REFERENCES 



2245 



reveals absence of any bacterium. They may apparently remain un- 

 changed for a long time, then may slowly disappear ; or a few may 

 break, leaving very small superficial ulcers, which heal spontaneously 

 and do not coalesce. The patient generally complains of very 

 severe pains in the hands and fingers, which may be continuous, or 

 may be of a neuralgic intermittent type. Pruritus is absent. There 

 is often diffuse hypersesthesia ; anaesthesia is never present. No 

 thickenings are found along the nerves of the arm. The general 

 health is not affected. 



Course and Prognosis. — The course of the disease extends to 

 several months, and occasionally to two or three years, with periods 

 of great improvement. Ultimately the condition may get cured 

 spontaneously. The general health is not affected, but the patient 

 is unable to work with his hands. 



Diagnosis. — This is based on the patient complaining of severe 

 pains in the hands and fingers, on the presence of deep-seated 

 cheiropompholyx-like vesicles, on the glossy skin, and on the long 

 course of the complaint. 



The condition is differentiated from cheiropompholyx by the 

 severe pains and absence of hyperidrosis; from a leprotic condition 

 by the absence of anaesthetic patches, and absence of other signs of 

 leprosy on other parts of the body. Moreover, though the course 

 is long, the disease generally becomes cured spontaneously. From 

 dermatitis repens of Crocker and acrodermatitis perstans of Hallo- 

 peau by there not being history of traumatism, by absence of 

 exfoliative lesions, b}^ the less severe objective signs, and by the 

 absence of the large foci of disease with marked borders and fringed 

 with sodden epidermis, which is thrown up by the undermining 

 exudate. 



Treatment. — The regular application of an ichthyol ointment 

 (2 to 5 per cent.) to the hands and fingers, and the administration 

 of the same drug (gr. iii.) three times daily by the mouth is beneficial. 



REFERENCES. 

 Melung. 



Balfour {191 i). Wellcome Reports, 



Castellani (1904-1912). Ceylon Medical Reports. 



Castor (191 i). Journal of Tropical Medicine. (Leucoderma.) 



ZiEMANN (1903). tiber ' Melung,' Archiv fiir Dermatologie u. Syphilid. 



Chloasma Symmetricum— Chloasma Bronzinum — Xanthoderma Areatum— 

 Dermatosis Festonata Frontalis. 



Cantlie (1908), Journal of Tropical Medicine. 

 Castellani (1904-1914). Ceylon Medical Rep>orts. 



Castellani (1910). Journ. Ceylon Branch British Med. Assoc., January. 

 Castellani (191 7). Journal of Tropical Diseases, October. 



