DERMATITIS CONGELATONIS

Symptoms.—Various grades of dermatitis from exposure to cold
are met with, varying from a simple hyperemia to that of deep tissue
necrosis. As in burns, it is usual to give a somewhat arbitrary division
into three degrees. In the first the part is noted to be hyperemic, some­
times of a dark or dusky hue; in this type there sometimes results weak­
ening of the circulation of the part, and the congestion persists, or is
readily provoked upon exposure to cold or to moderate heat. This
condition—chilblains—is often persistent and gives rise to a good deal
of burning and itching when the part becomes warm. In frost­bites
of the second degree there may be a bright red or livid skin, with more
or less serous exudation, usually in the form of vesicles and blebs, although
there is sometimes a serous undermining of the entire epiderm. In the
third degree the part is at first noted to be pale, stiff, and even brittle;
if not severe or if it may not have been long exposed, gradual reddening
takes place and the circulation is reëstablished, the surface presenting
moderate or marked vesiculation and bleb-formation, with some under­
lying superficial ulceration; or complete normality may be restored. Or
the part may go immediately into a state of necrosis or gangrene, a line
of demarcation gradually forming. As in dermatitis from exposure to
heat, there may be constitutional disturbances, if the part involved is
very extensive, and especially if the case is of the third degree. Even

DERMATITIS TRAUMATICA

437

in limited areas of this last grade there may develop some fever later,
and possibly septicemic symptoms may supervene as the part is cast off
and undergoes suppurative action. If the exposure has been prolonged
and involves a greater portion or the entire surface, the patient fails to
rally.

Prognosis and Treatment.—The prognosis is usually favorable,
both for the patient and for the part involved, if exposure has not been
too prolonged and the region involved not too large. Extensive cases,
however, and particularly if the resulting damage is of the third degree,
are always of serious import. The patient's general condition may de­
mand the free use of stimulants to overcome any shock and to support
the strength.

The local treatment of established chilblain has been considered
under Erythema Hyperæmicum. If the case is seen immediately after
exposure, the parts are to be brought back to the normal temperature by
first rubbing gently with snow or by applications of cold water, gradually
replacing these with water of higher degree until the normal temperature
is reached; soothing lotions or ointments may then be applied for a
short time.

If the action is of the second degree, the same preliminary measures
of gradually bringing the part back to the normal temperature are to be
adopted. Subsequently the vesicles and blebs are to be carefully opened,
and soothing remedies employed, such as are used in diseases with similar
lesions. Weak ointments of salicylic acid, from 10 to 20 grains (0.65-
1.33) to the ounce (32.) of zinc oxid ointment, or with the addition of 5
or 10 grains (0.33-0.65) of carbolic acid to the ounce (32.); or boric acid
ointment, or one with 5 to 10 per cent, ichthyol, will usually be all that
is required. Wet dressings, the same as referred to in burns, sometimes
prove more grateful. Cases of the third degree, especially the more
extensive forms, properly belong to the domain of surgery. In limited
areas the treatment is the same as in the other varieties. Proper anti­
septic precautions should be taken.

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