VARIETIES OF ERUPTION OBSERVED AFTER INGESTION OF DIFFERENT DRUGS. —Erythematous and erythemato-papu lar eruptions are sometimes observed after taking belladonna, hyoscyamus, stramonium, quinine, nitrite of amyl, chloroform, arsenic, opium, turpentine, cubebs, copaiba, antipyrine, and ben zoate of sodium. Sometimes these are attended with more or less severe itch ing, and may resemble urticaria. (See various remedies in which these mani festations occur.) Case of dermatitis medicamentosa dif fusa following upon a, dose of opium. The whole skin became red and covered with large scales. The skin was dry. Movements were interfered with on ac count of the pain in the skin. The epi dermis was shed in large plates so as to form complete casts of the hands and feet. The normal lines of the skin were accentuated. The mucous membrane of the mouth was dry and red. The patient complained of tenseness of the skin, chilliness, thirst, loss of appetite, head ache, and insomnia. Lanz (Monats. f. Prakt. Demi., No. 309, '93).
Mixed erythematous rashes (polymor phous erythema) have occurred after the administration of arsenic, quinine, digi talis, copaiba, and bromide of potassium.
Vesicular and bullous eruption may follow arsenic (herpes zoster), cannabis Indica, iodide and bromide of potassium, quinine, salicylate of sodium, and phos phoric acid.
Pustular and phlegmonons eruptions (pustules, boils, abscesses, diffuse phleg monous or erysipclatous inflammation) have been noted after taking iodide and bromide of potassium, arsenic, quinine, hyoscyamus, opium, chloral-hydrate, digitalis, iodide of mercury, calomel, and pilocarpine.
[I have observed a large multinodular, tubercular eruption follow the continued use of large doses of iodide of potas sium. Under the supposition that the eruption was syphilitic in origin, the dose of the iodide was increased, with the effect of aggravating the eruption. The suspicion that the lesions might be due to the iodide led to a. discon tinuance of the drug, when the nodules rapidly disappeared. GEonGE Rout.] Superficial ulcerations about the roots of the nails sometimes follow the pro longed administration of chloral-hydrate.
Purpuric extravasations have been noted after iodide of potassium, salicylic acid, quinine, chloral-hydrate, and cam phor.
Treatment.—The treatment of drug eruptions must be symptomatic. The administration of the remedy must be stopped, and other indications met as they arise.
Dermatitis Herpetiformis.
Definition.—An inflammatory, super ficially-seated, multiform, herpetiform eruption, characterized mainly- by ery thematous, vesicular, pustular, and bull ous lesions, occurring usually in yaried combinations, accompanied by burning and itching, pursuing usually a chronic course with a tendency to relapse and recur. (L. A. Duhring.) The acute obs-ervations and logical reasoning of Duhring with reference to this disease have led to a general ac ceptance of his views on the part of dermatologists. At one time Duhring classed the disease first described by IIebra under the name of "impetigo herpetiformis," as the pustular variety of D. herpetiformis, but in his latest publication ("Cutaneous Medicine," Part II) he regards it as advisable to consider the two diseases as distinct "from a clin ical stand-point, at least." Ynna and Stephen Mackenzie lay stress upon the neurotic origin of D. herpetiformis.
Symptoms.—Duhring, upon whose ex haustive studies the following descrip tion is based, recognizes five varieties of the disease, namely: the erythematous, vesicular, bullous, pustular, and multi form, indicating the prevailing type of lesion present.
There is usually a prodromic febrile stage, which, however, rarely amounts to more than slight chilliness, flushing, or heat, with the accompaniments of ma laise and constipation. Itching may pre cede the outbreak of the eruption. Any one variety of lesion may appear, or there may be from the beg,inning a com bination of two or more of them. The type of lesion may change during the course of the disease, or, as is more rare, may remain constant throughout the at tack, and may also show the same feat ures in subsequent attacks. The sub jective sensations are burning, itching, and prickling, which may be severe. In one case of the vesiculo-pustular variety, the itching and burning were most in tense, relief being obtained only after the application of strong ointments or lotions of cocaine.