Quain's dictionary of medicine by various writers : including general pathology, general therapeutics, hygiene, and the diseases of women and children : with fourteen coloured plates and numerous other illustrations / H. Montague Murray assisted by John Harold and W. Cecil Bosanquet.
- Date:
- 1902
Licence: In copyright
Credit: Quain's dictionary of medicine by various writers : including general pathology, general therapeutics, hygiene, and the diseases of women and children : with fourteen coloured plates and numerous other illustrations / H. Montague Murray assisted by John Harold and W. Cecil Bosanquet. Source: Wellcome Collection.
Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)
1945/1972 (page 1885)
![are similarly arranged in concentric circles round the anus. On the trunk they occasionally have the unilateral nerve-distribution of a zoster. The de- velopment of the lesions is usually very slow—ex- tending over years ; and ultimately flat xanthoma may show itself in the mucous membrane of the lips, cheeks, gums, tongue, fauces, pharynx, oeso- phagus, stomach, bile-ducts, intestine, peritoneum, conjunctiva, larynx, trachea, bronchi, pleura, on the endothelium of the heart or great arteries, and on tendons. Xanthoma iu children presents such well- marked peculiarities as to merit a few words of special mention. It has never been known to be associated with jaundice, but is often so with gout or rheumatism, while it is frequently hereditary, may affect several members of the same family, and is occasionally congenital. The lesions are generally asymmetrical, often unilateral, markedly tuberous ; and the eyelids are comparatively seldom attacked. Diagnosis.—Flat xanthoma may be confounded with miliitin if the little, projecting, whitish masses of inspissated sebum which characterise that disease are thickly grouped together so as to form a con- glomerate plaque. Almost invariably, however, a few characteristic outlying lesions are present. In any case the sebaceous contents of a milium can always be squeezed out after a shallow incision has been made, whereas in xanthoma the lesions are deeply situated in the corium, and cannot be ex- pressed. It will suffice to mention the possibility of errors in diagnosis with flat warts, colloid de- generation of the skin, adenomata of the sweat or sebaceous glands, and the extremely rare condition termed pseudo-xanthoma elasticnm Balzer), which is a degenerative disease of the elastic tissue of the skin. In the diagnosis of multiple xanthoma the pre- sence or history of jaundice is an important factor. The skin-disease which most closely simulates it is urticaria pigmentosa (hence called xanthelasinoidea by Tilljury Fox), but the history, distribution, and subjective symptoms of the two diseases easily serve to distinguish them. Prognosis.—In the great majority of cases xanthoma progresses slowly but steadily for months or years, and afterwards persists unchanged. In at least four instances, however, very gradual spon- taneous recovery has been known to occur, the skin regaining its normal characters. In a very small number of cases death has been attributed to patches on the endothelium of the heart or great arteries. Treatment.—Treatment is seldom resorted to except for the removal of disfiguring plaques from the eyelids. This can best be accomplished by excision, and great care is necessary not to cut too deeply, and thus give rise to subsequent ectropion or epiphora. Electrolysis has also been employed. A lo-per-cent. solution of perchloride of mercury in collodion has been successfully used by Stern for the cauterisation of painful masses on the elbows ; while Kaposi states that he has removed xanthoma- nodules from the palms and soles by repeated vigor- us washing with soft soap, and making the patients wear indiarubber gloves and s 'cks. In- ternal treatment is of no use. J. (. Pringle. XANTHOMA DIABETICORUM. Svnon. : X. Giycosurictini ; Lichen Z'/a/'f//(7cj-. - Although this lately recognised and rare condition - the identity of which was first clearly established by Mal- colm Morris in 1883—is now by universal consent considered as a member of the xanthoma-group, it presents several points of distinction which entitle it to separate description, in which its chief clinical characters may conveniently be contrasted with those of ordinary xanthoma. The following con- clusions have been arrived at from a study of all the indubitable cases on record, a considerable majority of which have occurred in males, the age of the persons affected ranging from seventeen to forty-eight years. Course and Symptoms.—The disease almost invariably occurs in people actually passing sugar in the urine, although frequently they have been noted as stout and apparently in good health. In a considerable proportion of the cases the presence of sugar in the urine is transitory, and unaccompanied by the other phenomena of true diabetes mellitus. In some cases, moreover, there is only a history of antecedent glycosuria. Many of the patients are alcoholic, and usually beer- drinkers ; while others are remarkably obese. The presence of pentose has been discovered in the urine of one case (Colombini), and this fact has been invoked in favour of a pancreatic origin of the disease (Hallopeau). The eruption evolves quickly, and, after a variable stationary period extending over months or years, diminishes with considerable rapidity, to disap])ear ultimately without leaving any trace of its existence. Sometimes its course is intermittent and successive outbreaks occur, while occasionally fresh lesions develop during the retrocession of older ones. As a rule the parts first affected are the extensor sur- faces of the limbs, especially of the forearms ; sub- sequently the lesions usually appear on the elbows and knees, where they have a great tendency to become confluent and form raised plaques. They are commonest on extensor surfaces, the buttocks, back, face, scalp, mucous membrane of the mouth, and bends of the ankle, but they do not generally affect the flexures. They have only once been observed on the eyelids, and the presence of jaundice has never been noted. The constituent nodules are at first bright red, but subsequently become yellow from fetty degeneration. They are much firmer and denser than those of ordinary xanthoma, are well defined, rounded or obtusely conical at the apex, and may present a yellow point like pus at the summit, but are in reality solid ; often there is a bright zone of congestion round their base. In some cases the nodules are very pale, while in others their colour remains pink rather than yellow. Many of them are in obvious relationship to hair-follicles. Itching and tingling are often troublesome, and occasionally there is great tenderness during the evolution of the tumours, while neuralgic pains sometimes precede their eruption. Occasionally ulceration and deep scarring ensue. Anatomical Characters.—Recent researches establish the close relationship between ordinary and diabetic xanthoma; ' discrepancies in the recorded appearances being fully accounted for by variations in the rate of the inflammatory process and differences in the methods of hardening and staining employed ' (Morris). Typical xanthoma- cells are present, albeit in less abundance than in flat xan'homa, while the inflammatory changes are more marked, especially in connection with sebaceous](https://iiif.wellcomecollection.org/image/b21274356_1947.jp2/full/800%2C/0/default.jpg)
