Definition. A recurrent, non-inflammatory disease of the sweat-glands, presenting small, discrete, deep-seated vesicles on the face.
Symptoms. The lesions are nearly always confined to the face and occur as discrete, round or avoid, clear, shiny, tense vesicles from pin-head to pea- size. They appear to be deep seated but project above the surface, resembling sago grains at their maturity. As they dry up they become whitish, like milium lesions. The larger ones may have a bluish tint or be slightly hyperemic at the periphery. Individual lesions dry up without rupture within one to three weeks, leaving the skin normal or lightly stained. The number of vesicles varies from a half dozen to two hundred, with subjective sensations of mild smarting or tension. Comedones or acne are frequently present. The disease may last for weeks or months, the vesicles never becoming purulent. However, it is always worse in summer and may entirely disappear in winter.
Etiology and Pathology. This is an affection almost exclusively limited to middle-aged women who expose their face, in washing over tubs, to warm moist air and especially those who perspire freely. The lesion is a cystic formation of the sweat-duct and has its beginning in the deep portion of the corium but gradually encroaches upon the epidermis.
Diagnosis. This affection might be mistaken for adenoma of the sweat-glands, sudamen, pompholyx and possibly eczema. Adenoma has an altogether different history and the contents are solid. Sudamen is an accumulation of drops of sweat under the corneous layer only and the small lesions rarely appear upon the face. Pompholyx occurs upon the palms of the hands or soles of the feet and the vesicobullae do not remain clear as in hydrocystoma. Absence of all signs of inflammation would serve to distinguish it from vesicular eczema.
Prognosis and Treatment. The disease is only a disfigurement, not affecting the general health in any way. While it is almost certain to disappear spontaneously in winter, it is also apt to recur in summer from exposure to the same causes and may become chronic from continued recurrence. Treatment consists in the avoidance of causal occupations, if possible. Puncture of the vesicles, followed by the application of mild astringents, may be advisable. Antimonium crudum seemed to benefit two cases.