Skin Diseases of Children/Scabies

by George Henry Fox

portions of the body in both sexes, and is especially common in the negro race. The tumors increase in size for a certain time and then often remain stationary for years. A characteristic peculiarity is their tendency to return quickly whenever excised. A spontaneous disappearance of keloid is more likely to occur in childhood than in adult life, and tumors developing upon large scars are more likely to disappear than those which seemingly spring from the normal skin. A favorite site of keloid is the sternal region, where it often appears in adults as an elongated flattened tumor crossing the median line in a transverse direction. Its frequent occurrence in this locality has been attributed to the common custom of applying blisters to this part for the relief of acute pulmonary affections. It also is seen frequently upon the scalp, face, neck, and trunk.

The treatment of keloid is usually discouraging. Excision, as has been remarked, is usually followed by a return of the growth. Good results have been obtained by deep linear scarification and the application of glacial acetic acid to the cuts, and also by the use of the electrolytic needle. Subcutaneous injections of thiosinamine have been recommended, and in hypertrophic cicatrica I have known this to be followed by benefit. The results from the subcutaneous use of this drug in lupus, psoriasis, and certain other skin diseases have not proved to be as beneficial as its enthusiastic advocates of a few years since were disposed to claim. But in the relief of corneal opacities and cicatricial contractions it has apparently proved of value. Whether its use in true keloid will effect even a notable improvement remains to be demonstrated; but in cases of scar keloid which are tending to recovery it might, at least, be tried in connection with the fatty inunctions and frequent massage which seem to do some good and certainly do no harm.

Scabies is a disease which in this country has notably increased in frequency during recent years. In most cases it is readily recognized by the characteristic location of the excoriated papules which mainly constitute the eruption. The disease, as is well known, is due to the burrowing of the acarus or itch-mite in the soft skin between the fingers and elsewhere, and is usually communicated by sleeping with, or in a bed which has been occupied by, a person affected with the disease. The mature, impregnated female alone makes the burrow in which the eggs are deposited, and dies after performing this function. In recent cases the burrows or cuniculi in which the female acarus has deposited her eggs may be found upon the web of the fingers, the anterior portion of the wrist, the axillæ, genitals, and ankles, and appear as small, curving dotted lines, from the extremity of which the insect may sometimes be dug out with the point of a needle. These burrows are often concealed by an eruption of vesicles, pustules, and crusted sores, and not infrequently the lesions of contagious impetigo are present. Upon other portions of the body the eruption usually consists of numerous excoriated papules covered by minute blood crusts. The anterior aspect of the forearms and the abdomen are especially apt to be the seat of the eruption, but when the disease has existed for several months the eruption may cover the

Fig. 59.—Scabies.

whole body, with the exception of the face, which always remains unaffected, except in the case of infants and very young children. The location of the eruption in this disease depends, to a great extent upon the character of the clothing which the patient wears, and differs in the case of men, women, and children. The excoriations about the breasts of women and upon the genitals of men and boys are due to the ease with which these parts can be scratched at night, while in young children who wear long, close-fitting night dresses the wrists and ankles are most likely to be the seat of the eruption.

The treatment of scabies is simple and effective. For generations sulphur ointment has been a standard remedy, and nothing else is needed, although many other remedies and combinations have been recommended. A warm bath should first be taken to soften the skin, and soap used vigorously to remove the dead epidermis covering the cuniculi. The sulphur ointment should now be rubbed gently into the affected skin, especially in those regions where the acarus is apt to burrow,

Fig. 60.—Pustules in scabies.

and this inunction repeated, without bathing, for about five successive nights. Under this treatment the itching is abated and the disease usually cured. In severe cases it may be necessary at the end of five days to repeat the bath and the subsequent inunctions. In infants and young children, or in patients with a very delicate skin, it is advisable to dilute the sulphur ointment with one or two parts of vaseline or cold cream.