DISEASES OF TIIE SKIN.
Besides the regular eruptions of pregnant women, there is often ex tremely severe itching of the skin, without visible lesion. This itching, which may commence at the beginning or not until the second half of pregnancy, may reappear during consecutive pregnancies, (cases of Mas lieurat Lagemard.) Sometimes temporary and passing, this itching is, in other cases, rebellious to all treatment, and only disappears after labor. Although not grave, it becomes the source of annoyance and even of weakness. Being aggravated by warmth and by rest in bed, it thus de prives the patients of sleep., In some cases, the sufferihg is so severe that the women scratch off the epidermis, thus adding to their torture. Often, the itching is confined to certain regions and reappears with each preg nancy, so regularly that the patient,s recognize the beginning of pregnancy by this sign. Hebra cites the case of a woman who saw this itching develop upon her fingers after the fecundating coitus, in seven consecutive preg nancies.
The real cutaneous eruptions usually appear in the first months, and then either disappear before labor, which is the exception, or at variable periods after labor.
The most common of these skin diseases are the so-called chloasma of pregnant women—the mask, and pityriasis versicolor. The favorite seats are the forehead, the cheeks and the chin. The eruption consists of yel lowish spots, more or less extended, but not reaching beyond the limit of the hair. Cazeaux believes that light is one of the chief necessities for their development, and that the shadow of the hair suffices to arrest their formation.
Hardy and Hebra separate these spots into two species: the ephelides and the pityriasis.
Hardy says that the ephelides are not projecting, and are not attended by pruritus or desquamation. They are composed of an accumulation of pigment in circumscribed areas. The ephelides often develop in women at the time of menstruation, and particularly during pregnancy. They generally dis'appe,ar after labor, but not always, to the despair of the patients.
Hardy advises the application, twice daily, of the following solution: If this is not sufficient, one may advantageously employ sulphur waters, particularly those of Luchon and Bariges, locally applied.
Pityriasis versicolor, although resembling the ephelides,differs essentially from them in that it is papular. The papules are covered by little scales. This eruption is always accompanied by slight itching, and is a parasiti cal disease occupying, according to Hebra, the hair bulbs. The micro scope facilitates the diagnosis, allowing some spores and numerous ramifi cations in the scales.
The treatment consists in sulphur lotions, douches, and sulphur oint ments. Hardy advises sublimate lotions and. citrine ointment. Jeannin believes in an intimate relation between menstrual troubles and this erup tion. It is, according to him, due to the arrest of the menses, and preg nancy is not indispensable for its occurrence, since it is observed in women or girls who have not conceived, when their menstruation is dis turbed. He does not believe that the parasite, microsporon furper, is
indispensable, but it may be observed, which justifies the classification of Hardy. Parrot is opposed to Jeannin, in that, while he admits that chloasma may be related to menstrual disorders, he attributes it to a neu ropathic condition, finding expression in certain genenll pigmentations of the skin.
Hebra mentions acne, or inflammation of the hair-follicles, or of the sebaceous follicles. It may be common acne or acne rosacea. The latter resists all treatment until after labor. In some women, the nose is the part attacked, and it becomes red, tumid and covered with the pimples of acne. Again, a true eczema may be developed in the early stages of pregnancy, and may become terribly severe, as in one case of our own.
Urticaria is another eruption affecting pregnant women, and may reap pear at certain hours of the day, after meals or in the evening. We have seen a case which yielded to alkalies and quinine. Hebra has seen two cases of puerperal pemphigas. In one case it appeared two days after labor, and there was no relapse in later pregnancies. In the second case, the eruption appeared in three consecutive pregnancies, in the same woman. The first time it c,ame at five months and .disappeared after labor. The second time it appeared at three months, and did not disap pear until a month after labor. The third time it became chronic and did not disappear. The woman was delivered of a dead child. Klein has seen a persistent pemphigus, which reappeared in two pregnancies. He also obeerved impetigo herpetiformis, which showed itself, in five e,ases, during pregnancy and labor. The eruption was pustular. The pustules appeared on the inside of the thighs, either discrete or in groups, and thence invaded the legs, the abdomen, the chest, the arms, the forearms, the hands, feet, neck, face and scalp. The eruption came out in crops and was attended by burning fever and great prostration. Before each eruption there was a chill with a pulse of 104° and a temperature of 105°, which then slowly subsided. There was diarrhcea which was once bloody. The urine was acid, dark-colored and contained a little pus, much urea but no albumin. Of the five women, three were delivered from two to five weeks before the eruption, two were attacked in the last months of pregnancy, and were delivered at the hospital. The symptoms remained unchanged after labor. Among the five women four died. They had no puerperal disease, and showed no trace of syphilis. Vrain reports one case of erythemato-tubercular scrophulide of the face, and one case of stru mous lupus during pregnancy, and aggravated by subsequent pregnancies: Eczema of the face and hands, 3 cases; of the scalp, 2 cases; zone and eczema impetiginosa, 1 case.
The most common skin dise,ase, with pregnant women, is certainly prurigo.