Skin Diseases of Children/Purpura

by George Henry Fox

sometimes noted. An examination of the blood will sometimes reveal the presence of malarial organisms.

The eruption always tends to a spontaneous recovery and usually shows no disposition to recur. While no medicinal treatment is absolutely necessary, a saline laxative at the outset will often do some good, and may be followed by the administration of salicylate of soda.

Locally a lead-and-opium wash, or a lotion of zinc oxide in lime water, will tend to allay the burning pain or tenderness of

Fig. 54.—Erythema nodosum.

the lesions, which is often a distressing symptom, and rest in bed for a few days is desirable during the height of the attack.

Purpura, or idiopathic hemorrhage into the cutaneous tissues, results from many causes and occurs in connection with various diseases. It is usually characterized by small petechial or larger guttate spots, which are at first of a bright claret hue, but which rapidly assume a dull-purplish color. The eruption is readily distinguishable from an erythema or any inflammatory exanthem, since the redness does not disappear under firm pressure of the finger.

In purpura simplex the lesions are commonly symmetrical and seen upon the legs, but in children more frequently than in adults the eruption may appear upon the thighs (Fig. 55) and other portions of the body. In a child suffering from whooping cough I have seen the chest dotted with petechial spots. When the hemorrhage takes place in or around a hair follicle the lesions are apt to he elevated, and to this condition the term purpura papulosa has been applied.

In mild cases of purpura simplex the lesions usually appear suddenly without other symptoms, and gradually fade away

Fig. 55.—Purpura.

in one or two weeks, unless a fresh outbreak occurs. In this event the bright-red color of the recent spots contrasts strongly with the dull livid hue of the older lesions.

In severe cases of purpura the eruption may be very abundant, and with the cutaneous lesions hemorrhage from various mucous surfaces may occur. The gums are usually swollen and bleed easily. Epistaxis is frequent and blood is often noted in the stools and urine. This form of the disease is called purpura hemorrhagica. It is characterized by marked constitutional symptoms, and the weakness resulting from a continued loss of blood sometimes leads to a fatal termination.

Another form of the disease is associated with severe arthritic pains and the appearance of elevated purpuric lesions, especially in the vicinity of the affected joints. This is termed purpura or peliosis rheumatica. This affection usually runs a brief course, although a repeated onset of fever and rheumatic pains, followed by cutaneous hemorrhages, may protract it for months. It commonly attacks those who have a rheumatic tendency but are otherwise apparently well.

There is little difficulty in the diagnosis of purpura, as the color of the lesions is characteristic and their hemorrhagic nature can be readily demonstrated by the pressure of the finger. It is well to remember, however, that cutaneous hemorrhage is not infrequently an accompaniment of the eruption in severe cases of the common exanthemata.

In the treatment of mild cases of purpura, rest in bed, with a nutritious diet and administration of the tinctura ferri chloridi, is generally followed by a prompt recovery. In severe cases, especially of the Hemorrhagic type, iron, turpentine, and ergot are commonly employed with good effect. Ergot may be given by the moath or by hypodermatic injection. For the latter purpose a grain of ergotin may be dissolved in warm water and glycerin, and injected with such frequency as the exigencies of the case may demand.

Molluscum is a term which has been applied to two distinct affections having no pathological relation to one another. One is the molluscum fibrosum of older writers, which is now commonly designated as fibroma. The other is the molluscum contagiosum, which was first described by the English dermatologist Bateman early in this century. The latter is a somewhat rare affection of the skin, but of much more frequent occurrence in childhood than in adult life. It consists of one or more small, flattened whitish tumors, varying in size from a pin's head at the outset to a split pea when fully developed. These little growths are sometimes pedunculated and usually present a central depression, from which a whitish substance can be readily pressed out. This looks like ordinary sebaceous matter, but under the microscope is found to contain certain oval corpuscles which are a characteristic of the disease.

The tumors are commonly seen upon the face and neck, but may occur on various portions of the body. They are usually multiple, sometimes numerous, and, though unsightly, are