ANOMALIES OF THE SEBACEOUS GLANDS SEBORRIICEA By seborrhcca is understood a pathological increase of the secretion of the sebaceous glands. It is divided into (1) seborrhom oleosa and (2) seborrhcea sicca Jurfuracea-pityroides, pityriasis capitis) accord ing to whether the secretion of the sebaceous glands is oily or dry.
Seborrivea oleosa is principally met with in the later stages of in fancy in the shape of lardaceous, oily secretions, so that the face, es pecially the nose and the forehead, but also the chest, are covered with a glistening fatty layer. This is quite a harmless condition, the only treatment necessary being dusting with powder.
The second form, seborrhma sitya, occurs in the first few months of life, especially on the scalp (over the large fontanelles). The scalp is covered with yellow or yellowish brown, lardaceous, scaly masses which frequently assume a gray or grayish black color owing to accumulation of dirt and dust. On removal of the scales the ex posed skin looks slightly' hyperfemic and macerated and is eovered with a thin, oily layer. The affection may spread to the eyebrows, fore head, nose and chin, from there to the back, chest and folds of the body. All these parts are covered with yellowish scales. In the course of the first few years the seborrhma gradually disappears, or else it may be complicated by eczema (eczema seborrhoicum).
In the later periods of childhood seborrhma occurs in the shape of a grayish white diffuse furfuraceous desquamation, especially on the head (pityriasis capitis); the skin is covered with small whitish scales, has a milky appearance, and frequently there is a secondary falling out of the hair at this early age. This stage is chiefly found at puberty as status seborrhoicus and is occasioned (1) by an engorgement of the sebum in the glands; (2) by a cornification anomaly which leads to an occlusion of the sebaceous glands, while (3) at this period an increased production of sebum and the growth of hair act as irritations. Very
often there are also seborrlunic, sharply demarcated yellowish spots covered with small scales, which are more or less distinct, and which sometimes disappear and reappear, spread to the face, the nasolab ial folds, and chin, cheeks and finally to the chest, where they attack the sternum (Eczema seborrhoicum, Enna, see p. 475).
Pathology.— T e micro scopic weaminations conducted principally by Pohl-Pi nkus, Piffart, Enna, Ehrmann, disclose an enlargement of the sebaceous glands and a thickening of the corneal layer. In the enlarged follicles and infundibula of the hair there are broken off bits of hair and a cone called by Sabouraud "Bakterienkokon" or utrieulus, which is formed of corneal cells and is pervaded by rods and microbacilli.
Etiology.—The cause of se borrhcea is unknown. tnna, Sabouraud and others regard the above mentioned mierobacillus as the causative factor of sebor rInea. There is no doubt that heredity plays a role and that antemia and chlorosis as well as irritations occurring at puberty in the region of the sebaceous glands form a suitable culture ground for the accumulation of organisms. Probably the disease is of parasitic origin, although proof for this assumption is yet to be forthcoming.
Treatment.—The object of the treatment is to remove the de posits and prevent the accumulation of parasites by antiphlogistie measures. We should therefore endeavor to cleanse the scalp with weak alkalies (bicarbonate of soda), with tincture of green soap, or sul phurated resorein soap, and to soften the scales by the application of 5-10 per cent. salicylate oil, which requires an addition of 40 per cent. eastor oil to dissolve the salicyl, or of salicylic sulphur ointment [lie. salicyl, 0.2 Gm. (3 gr.), precip. sulphur 5.() Gm. (11 dr.) ung. leniens, ol. oliv. aa 20.0 Gm. t6 dr.)]. At the same time massage, washing with sub limate (Lassar) or spirits of salicyl or resorcin, may produce an tation of the skin which may lead to an improvement of the circulation.