ACNE ROSACEA. 497 



thickly smeared with white-precipitate ointment, or with a paste made 

 of equal parts of sulphur, glycerine, and alcohol. 



CHAPTER XVII. 



ACNE ROSACEA GUTTA ROSACEA CHRONIC INFLAMMATION OF THE 

 SEBACEOUS GLANDS OF THE FACE, WITH DILATATION OF THE BLOOD- 

 VESSELS AND GROWTH OF THE CONNECTIVE TISSUE ABOUT THEM, 



ETIOLOGY. In acne rosacea the sebaceous glands of the face, 

 especially those of the nose, become the seat of a chronic inflamma- 

 tion. The tendency to suppuration in this affection is much less than 

 in acne vulgaris and sycosis ; but, on the other hand, it is always ac- 

 companied by an inflammatory hypertrophy of the surrounding connec- 

 tive tissue, as well as by considerable dilatation of the blood-vessels 

 about the diseased glands. Acne rosacea is particularly common 

 among tipplers, especially among wine and brandy drinkers ; although 

 it is by no means so exclusively confined to such individuals as to war- 

 rant the inference that a person is intemperate because he has acne 

 rosacea on his face. Women at the climacteric epoch, even though they 

 never touch wine, beer, or spirituous liquor, are often afflicted by this 

 disorder, which is all the more distressing to them because of the pre- 

 vailing prejudices regarding its cause. Young women, also, with de- 

 ranged menses, sometimes are attacked by acne rosacea. 



SYMPTOMS AND COURSE. The disease commences by the appear- 

 ance upon the face of discrete coppery-red spots, whose color depends 

 upon the varicose dilatation of small blood-vessels. Acne nodules 

 then develop upon these bluish-red spots ; but, even when pustules 

 mature, the nodules do not decrease in size, but continue gradually to 

 grow larger. The effect of this constant formation of new tubercles, 

 and of the excessive hypertrophy of the adjacent connective tissue of 

 the skin, is to give rise to most unsightly deformity. The nose, which 

 is the usual seat of acne rosacea, becomes enlarged and misshaped, and 

 in bad cases it is studded with knobs and humps of various size, and 

 assumes a purple color. The forehead and cheeks are often similarly 

 affected, and sometimes the disease involves the whole face. 



TREATMENT. As soon as acne rosacea begins to appear, the use 

 of spirituous liquors is to be strictly prohibited. If there be any de- 

 rangement of menstruation, it is to be treated according to directions 

 already given. It is also advisable to endeavor to compress the ves- 

 sels of the reddened spots by painting them with collodion. When 

 this treatment is not well borne, Veiel obtains benefit from concen- 

 trated lead- water, with the addition of terra sigellata and a little cam 



