Five cases of acne scrofulosorum in infants. Clinical features: an indolent, small papulo-pustular or acneiform erup tion, occurring in infants, sparsely dis seminated and not grouped, unaccom panied by subjective symptoms. It affects chiefly the extremities, the lower in particular, and their extensor sur faces. The buttocks and regions above are often involved. The lesions appear successively or by subacute outbreaks. The papules develop about the hair follicles and become successively pust ular and crusted. When the crust with a central plug is lost, a flattened, era teriform, irregular lesion, like those of lichen planus, is left. After complete involution, a stain or faint scar remains. T. Colcott Fox (Brit. Jour. of Derm., vol. vii, No. 11, p. 341, '95).
Acne artificialis seu medicamentosa is a form of acneic eruption produced by the ingestion of certain drugs, as the iodides and bromides, and also by the external applications of certain remedies, such as tar, the paraffin-oils, etc.
An artificial type of acne may be seen on the chest, abdomen, and hack, the cheeks, forehead, and chin being affected in those who are taking iodide, .while the chin is covered when the cause is either menstrual or intestinal. That as sociated with rosacea begins around the nose. In the cachectic type or in those who are hard students or of a nervous temperament it is more frequently wit nessed on the forehead. Those who present lesions upon the entire face are generally found to suffer from habitual constipation. The treatment should be based upon these facts. Dyer (New Orleans Med. and Surg. Jour., June, '94).
"Acne atrophica" is a name given to those cases of acneic eruption which tend to leave depressed scars. This probably occurs most frequently in those cases in which the lesions are sluggishly papular or papulo-pustular, the lesions disappear ing by absorption or crusting and leaving behind small punched-out cicatrices.
Acne hypertrophica is really the op posite of the last-named variety, and occurring in about the same kind of cases, small, whitish, connective-tissue pin-point or small-pea sized projecting hypertrophies marking the sites of the lesions. It is rare.
Etiology. — Acne begins usually near puberty, when the pilar system is more actively developing, and the functions of the sebaceous glands likewise; and is more frequent among patients with di gestive troubles, constipation, dilatation of the stomach, menstrual irregularities, the strumous diathesis, possibly the ar thritic diathesis, and disturbances of the nervous system.
Anmmia, dyspepsia, constipation, amen orrhoea, and dysmenorrhoea are all ex ceedingly common functional derange ments or disorders occurring simulta neously with acne. but no more a cause of it than of psoriasis and scabies. Stephen Mackenzie (Brit. Jour. of Derm.,
Oct., '94).
Constipation is a most important fac tor. That nerve-influence considerably affects acne may be witnessed during menstruation and dyspepsia. Stopford Taylor (Brit. Med. Jour., Oct., '94).
It has been also alleged that lesions of the genito-urinary organs and vene real excesses may provoke the disease. Lesions may be due to mechanical irri tation caused by the product of secre tion remaining in the excretory canal or gland itself. Some drugs, as already stated, — such as the bromides and iodides, — are occasionally responsible for the eruption or an increase in an already existing eruption. Certain drugs applied externally may also provoke acneic lesions, such as tar and tar prod ucts, juniper-oil, and the like. Workers in paraffin and paraffin products will not infrequently be found affected with papules and pustules, especially those of a furuncular or abscess type.
Professional form peculiar to workers in paraffin; eruption papular, furuneu bons, or acneiform ; affects hairy portions of the skin. Gervais (These de Paris, '95).
[As in artificial eruptions, individual predisposition here naturally plays a most important role. L. BROCQ, Assoc. Ed., Annual, '961 Stubborn indurated and pustular acne witnessed in persons exposed to chlorine vapor. The condition is analogous to iodine and bromine acne. Treatment is very unsatisfactory. Hcrxheimer (Munch. med. Woch., Feb. 25, '99).
Pathology.—In most cases the process begins by a perifolliculitis, which later on gives rise to a purulent folliculitis. It would thus seem that the sebaceous glands play but a small part in the af fection. In some cases, however, when comedones arc present, the sebaceous gland itself is the starting-point of the inflammatory process. (Brocq.) Even when the focus of irritation is in the follicle, it is frequently limited to the sebaceous or sebaceous pilary canal. (E. Besnier, A. Doyon.) The papillae surrounding the come done and the superficial layers of the corium are filled with blood-vessels full to repletion, and of exudation cells which are found in dilated vacuoles. (Kaposi.) If the process is very intense, the seba ceous gland may be entirely destroyed by the local inflammatory action, while the pilar bulba persists. (Kaposi.) The acneic process may be divided into two parts: 1. Closure of the sebaceous follicle and formation of corned°. 2. Suppuration, which only occurs in those follicles where the staphylococci aurens et albus have penetrated before the coined° formed. (Unn a.) ]n true acne the bacillus described by Duna is invariably present. It always occupies the same portion of the com edo,—namely, the bottom of the central cavity, only reaching the uppermost part in markedly developed comedones. Mena hem Hodara (Jour. des Mal. Cut. et Syph., Sept., '94).