Skin Diseases of Children/Papilloma Lineare
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PAPILLOMA LINEARE.
From the collection of photographs of
Dr. GEORGE HENRY FOX.
PAPILLOMA LINEARE.
The affection of the skin to which attention is now briefly called under the name of linear papilloma is somewhat rare and is described in the text books of dermatology under a variety of titles. It is frequently congenital, often develops in childhood, but may first appear in later life. It is characterized by warty excrescences, either colorless or pigmented, occurring in small groups running in one or more lines for some distance over the surface of the skin and frequently appearing upon only one side of the body. The neck, trunk, or one of the extremities may be the seat of the disease, and in rare cases the greater portion of the body may be affected. In congenital cases the warty outgrowth is apt to be fibrous and tough, while in cases developing later in life the lesions are softer, sometimes slightly scaly, and far more amenable to treatment. In some cases they have been known to disappear spontaneously or after some cutaneous exanthem, but a tendency to reappear upon the same site is usually manifested.
Of the names which have been applied to the affection the following may be mentioned: ichthyosis hystrix scu localis, ichthyosis linearis neuropathica, naevus verrucosus, naevus unius lateris, nerve naevus, and papilloma neuroticum.
The dark, fissured masses sometimes observed about the elbows and knees in severe cases of ichthyosis bear some resemblance to the warty lines seen in this affection, but they are simply accumulations of epidermis and not papillomatous in character. In linear papilloma, however extensive it may be, there is nothing suggestive of ordinary ichthyosis, and the statement made by some writers that a xerodermatous or parchment-like condition of the skin often coexists with papillomatous streaks is by no means in accord with my experience. The disease in question might be classed with ordinary verruca (warts) more justly than with ichthyosis. The term nævus verrucosus would be applicable to this affection, but the fact that this name is commonly applied to the soft, flattened, pigmented, warty outgrowths so frequently seen upon the backs of old men and women renders its use objectionable in case of the disease under consideration. Nævus unius lateris is descriptive of most cases of this affection, but the fact that it may occur on both sides in certain cases may cause the name to sound absurd at times.
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Fig. 26.—Linear papilloma.
The papillomatous streaks of this disease (like zoster) run transversely upon the trunk and longitudinally upon the extremities. They run in the direction of the natural cleavage lines of the skin, and, though they usually appear to follow the cutaneous distribution of certain nerves, they do not always do this with any great degree of accuracy. It would seem, therefore, that the name of linear papilloma as a descriptive title was preferable to the term nerve nævus or papilloma neuroticum.
In the accompanying plate, illustrating a case presented to the New York Dermatological Society by Dr. Cutler, the linear character of the affection is plainly shown in the streak coursing down the thigh and leg. In Fig. 26 the verrucous surface of the patch is quite apparent, while in Fig. 27 is seen the tendency of the lesions to form a broad, pigmented, warty patch in the axilla, from which a single line runs down the inner surface of the arm.
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Fig. 27.—Linear papilloma.
The treatment of linear papilloma consists in the use of agents which tend to destroy or remove the excrescences. In cases of recent development, where the lesions are soft, the repeated application of a saturated solution of salicylic acid in collodion will act as effectively as it usually does in the case of corns and warts, and will soon leave the affected skin in a normal condition. In cases of longer standing it is advisable to use the curette, and where the eruption is extensive to remove small portions of it at a time. But in certain cases, especially those which have existed since birth, the lesions are apt to be of such a dense fibrous character that the curette is of little use, and their removal is best effected by means of the curved scissors. It is doubtful whether any internal remedy is capable of affecting the growth in any notable degree.