Psoriasis--verruca--epithelioma : a sequence / by James C. White.

  • White, James C. (James Clarke), 1833-1916.
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

Credit: Psoriasis--verruca--epithelioma : a sequence / by James C. White. Source: Wellcome Collection.

    7/12 (page 169)
    ^ e see, therefore, that these three dermatoses which enter into the clini¬ cal history of our case, and which are in their nature apparently as unlike as their companionship is rare, have a close affiliation in their anatomical relations. The transformation of patches of psoriasis into horny or warty permanent growths is not referred to in most works on dermatology as of possible occurrence even ; the transformation of verrucous growths into epithelioma is of not very infrequent occurrence ; but the sequence fol¬ lowed in our case, psoriasis—verruca—epithelioma, is extremely rare or unparalleled in dermatological history. Milton says1 “ there is a form of wart so like lepra,2 or of lepra so like wart, that I am at a loss to know which it is,” and in one of the three cases observed by him the growth “ began as lepra-spots and Gaskoin3 states that ‘‘psoriasis often displays a condition which shows a near approach to warts.” TV ith the difficulty of distinguishing palmar psoriasis at times from syphiloderma of this part, the resemblance of these secondary callosities to the latter, or the sypliilide cornee of French writers, is worthy of special mention in connection with our case. To one who had not ob¬ served the disease from its early manifestations and watched the local changes above referred to step by step, the appearances of the hands alone, while the disease was in a quiescent state as far as the general surface was concerned, might have suggested the question of their syphilitic character. They were, however, well marked horny concretions, rising above the general surface in the form of prominent, more or less conical elevations. They had not that appearance of being embedded or encapsuled in the skin, as if they could be easily enucleated, nor were they seated upon a hypersemic base or surrounded by a scaling ring or wall-like edge. They were in reality, what close observation and their history demonstrated, horny concretions, true warty growths springing up from the seats of old patches of psoriasis. In other words, a long-continued process of modi¬ fied epidermal formation had upon parts spontaneously prone to such development transformed itself into a permanent hypertrophy of the same cell tissue. The subsequent change is of far less uncommon occurrence, that namely of so-called benignant epidermal growths into those entitled malignant. Epithelioma may follow simple prolonged inflammation of the cutaneous tissues, as in the so-called Paget’s disease of the nipple, or protracted granulation formation, as in the exuberant outgrowths of elephantiasis, chronic ulcers of various origin, in lupus, old fissures of the lip and elsewhere, etc.; but even in these cases, where the primary disease is seated in the deeper layers of the skin, the epidermal tissues become 1 Pathology and Treatment of Diseases of the Skin, Lomlon, 1872, p. 329. 2 The word lepra is here used in the British sense, synonymous with psoriasis.