Regional Bezenia.—It is usual to de scribe eczema as it appears upon different regions, as, for instance, the hands, face, scrotum, legs, etc.; but the disease in reality differs little, certainly not ally, as it occurs upon different parts. The description of the several types of the disease as already given suffices.
It is noted that the most common seats for eczema in those of the active age, be tween 21 and 50, is about the hands, less frequently about the face or the scalp; the scrotum is not an uncommon site, and also the anal region.
There is a remarkably-obstinate form of chronic eczema, which attacks the palms, and, though more rarely, the soles sometimes also. The disease commonly takes its origin in the centre of one palm, though it is generally not long until both are implicated. There are hard, scaly patches of infiltrated skin, involving more or less of the surface; there is ragged and uneven scaling, while in the natural lines of flexion, or inde pendent of these, are deep and painful cracks. The hands feel hot, and burn and itch at times. This morbid condi tion advances sometimes along the fingers toward their tips, the pulp remaining, as a rule, immune. A symptom ob served in the feet which is not so evi• dent on the palms is the existence of a band of congestion beyond the scaly area, fading imperceptibly into the natural tint of sound skin. Though met with in both sexes, this variety of eczema is most commonly- encountered in women, and in them aboitt the menopause. Jamieson (Edinburgh Med. J0111%, Jan., '08).
In a recent analysis of 10.000 mis cellaneous skin cases in the writer's pri vate practice, 32.01 per cent. suffered with eczema. Neurotic eczema is fre quently observed in infancy, in connec tion with cutting of the teeth; in child hood it is less common; its most Ire quent time of occurrence is between 20 and 55 years of ago. Various forms or Phases of nerve disturbance are seen in connection with neurotic eczema, and they may be considered under the fol lowing heads: (1) neurasthenia, or nerve-exhaustion; (2) nervous and mental shock; (3) reflex phenomena (a) of internal origin or (b) peripheral; (4) neuroses, (a) structural or (b) func tional.
The eruption is apt to come first upon the hands and face, less commonly on thc feet. But from its starting-point it may extend over large surfaces. Neurotic eczema upon the hands is very apt to exhibit vesicles; but on the adult face the eruption is quite as likely to as
.sume and maintain the erythematous form, with vesicles, and often without moisture, unless scratched. The groups of lesions have a tendency to be pretty sharply defined, in more or less her petie patches, which may present mainly solid papules, or, when torn, a raw sur face. It is intensely itchy, and the spasms of itching are sometimes fearful and utterly uncontrollable. L. Duncan Bulkley (Jour. Amer. Med. Assoc., Apr. 16, '9S).
In eczema about the finger-nails the matrix or the bed of the nail may be affected, primarily, or by contiguity from eczema on the back of the finger. The first sign is the redness of the supra-ungual tissue, which becomes painful to pressure. Rarely, so much serum may exude that the nail is lifted up, and finally falls off. Striations are noted in the nails, with punctiform de pressions. The whole nail may be raised from its bed or a depression may appear in the median line. If the ec zema is chronic the nails will be de formed. W. Dubreuilh and D. Freche (Jour. de med. de Bordeaux, Apr. 14, 1901).
In those past the age of 50 the most common site is the lower leg, although eczema of the face is not infrequently met with.
General Symptomatology.—The sub jective symptoms in eczema are itching, burning, and a sensation of heat. These may be severally present, or, as is more commonly the case, one is predominant. The degree varies, sometimes slight and at other times almost unbearable. As a rule, there are no constitutional symp toms so-called in eczema cases. In ex tensive general acute eczema there may be slight febrile action and sometimes slight chilliness at the outbreak of the attack. The degree of inflammatory ac tions varies in the same case from time to time and in different cases. The dis ease may be acute both in type and its course, running to an end in several weeks or one or two months. As a rule, however, whatever the type of the in flammatory process—acute, subacute, or chronic—the disease is persistent and long-continued, with, in most cases, little, if any, tendency to disappear taneously. Seasons often have an ence, the disease usually being less active or partly or completely disappearing in the summer weather. On the other hand, there are cases of the disease met with that are at their worst in summer time, and frequently disappear in the colder weather; such instances are, however, exceptional.