There are two sets of organs to deal with here-the sweat glands and the sebaceous glands.
I. Diseases of the Sweat Glands.
The deviations from health may be functional or structural; the former include all those cases in which the sweat varies in amount and kind, but in which there is no change in the actual of tissue of the glands or follicles themselves; the latter, those in which the sweat follicles are likewise congested, obliterated, inflamed, enlarged, or otherwise structurally altered.
The disorders may be arranged thus:
A. Disorders of Function and B. Structural Disorders.
A. Functional Disease of the Sweat Glands.
HYPERIDROSIS is the term applied to excessive sweating. It is, however, not very often an independent form of disease. it occurs in connection with general febrile disturbances, as in pneumonia, phthisis, rheumatism-appearing to be ” critical ” in some cases. It may, however, occur as a purely local disease, and then the excessive secretion of sweat takes place from the face, the hands, the feet, or the armpits, an it is very annoying. A similar state of things is natural to some persons. The sweat may be very offensive. Hyperidrosis may give rise to eczema and intertrigo, as about the feet frequently. In some cases hyperidrosis, that is, freer secretion of sweat then usual, may be conjoined with or followed by more or less congestion of the follicles, and then the morbid states known as miliaria and lichen tropicus result. If the sweat fails to escape it may collect under the cuticle, forming sweat vesicles. This is sudamina.
Probably the most annoying form of this affection is that where the feet are the parts attacked. Various means have been used with varying success. Dr. Armingaud recommends a hypodermic injection of Pilocarpine in cases of fetid foot-sweat.
Chronic acid has been used with excellent results. Frequently, one application of a five per cent. solution of chromic acid suffices. The solution should be applied with cotton-wool to the soles of the feet and between the toes. If there are wounds on the feet, they had better be healed before applying the chromic acid.
Therapeutical indications:
Baryta carb.- Fetid foot-sweat, with callosities on the soles which are painful on walking; soles feel bruised at night, keeping one awake, after rising and walking.
Calcarea carb.- Foot-sweat which makes the feet sore feet feel cold and damp, as if she had wet stockings; burning in the soles.
Canthar.- Temporary cold sweat on feet; smells like urine.
Carbo veg.- foot-sweat excoriating toes; toes red, swollen’ stinging, as if frosted; tip of toes ulcerated.
Graphites.- profuse foot-sweat, not fetid as in Sepia or Silic, but the most moderate walking causes soreness between the toes, so that the parts become raw; spreading blisters on the toes, thick and crippled toe-nails.
Helleborus.- Humid, painless vesicles between the toes.
Iodum.- Acrid, corrosive foot-sweat; edematous swelling of the feet.
Kali carb.- Profuse fetid foot-sweat; swelling and redness of the soles; chilblains; stitches in the painful and sensitive corns.
Acid Lacticum- Profuse foot-sweat, but not fetid.
Lycopod.- Profuse and fetid foot-sweat, with burning in the soles; one foot hot, the other cold, or both cold and sweaty; swelling of the soles; they pain when walking fissures on the heel.
Mur.ac.- Cold sweat on the feet, evening in bed; swelling, redness and burning of tips of toes; chilblains.
Nitr. ac.- Foul-smelling foot-sweat; chilblains on the toes.
Petrol.- Feet tender and bathed in a foul moisture; feet swollen and cold; hot swelling of the soles, with burning; heel painfully swollen and red; chilblain; tendency of skin to fester and ulcerate.
Plumbum.- Fetid foot-sweat, swelling of the feet.
Podoph.- Foot-sweat evenings.
Sepia.- Profuse foot-sweat or very fetid, causing soreness of toes; burning, or heat of the feet at night; crippled nails.
Silicea.- Offensive foot-sweat with rawness between the toes; itching of soles, driving to despair.
Squilla.- Cold foot-sweat; sweat only on toes; soles red; and sore when walking.
Sulphur.- Sweating and coldness of the soles; burning soles, wants them uncovered.
Thuja.- Fetid sweat on toes, with redness and swelling of the tips; nets of veins, as if marbled, on the soles of the feet; suppressed foot-sweats, nails crippled, brittle or soft.
Zincum.-The feet are sweaty and sore about toes; also fetid; chilblains from scratching and friction; the suppression of sweat causes paralysis of the feet.
Anidrosis.
A disorder of the function of the sweat-glands, characterized by deficiency or absence of perspiration.
It is either idiopathic or symptomatic, general or confined to a location, and derived from ancestors or acquired in life from such predisposition, and may or may not be permanent.
This functional disorder of the skin is found apparently alone, unaccompanied by any other disturbance of health, in which case it is known as idiopathic. a typical case is the instance of a person who perspires but little, or apparently not at all, under conditions which would naturally provoke or accelerate the secretion of sweat, were the glands in their normal condition, as when no effect results from moist or dry heat, or diaphoretics. The skin is dry and harsh to the touch, such as seen in cases of ichthyosis or xeroderma.
The symptomatic is the more common form, and is often found associated with other cutaneous or general diseases or nervous disorders, and accompanied by general debility and impaired nutrition. There is the same dry, rough skin as in the idiopathic form, and the patient feels a tightness of the skin, with an itching sensation. This condition is general, as in diabetes; or local, as in nervous disorders like certain forms of neuralgia and paralysis; and it may be temporary, as in fevers, eczema, and psoriasis; or permanent, as in diabetes and tuberculosis.
Etiology.- Idiopathic anidrosis may be ascribed to a faulty development of, or defect in, the sweat-glands from hereditary, congenital, or other causes, as shown in the ichthyotic, xerodermic, and paralytic conditions, the otherwise general good health remaining unaffected. Symptomatic anidrosis, on the other hand, may be ascribed to functional torpor resulting in deficient secretion without structural defects in the sweat-glands, as found in cases of eczema, psoriasis, diabetes, and phthisis.
Prognosis.- In the idiopathic form, this is uncertain and unfavorable; but in the symptomatic form it is to be determined by the nature and duration of the primary disorder.
Treatment.- In the old school, the concensus of opinion seems to be that when treatment is admissible in the idiopathic form, benefit is only to be derived by stimulating the functions of the sudoriparous glands, and by the application of suitable emollients to relieve the existing dryness of the skin. In the symptomatic form the exciting cause would be removed, and the treatment directed to the relief of the subjective symptoms present. They claim that the activity of the sweat-glands may be restored mainly by diaphoretics. Resort should also be made to friction and to the use of alkaline, Turkish, or other hot baths.
Internal remedies may assist in some cases, and those heretofore found of benefit are:
AEthusa.- The skin has a dry, white, leathery appearance.
Natrum carb.- The skin of the whole body becomes dry and cracked.
Phosphorus.- The skin is dry and wrinkled.
Plumbum.- Dry skin, with absolute lack of perspiration.
Potass. iod.- The skin is dried up, and rough, like hog skin.
Dysidrosis.
This name is applied to an acute affection of the sweat- glands and ducts, characterized by vesicular eruptions, usually located and confined upon the palms of the hands, but sometimes upon the soles of the feet; and in either case the sides of the fingers and toes may be involved. The vesicles at first are small, discrete, and deep; afterward they become confluent and superficial; and, finally, disappear by absorption.
The earliest symptoms of this affection, previous to the appearance of the eruption, are a tingling sensation, accompanied by heat and tension of the parts involved. When the eruption first appears, the vesicles are minute, transparent, and discrete, imbedded deeply in the skin, and there they slowly increase and become opaque or whitish in color. The end may come here, and the eruption disappear by absorption, accompanied by slight scaling of the parts affected; but, when the affection continues, the vesicles grow larger and coalesce, forming bullae; and when its course is run, usually in a few days or weeks, absorption, or rupture and evaporation of the fluid contents take place, and the bullae disappear, leaving a dry, reddened skin. The reaction of the fluid contained is acid. More or less pruritus is always present.
The eruption is usually symmetrically distributed, and, when both the hands and feet are involved, it first appears on the hands. The duration and severity of the attack are increased in persons of impaired health. Such persons, particularly young women, are predisposed to this affection, being in a relaxed and depressed nervous state, manifested in part by a mild, continuous hyperidrosis of the palmar surfaces of the hands.
