Disorders and Diseases of the Skin

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Causes

The causes of skin diseases are very numerous, since the skin may be injured by many factors which do not affect the inner organs and tissues. There may be predisposing or exciting factors, and immediate causes. Predisposing Conditions include climate, race, age, sex, occupation, diet, constitution and temperament.

Immediate Causes are :

hereditary defects, or maldevelopments;
physical causes such as friction, heat and cold, irradiation, or pressure;
chemical agencies, such as acids, alkalis, drugs, tars, dyes, vegetable and plant irritants, and proteins;
parasites, mainly bacteria, fungi and viruses;
circulatory disorders;
nervous disorders;
disorders of the glands and their hormones;
systemic diseases.

An understanding of the causes is necessary to arrive at a correct diagnosis, and to do this the sequence of the disturbing symptoms must also be followed. The eruption must be examined as to colour, size and shape, distribution, character of surface, nature of lesion (pustule, vesicle, weal, etc.), duration of symptoms, and occupation of patient; and finally, it must not be forgotten that two separate diseases may exist together.

Signs and Symptoms

Associated with most skin complaints are a wide range of lesions or eruptions and a more limited number of symptoms.

Symptoms

The chief of these are itching, tingling, burning, pricking, increased and decreased sensitivity, crawling sensations, and pain; itching is the commonest symptom, and may be intermittent or continuous, while pain is less usual.
Lesions include primary or secondary manifestations; the primary may be in the form of macules or spots, papules or pimples, nodules, tumours, weals, vesicles or small blisters, and bulla; or large blisters. The secondary effects may appear as scales, fissures, excoriation, crusts, ulcers, and rarely malignancy.
Various terms are used to describe the conditions seen in different skin diseases, and it may help the reader if these are briefly explained here.
A macule is a small flat patch or spot of discoloration, not raised above the surface of the skin. A larger lesion of this type is called a plaque, whereas large reddened areas are referred to as erytlsema.
A papule is a raised solid pimple, not larger than a pea.
A tubercle or nodule is a similar raised eruption of larger size.
A vesicle is a small raised spot containing fluid; a bulla or blister is larger than a vesicle.
A pustule is a small raised lesion containing pus; a furuncle or boil is a large pustule.
A scale is a dead flake of the epidermis or outer horny skin.
Crusts and scabs consist of skin cells, fibrin, dried serum, white blood cells and sometimes pus cells.
A weal is a transitory raised lesion of the skin, with cedema in the part concerned. Scars are formed by fibrous tissue, and may be red in recent cases, or white in long-standing cases.
An excoriation is an abrasion of the epidermis.
A fissure is a crack of variable depth.
An ulcer is a local lesion with loss of skin tissue.

General Treatment

The practical measures to be considered include general hygienic measures, diet, in-vestigation for presence of septic foci in the body, medicines and external applications, and physical treatment.

General Hygiene

In acute or extensive skin eruptions the patient is best in bed, which provides rest, and makes the application of remedies easier. The bowels should be kept opened regularly, saline aperients being generally suitable.

Hard water is often irritating to the skin, but artificial water-softeners, such as bath salts, are often unsuitable. Soap should be avoided in irritative conditions such as eczema or dermatitis.

Diet must be suitable, nourishing and well balanced, with avoidance of items known to disagree, as for example, shell fish in cases of urticaria, or alcohol in acne or rosacea.

Baths

Prolonged immersion baths are sometimes used for the treatment of dermatitis. Continuous irrigation may be used for extensive burns; it greatly reduces pain and prevents infection of large areas.
Applications may be dry or moist, and may or may not contain medicaments.
Powders are used as drying and astringent agents. They are also soothing and absorbent.
Lotions are useful for large areas; they may be astringent, antiseptic, sedative, etc.
Plasters are used spread on cloth (cotton or synthetic) for close contact and prolonged application.
Ointments and Pastes are two of the commonest skin applications. Vaseline (soft paraffin), lanolin, olive oil, etc., form common bases for incorporating medicaments.
Creams are soft ointments, which are easy to spread.
Poultices are used to allay inflammation, and to reduce pain and congestion in septic conditions. They may be made of starch, linseed, kaolin, simple bread, or lint fomentations, and may contain medicaments such as ichthammol.
Drugs are selected according to individual requirements, and idiosyncrasies must be recognised. Sedatives are often required to allay irritation, and to prevent insomnia.

Physical Methods of treatment include application of cold, as carbon dioxide snow for birthmarks; heat, in the form of poultices, cautery and diathermy; electricity, in galvanic baths, ionisation and electrolysis; and irradiation, such as ultraviolet light, X-rays, and other forms of radiotherapy.

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