Ecthyma

Ecthyma is a pustular disease of the skin, in which the pustules often reach the size of a pea, and have a red, slightly elevated, hardish base. In the course of two or three days after the appearance of the pustule it is replaced by a scab, which adheres firmly to the base, and is somewhat concave. On its removal, a deep red mark, a new scab, an ulcer, or a healed scar remains. The disease may be acute or chronic. The acute form is ushered in by slight constitutional, not amounting to febrile, symptoms, and by a burning or pricking pain at the seat of the eruption, which is most commonly the back and shoulders. The disease runs its course in ten days or a fortnight. In chronic ecthyma, the pustules which follow in crops (often for several months) are usually scattered over the extremities. This form of eruption indicates a low state of the system. It sometimes follows the acute disease, and not unfrequently is a tertiary symptom of syphilis. Pustules, which in no respect seem to differ from those of ecthyma, are produced by various local irritants. Thus the affection of the hands, popularly known as the grocer's itch, is produced by the irritation of brown sugar, perhaps by the acari which are so often present in it. Stone-masons are said occasionally to suffer from a similar disease. With regard to treatment, the acute form would in most cases doubtless disappear in the course of a fortnight if left entirely to itself; but as the bowels are usually disordered, an occasional alternative aperient, as a few grains of gray powder with a little rhubarb, may be prescribed, and tepid water applied locally gives great relief. The patient should, moreover, be kept on a moderately good, nutritious diet. In the chronic form of the affection a liberal diet is necessary; the use of wine or porter is sometimes desirable; while tonics, such as a combination of bark and nitric acid, are called for. Tepid baths are often useful, and if there is sleeplessness, an opiate should be taken at or shortly before bedtime.