DERMATOSES IN METABOLIC DISTURBANCES 703 



psoriasis scales. Schamberg and his collaborators found that psoriatics 

 stored nitrogen easily, and that very little of this substance was excreted 

 in the urine, that a low nitrogen diet was beneficial, and that huge quan- 

 tities of nitrogen were lost in the scales, and finally, that the retention of 

 nitrogen was not registered in increased weight. In general, there is a 

 widespread belief that restricted nitrogen intake is beneficial to psori- 

 atics. The English dermatologists associate the disease with gout. There 

 is no doubt that psoriasis is greatly influenced, for better or worse, by 

 physiological crises in the patient. Thus, in some women, the disease 

 improves or increases during pregnancy, lactation, "or the menses, while 

 in both sexes it gets better or worse during acute intercurrent illnesses. 

 At times there is involution on a restricted nitrogen diet ; at times the re- 

 verse is true. The conclusions to be drawn are so uncertain, the facts 

 apparently so contradictory, that psoriasis may be regarded as a disease of 

 probable metabolic origin, of which nothing further may be stated than 

 the probability. 



Dermatoses Conceived to be Due to or Associated with 

 Carbohydrate Metabolism 



There is some evidence that rosacea, acne, and many of the suppura- 

 tions of the skin have an associated hyperglycemia. On the other hand, 

 Pels did not find this to be the case, but rather that the blood sugar was 

 increased in eczema and the erythemas. In diabetes, it is widely known 

 that intertrigo, gangrenes, and a peculiar yellow, nodular disease, called 

 diabetic xanthoma, arise. All of these conditions improve or disappear 

 with the control of the underlying condition. 



Dermatoses Conceived to be Due to or Associated with 

 Miscellaneous Causes 



Xanthoma tuberosum is associated with disturbed cholesterin metab- 

 olism, as Lebedew showed in a beautifully conducted piece of research. 

 He fed cholesterin to rabbits and typical xanthoma lesions developed at 

 sites traumatized by setons. Schwartz, Levine and Mahnken found a 

 diminished alkali reserve in a wide range of unrelated dermatoses. This 

 work could not be corroborated by Sweitzer and Michelson. Barber as- 

 sociated the seborrheas with acidosis in a very inclusive study. Severe 

 illnesses cause dystrophies of the nails, as Heller (c) pointed out, although 

 the fact is known to every internist. After severe febrile diseases hori- 

 zontal ridging of the nails occurs. The hair also falls out. 



This, then, is a resume of the little that has been accumulated in the 

 field in question. One thing is clear, namely, that a relationship exists 



