ACNE.
Definition. — Acne is characterized by the presence, on the face, of small eleva tions or nodosities varying in size from a pin-bead to a pea. These elevations, or pimples, are also present on the back, shoulders, and chest in many cases.
Symptoms. — The elevations are con ical or hemispherical, and, as a rule, in the earliest stage of the lesion somewhat painful, especially upon pressure. In most of the lesions there is a distinct tendency to suppurative change. In the centre of the lesion a whitish-yellow spot forms where the pus raises the epidermis. In from three to ten days, or even longer. the lesion breaks and a small amount of pus is discharged. At other times the pus dries to a thin crust, or occasion ally the contents, especially in sluggish lesions, are absorbed. A red elevation is left which gradually flattens out, leav ing a brownish stain, which eventually disappears. The surrounding skin is fre quently oily and shiny. Tumors as large as a pea or a small nut, formed by re tention-cysts of sebaceous glands, are sometimes seen; they may gradually work to the surface or may persist tor months and finally disappear or form hard spherical indurations by retraction and inspissation of their contents. Scar ring, usually consisting of small, white, cicatricial depressions, is to be seen as a consequence in some cases. In the majority of cases, however, permanent marks are not left. The regions most affected in acne are the face, shoulders, and anterior and posterior aspects of the shoulders. Occasional cases are observed in which the back, extending as far down as the sacrum, is the chief seat of the disease. In rare instances (acne cachec ticorum, acne scrofulosormn, and acne medicamentosa) the eruption may be more or less general.
Varieties.—There are several varieties of lesion observed in acne, one kind of which is apt to predominate, and this has given rise to the so-called varieties of the disease.
Acne vulgaris, or acne simplex, is, by far, the most common clinical type. The lesions are usually of a mixed character, consisting of black-heads, pin-head to pea- sized papules, papulo-pustules, and pustules. Each lesion may in its begin
ning have a small, red areola. There is also slight pain upon pressure. The lesions are rapid in evolution, running a course in several days to a week. As in all types, they are discrete and isolated.
The term "acne papulosa" is given to a not uncommon type in which the lesions are usually small and show but little disposition to reach the pustular stage, disappearing by absorption or by desiccation and exfoliation.
Acne punctata might be termed mi nute papular, the lesions being, for the most, pin-head in size, with a central comedo, or black-head.
Acne pustulosa is another type in which the lesions go rapidly into the pustular stage, the eruption appearing, for the most part, to be made up, almost entirely, of pustules. In size they vary from a large pin-head to a large-sized pea. "Acne indurata," or "tuberculosa," is a form of the eruption in which the lesions tend to be closely crowded here and 'there and in such places, and also with single lesions, the underlying base becomes hard, inflamed, and indurated, being also somewhat deep-seated.
In acne phlegmonosa the inflamma tory and suppurative process begins deep down in the sebaceous gland, forming veritable small dermic and intradermic abscesses, usually with but slight tend ency to break through the surface.
Acne cachecticorum characterizes an acneic eruption, more or less general, occurring in weak, eachectic individuals; the lesions are livid, indolent, violet-red papulo-pustules of moderate and large size and of slow evolution, leaving, as a rule, small cicatrices. Acne scrofula sorum is really a variety of the last named, — acne cachecticorum, — occur ring in those of distinctly strumons or tuberculous temperament.
Severe case of acne scrofulosorum in girl with no tubercular family history, but with enlarged cervical glands. Ac neic pustules and comedones extremely numerous, developed in crops, suppurated freely, left deep livid-blue scars, most noticeable over buttocks and thighs. J. J. Pringle (Brit. Jour. of Derm., Apr., '95).