ACUTE INFLAMMATION OF THE SKIN. 455 



lines or marks which are thus made upon the skin are not indicative 

 of different forms of disease, but merely of different stages of develop- 

 ment of the same morbid process. 



Erythema papulatum or tuberculosum, however, differs from ery- 

 thema nodosum. This affection is most liable to attack young per- 

 sons, and is far more common in females than in males. Its seat is 

 almost without exception upon the lower extremities, especially upon 

 the legs. It consists in small circumscribed infiltrations in the deeper 

 layers of the skin, accompanied by extravasation of blood. We at 

 first perceive rounded knots of the size of a hazel-nut or of a walnut, 

 covered by slightly-reddened skin, and somewhat painful to the touch, 

 so that they strongly resemble bruises (dermatitis contusiformis). The 

 rose-red color of the skin gradually grows darker, and then changes 

 successively to a violet, to blue, green, and finally to yellow, the se- 

 ries of changes being entirely similar to that which occurs in traumatic 

 extravasations beneath the skin. Erythema nodosum is always accom- 

 panied by febrile disturbance, which debilitates the patient and con- 

 fines him to bed. The disease usually lasts one or two weeks, and its 

 termination is also followed by desquamation of the epidermis. As 

 a great rarity, erythema nodosum also becomes chronic, the first nodes 

 subsiding with desquamation of the epidermis, and new ones succeed- 

 ing them. 1 



TREATMENT. Erythema resulting from local irritation soon sub- 

 sides when the exciting cause is removed. When the burning pain is 

 severe, we may make applications of cold water or of lead water. In 

 erythema intertrigo, in order to prevent the friction of the opposing 

 surfaces, we must sprinkle them with fine powder, lycopodium seeds 

 mixed with oxide of zinc being the one most in use (sem. lycopod. ss, 

 zinci oxid. 3 ss), or else a pledget of charpie, smeared with zinc oint- 

 ment, may be inserted between the surfaces. Erythema arising from 

 the pressure against the bed (decubitus) may be relieved by the use 

 of circular india-rubber pads filled with air. When it results from 

 contact of acrid secretion, the skin should be protected from it by a 

 coating of lip-salve or other grease. Erythema papulatum requires no 

 particular treatment, although, if it be attended by much burning, we 

 may make use of cold compresses. In erythema nodosum proper at 

 tention must be paid to the fever and to the strength of the patient 

 Compresses wet with cold water, or with lead-water, should be applied 

 *o the nodules if they are painful. 

 79 



