2232 



DYSIDROSES AND DYSTROPHIES 



to a deep black bronzine one (see Chloasma Bronzinum). On close 

 examination it will be found that often patches of hyperpigmenta- 

 tion are seen side by side or alternate with patches of depigmentation 

 of various degree, but generally slight. The patches of chloasma 

 solare may appear quite suddenly without being preceded by 

 erythema solare; in one of our cases they appeared on the fore- 

 head twenty-four hours after a motor-car drive in the midday sun 

 without the hood on; in another, a European lady, who had a 

 very delicate skin and was used to wearing gloves, very dark 

 hyperpigmented patches appeared on the back of the hands and 

 wrists twelve hours after exposing her hands without gloves to the 

 midday sun. In addition to hyperpigmented spots, depigmented 

 patches also developed. 



2. Chloasma caloricum, from exposure to heat, or possibly the 

 glare of fires. We have seen it several times in stokers. 



3. Chloasma traumaticum, from mechanical irritation of any 

 kind, scratching, etc. 



4. Chloasma toxieum, due to irritating drugs, as, for instance, 

 after a blister. 



5. Chloasma symptomaticum, as, for instance, chloasma uterinum, 

 found during pregnancy or during chronic diseases of the female 

 genital organs. Chloasma uterinum is quite common in Sinhalese 

 women, and is plainly distinguishable. 



6. Chloasma malaricum and kala-azar chloasma, an important 

 type of chloasma symptomaticum, is found in patients suffering from 

 chronic malaria and kala-azar. A diffuse type of hyperpigmenta- 

 tion observed in chronic malaria and closely resembling Addison's 

 disease has already been described (see p. 11 80). 



Hyperpigmentation may occur also in syphilis, leprosy, tuber- 

 culosis, diabetes, and many other chronic diseases. 



In India a ' pigmentary fever ' has been described of short 

 duration, and said to be characterized by the appearance of hyper- 

 pigmented patches on the face (see p. 1461). 



Chloasma Symmetricum. 



i' This condition, which has been described Castellani, is often 

 met with in Sinhalese, who greatly object to it. It is characterized 

 by the presence of two dark brownish chloasma patches situated 

 symmetrically one on each cheek, generally on the malar region. 

 In some cases, in addition to these two patches, a third one'is found 

 on the nose. The colour of the patches is generally dark brownish, 

 very rarely bronzine. The causation is unknown; it does not seem 

 to be congenital. No treatment is of any avail. 



Chloasma Bronzinum. 



This somewhat rare affection is met with among natives as well 

 as Europeans in India, Ceylon, the Malay States, China, and other 



