesion begins as a pustule. As the pustule enlarges, the skin becomes reddened, tense, and shiny. Pain and tenderness develop. The furuncle rapidly matures (comes to a head), and usually ruptures spontaneously, discharging pus. The treatment is heat, and incision and drainage. Under certain circumstances, antibiotics, such as penicillin, are indicated.

(2) Carbuncle. A lesion that resembles the furuncle, since it has the same cause and early course, but carbuncles are larger, and produce fever and leukocytosis (elevated white cell count in the blood). When a carbuncle ruptures, pus is discharged through several openings in the skin. The treatment consists of surgical drainage of the carbuncle and penicillin.

(3) Cellulitis. An acute, deep-spreading inflammation of the skin and subcutaneous tissues. Streptococcic infections tend to spread more than staphylococcic infections, because they produce an enzyme which breaks down the wall the body tries to form around the infection. The skin becomes red, tender, and swollen. The patient has fever. The infection may spread through lymph vessels, producing red streaks on the skin. It may enter the bloodstream and be carried through the body (septicemia or blood poisoning).

d. Fungal Infections. Fungal infections are among the most common of all diseases. In order for the fungi to produce skin infection, certain favorable conditions are required. Some of these conditions are: lack of cleanliness; excessive moisture, usually due to perspiration; and irritation of the skin, usually because of tight clothing.

(1) Dermatophvtosis pedis. Dermatophvtosis pedis (also called tinea pedis and athlete's foot) may be recognized by the presence of superficial fissures between and toes, and vesicles on the sides and beneath under the toes. If secondary bacterial infection occurs, pustules appear, and ulceration may result.

(2) Dermatophvtosis (tinea) corporis, capitis, and cruris. These fungous infections are commonly called ringworm. Dermatophytosis (or tinea) cruris is also called "jock itch." The diagnosis of ringworm is made by the presence of a few (usually not over two or three) circular, ring-like, red, scaling lesions, clearing at the center, with advancing vesicular margins. Tinea cruris is distinguished by its location on the upper surface of the thighs. Excessive perspiration and friction from clothing are important contributing factors. Therefore, an important part of the treatment consists of exposing the involved parts to the air as much as possible.

e. Arthropod Infestations and Infections. The arthropods are many-celled animals with outer skeletons but without backbones, and include such organisms as crayfish, spiders, mites, ticks, centipedes, and insects (lice, mosquitoes).

(1) Pediculosis. Pediculosis is an infestation of the skin with lice.

(a) Diagnosis of louse infestation. Lice have a habit of living in the clothes and bedding of patients and coming out only at the night to feed. This fact must be taken into account when examining a patient suspected of being infested. The small louse bites may be quite difficult to locate in the absence of the louse, although the patient has usually scratched the skin in the area very vigorously, leaving scratch marks.

(b) Treatment. Pediculosis is treat by application of gamma benzene hexachloride (LindaneĀ®).

(2) Scabies. Scabies is a disease caused by a very small mite that burrows into the skin. The infection often begins between the fingers, and spreads to the body, especially the lower abdomen, buttocks, and genitalia. The mite causes much itching (especially at night), and there is abrasion of the skin from scratching. Secondary infection by bacteria may occur, with the formation of pustules. The abrasions and pustules often obscure the typical lesions of scabies, which are threadlike, twisted lesions with a small raised area at one end. All washable clothing should be thoroughly laundered, and other clothing dry-cleaned.

f. Allergic Conditions. In allergic conditions, the patient is sensitive to certain foreign substances that may contact his skin, or be introduced into his body in the food he eats or the air he breathes. A first contact is necessary to produce the sensitization, following which the patient reacts to contact with the foreign substances in an abnormal manner. Some substances can provoke an allergic reaction in anyone contacting them.

Others appear to produce allergy only in certain individuals who have a constitutional or inherited predisposition to allergy.

(1) Urticaria. Urticaria (commonly called hives) is an allergic condition which results in the formation of wheals (rounded or irregular shaped, transitory elevations of the skin). Urticaria is usually caused by eating a substance to which the patient has been sensitized, but may also be caused by a local allergen such as poison ivy; or it might have a psychogenic origin. It is usually associated with much itching and may cover the whole body. Often it is difficult to determine the cause, and the disease may constantly reoccur.

(2) Contact dermatitis. Contact dermatitis (dermatitis venenata) is due to sensitization of the skin by direct contact with a sensitizing substance. The development depends on how much of the substance is contacted, and how often. Why sensitivity occurs is not known. At the beginning, the skin is reddened in the contacted area, then raised lesions appear, and then blisters. The lesions may spread over the body. The vesicles may become infected by bacteria, and pustules appear. There is marked itching. The patient may carry the sensitizing substance to other skin areas by his hands. The sensitizing substance may be almost anything. Examples include: poison ivy, medicines, clothes, and soaps. A painstaking and thorough search is necessary to find and remove the allergen. Treatment includes removal of the allergen, mild bland applications, and antihistaminics in some cases.

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