Skin Diseases of Children/Keratosis Follicularis

by George Henry Fox

cases to originate in the same locality. Children suffering from molluscum are especially prone to have warts upon the hands.

The diagnosis of molluscum is usually made with ease by any one at all familiar with the appearance of the tumors. Large milia upon the face might be mistaken for them; but these tumors are rounded, of much firmer consistence, not likely to occur in groups, and always lack the characteristic flattened surface and central umbilication.

The treatment of molluscum is simple and effective. Many of the tumors, after a duration of a few weeks or months, undergo a process of destructive inflammation, and a spontaneous cure results. This is especially apt to be the case when two are close together and coalesce as they increase in size. If a tumor is vigorously compressed and the contents evacuated it will usually disappear. Incision and cauterization, or abscission by means of a sharp knife, have been recommended, but the simplest method of removing the tumors is to scrape them quickly with a curette and to lightly touch the bleeding surface with nitrate of silver. The main object in treating these tumors is to destroy them completely and to excite as little inflammation as possible in so doing. When even a large molluscum is removed by means of the curette no scar or trace of the growth is usually left, since the tumor is an outgrowth of the epidermis and does not involve the true skin. But when an inflamed molluscum is scratched or irritated to the extent of inducing a purulent secretion, a slight pit may be expected to result.

Keratosis follicularis is an affection not infrequently seen in childhood, especially among children who are poorly cared for. It is the result of an abnormally dry condition of the skin and the accumulation of epidermic scales in the hair follicles. This produces an eruption of small, conical papules, which are commonly found upon the outer aspect of the extremities. These are usually of the color of the skin. Sometimes they are discolored by dirt, and in some cases they become inflamed and present a dull-red hue. The fine hairs growing upon the affected skin are often broken off or coiled up in the follicles. When the disease is severe and of several years' duration the .skin has an ichthyotic appearance and to the touch feels like a nutmeg grater. The disease is described in some text books under the name of lichen pilaris or keratosis pilaris, but the follicle is primarily involved and not the hair. Recently the term keratosis follicularis has been applied by some writers to an entirely different and extremely rare disease described by Darier.

The treatment of the disease is mainly palliative, as in many cases time alone will effect a complete cure. The daily inunction of the skin with some fat or oil, and the frequent resort to hot baths and vigorous soap frictions, will be productive of much benefit and often restore the skin to its normal condition.

Fig. 57.—Keratosis follicularis.

But this treatment must be continued for some time to prevent a return of the disease. A Turkish bath once or twice a week will prove of service.

Keloid is a dense fibrous tumor of the skin, which in certain individuals is liable to develop upon the site of a cut, burn, or other injury. A distinction has often been made between true and false keloid, many writers claiming that the former develops spontaneously while the latter is always an outgrowth upon a scar. This distinction, however, is of little value, since the growth is the same in either case, and it is impossible to assert, in any case of spontaneous keloid, that it has not been preceded by some prick or slight injury to the skin. A distinction, however, may be justly drawn between keloid and a hypertrophic cicatrix. Many scars, especially those following burns, are prone to pucker and bulge until a tumor is formed which looks very much like keloid, being rounded, smooth, reddened, and often very firm and even painful. But while keloid is characterized by a marked tendency to enlarge its area by the forma-

Fig. 58.—Keloid.

tion of claw-like processes suggestive of a crab, and to persist indefinitely, the hypertrophic cicatrix never extends beyond the limits of the scar tissue and tends to a gradual disappearance rather than to an increase in size.

Keloid is usually single, but many tumors may be present, and in some cases these attain considerable size. The growth is commonly painful when squeezed or pressed, and sometimes a continuous burning or pricking sensation is experienced. A spontaneous disappearance of the tumors has been reported, but this is exceptional. Keloid occurs at all ages, affects various