CHAPTER XV 

 SKIN DISEASES 



"To treat skin disease wholly from without," Ravaut has recently 

 declared, "is as irrational as treating the skin lesions of syphilis by 

 local applications alone. And yet the dermatologist is too apt to 

 focus his attention exclusively on the local process. He must be a 

 biologist, not a mere botanist." While Ravaut's statement is rather 

 broad, there is nevertheless much value in the emphasis that he places 

 on the fact that the dermatologist, as the result of more recent work 

 in the general pathology and physiology of the skin, must not be 

 satisfied with a purely local conception of the pathology or the therapy 

 of the particular disease that may be under consideration. 



Not only must we consider the fact that general systemic re- 

 actions can profoundly alter the reactivity of the skin both en- 

 hancing or retarding inflammatory processes but we must take cog- 

 nizance of the fact that the integument seems to respond to bacterial 

 invasion or protein injection, perhaps even to other chemical or physi- 

 cal agents with an allergy, an alteration in reactivity which is the 

 more remarkable in that it seems to be a definitely localized phe- 

 nomenon, an acquired property of the individual cell. This allergy, 

 once established, may be transplanted if the cell is transplanted, but 

 the general organism need take no part in the alteration whatso- 

 ever. 



Equally interesting is the effect of the stimulation of skin metab- 

 olism and the effect on systemic diseases, as Heims has indicated and 

 as Bloch and Hoffman have discussed at greater length. These have, 

 however, been discussed in another chapter. 



During the past two decades a considerable number of observa- 

 tions concerning the effects of systemic alterations on skin diseases 

 have been gathered, but even previously one finds isolated records 

 that are of particular interest. One needs but recall the observation 

 that a variety of drugs thyophen, benzol, acetone, taurin and amines 

 (Spiegler), atoxyl (Moro and Stheeman), cantharidic acids and salts 

 (Liebreich) would, when injected, cause a reaction at a lupus focus; 

 that dietary faults aggravate an eczema; that intercurrent infections 

 would favorably influence a preexisting skin lesion (Restrepo has but 

 recently reported such a case) or that yeast therapy might influence 

 a furunculosis. 



Skin diseases have afforded particularly favorable material for 



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