702 WALTER J. HIGHMAN AND JEFFREY C. MICHAEL 



the field has been exploited rather than studied, and a gracious curtain 

 of reserve may be allowed to descend until scientific footlights illuminate 

 a worthier scene. 



Our knowledge may be summed up very simply. We know that 

 thyroid disease may cause a few cutaneous changes, well recognized for a 

 generation or more. Hirsutes is at times associated with pituitary dis- 

 turbances. Acanthosis nigricans is due to abdominal neoplasia which 

 may derange the sympathetic system. Addison's disease is caused by 

 lesions in the suprarenal gland. Nothing more can be asserted. Other 

 than this, so far as the skin is concerned, endocrinology will still be more 

 honored in the breach than in the observance. 



Dermatoses Conceived to be Due to or Associated with 

 Disturbed Nitrogen Metabolism 



Disturbed nitrogen metabolism has been regarded as the cause of nearly 

 every dermatosis, the etiology of which had not been otherwise con- 

 jectured eczema, psoriasis, pemphigus, prurigo, the lichens all have been 

 referred to this origin. With this belief in mind, one of us (Highman) 

 examined about forty cases of nephritis with hypertension, many of which 

 were uremic, and except for an isolated case of pruritus, or prurigo, we 

 have yet to see a single instance of renal disease with or without evidence 

 of disturbed nitrogen balance, accompanied by a true dermatosis. This 

 is significant, but not conclusive. There may be disturbances of nitrogen 

 metabolism unaccompanied by renal disease, with a greater incidence of 

 cutaneous involvement. Experience negates this, although the literature 

 reflects the assumption, however unsupported by fact, either clinical or 

 experimental. 



Schamberg and Raiziss found no relationship between nitrogen dis- 

 turbance and eczema, in two carefully studied cases. Johnston, on the 

 other hand, found a disturbed nitrogen balance in psoriasis, urticaria, 

 eczema, dermatitis herpetiformis and prurigo. The most constant change 

 was a decrease in urea, and a corresponding increase in rest nitrogen. 

 Tables accompany his studies. Arignac, quoted by Von Noorden, found 

 the urea increased. Examples might be reduplicated, but there is no 

 agreement in findings in any disease. 



Perhaps psoriasis has received more study than any other dermatosis. 

 Linser, in psoriasis and leucemic exfoliative dermatitis, found an increased 

 albumin destruction where the patients were exposed to high temperatures 

 (15 to 30 degrees centigrade) for eight days. In these diseases he found 

 the surface temperature only one degree centigrade lower than the rectal, a 

 phenomenon he ascribed to dilatation of the skin capillaries. Von Noorden 

 quotes several writers who determined a great loss of nitrogen in the 



