KERATOSIS SENILIS

Old age of the skin, or atrophia senilis (q. v.), is characterized by
various changes: sometimes more or less thinning of the derma, freckle-
like and larger pigmentary spots, seborrheic warts (q. v.), greasy crusted
or scaly patches, usually pea- to bean-sized or larger, and somewhat
hard, generally small, thickened epidermic patches. This last formation
is the ordinary type of lesion to which the name of keratosis senilis is
commonly applied, but in reality it is often applied to the last two.
The greasy crusted or scaly spots begin, as a rule, by a slight pigmenta­
tion, and this may remain as such, or after a time it is noted to be greasy
to the sight and touch. Later it becomes irregularly covered with a thin
scarcely noticeable, scaly coating, which can easily be rubbed off. Grad­
ually the scaliness increases in thickness, and sometimes in area, is dirty
gray or brownish gray in color, and often quite adherent; and when
removed, the surface is moist or oily, and after a time an atrophic thin­
ning is observed. It may remain almost indefinitely as such, the scaly
crust being rubbed, washed, or cast off from time to time, and gradually
renewed. In many instances, however, the process advances, and the
degenerative thinning is followed by superficial abrasion, and sometimes
with scarcely noticeable papillary prominences, and now, when the crust
is at all forcibly or harshly removed, slight bleeding—one or two droplets
—may occasionally be observed. The discharge from the abrasion, or
perhaps now superficial ulceration, together with the oiliness of the im­
mediately surrounding border, gives rise to a slightly thicker crust.
From such a degenerative seborrheic patch often results a beginning
superficial epithelioma or rodent ulcer. In other instances the sebaceous
scaliness may be more of the nature of a somewhat horny concretion,
and limited to one or several contiguous gland-ducts, finally presenting
sometimes an ill-defined, warty-looking aspect. This coating or forma­
tion is apt to be more adherent, and not so readily dislodged, partaking
of the nature of both a keratosis and a degenerative seborrhea. After
a time atrophy may take place, or the base, especially the peripheral

KERATOSIS SENILIS

535

portion, shows slight abrasion or ulceration, and practically the same
stage is reached as above indicated.

In the true keratosis senilis the earliest manifestation is frequently
a slight discoloration, and over which, after a while, the horny layer
of the epidermis becomes harder, and thickens somewhat, forming a
roughness or scaliness. To the finger it now feels rough, harsh, and
hard or quite horny, not greasy, as a rule, as in the degenerative sebor-
rheic patch. The spot becomes slightly or moderately elevated, grading
off into the surrounding integument, or being somewhat sharply defined.
It now consists of a hardened or horny elevated spot, with trifling dry
harsh adherent scaliness, and appearing as if the tissue thickening involve
both the upper corium and epidermis. The surface in some instances

Fig. 126.—Keratosis senilis, scurfy and scaly spots and patches, with degenerative
changes, on the cheek, tending to become epitheliomatous; small epithelioma on neck,
developed from a similar spot.

is uneven and wart-like, and the color is usually dirty or yellowish gray
or blackish gray, and occasionally quite dark. In area it varies from
that of a pea to a half-inch or so in diameter. It may remain more or
less indefinitely as such, or atrophic changes begin to present, which
gradually lead to epithelial degeneration, abrasion, ulceration—in short,
to the development of an epitheliomatous lesion. As with the degenera­
tive seborrheic patch, one, several, or many may be present.

The usual site of these formations is the face, but the back of the hand
is also a quite frequent situation. As a rule they are observed in those
past the age of sixty, but to this there are many exceptions, old age
changes in the skin often presenting as early as the age of forty and some­
times earlier, even though the patient be yet in other respects possessed

536

HYPERTROPHIES

of the attributes of vigor and active adult life. They are, as White¹
points out, much less likely to develop upon persons who have kept
their cuticle and sebaceous glands in proper order through life by suffi­
cient use of soap than in those who have been more or less negligent in
this respect. Habitual exposure to sun and to wind, has also a favoring
influence,² especially to actinic rays of light. There is, however, in
some individuals a peculiar proneness to these degenerative formations.

Prognosis.—Ordinarily in their earlier development, both as to
the degenerative seborrheic spots and the keratoses, if properly looked
after, their further formation or progress can be prevented by proper
measures. Their chief significance is the possibility or probability of
undergoing epithelial degeneration and development into epithelioma—
not at all an uncommon result when neglected, although, for the most
part, usually into but slowly progressing and comparatively benign
lesions, which, however, sometimes become transformed into an epi-
thelioma of more malignant character.

Treatment.—In their earliest appearance the use of a simple
mild ointment, such as cold cream or vaselin, rubbed in gently at night
and washed off with soap and water in the morning, will often suffice
to remove the blemish, or, at all events, stay its progress. If of more
positive character, the ointment can be rubbed in after the morning
washing as well. When there is considerable hardness, the continuous
application of the ointment over night as a spread plaster is more efficient.
The addition of salicylic acid, in the proportion of 1 to 4 or 5 per cent.,
is to be made when the condition is obstinate or more advanced. In
the latter event an ointment composed of 5 to 20 grains (0.33-1.33)
each of salicylic acid and sulphur to the half-ounce (16.) of ointment
base,—vaselin or equal parts of vaselin and lard or cold cream,—and
gently rubbed in at night after a preliminary soap­ and-water washing,
will be found of greater value, and often curative. I have found these
two drugs especially valuable in these conditions; D. W. Montgomery³
and likewise others have had similar experience. In the treatment of
the degenerative seborrheic spots it is not necessary to go beyond the
treatment indicated, unless epithelial changes with ulceration have already
set in, in which case the management becomes that of superficial epithe-
lioma (q. v.).

The advanced, and sometimes the slight, true keratosis senilis, in
which there is a good deal of horny hardness or wart-like development,
will usually require more energetic measures. If rebellious to the means

¹ J. C. White, “The Old Age of the Skin,” Boston Med. and Surg. Jour., 1882, vol.
cvii, p. 484. This and other forms of keratosis will also be found more or less exhaust­
ively dealt with in the paper by Dubreuilh, “Des Hyperkeratoses circonscrites,”
Annales, 1896, p. 1158 (with review of the subject and references); and especially as
regards their significance as precanervous affections, by Hartzell, Jour. Cutan. Dis.,
1903, p. 393 (with 3 histologic cuts and bibliography).

² D. W. Montgomery, “Unusual Exposure to Light Followed by Seborrhœic Kerato-
sis,” Jour. Amer. Med. Assoc, Jan. 4, 1913, p. 7, briefly reviews this question; Hyde,
Amer. Jour. Med. Sci., Jan. 1906, and Dubreuilh, Annales, 1907, p. 387, were of the
opinion that such exposures favor the production of epithelioma, doubtless in conse­
quence of later changes and irritation of such keratoses.

³ D. W. Montgomery, “A Contribution to the Treatment of Senile Patches,” Phila.
Med. Jour., 1898, vol. i, p. 211.

KERATOSIS PILARIS

537

already suggested, trichloracetic acid¹ may be carefully applied, washing
it off as soon as the patch gets white; or a strong salicylic acid ointment,
5 to 15 per cent, strength, can be applied as a plaster over night for one
to several nights, a mild salve application being made in the daytime.
This latter remedy may also be applied in the form of a 10 to 25 per cent,
plaster-mull, or in collodion, in 5 to 15 per cent, proportion. Two or
three such applications will often suffice to remove the thickening, and
subsequently the mild salicylic acid salve, with or without the addition
of sulphur, can be used. Sometimes, however, their complete removal,
without cauterizing or operative methods is not possible, but, as a rule,
their further progress can usually be stayed. If obstinate, the strong
salicylic acid plaster or collodion applications should not be continued
indefinitely, as possible irritation and degenerative changes might be
promoted. The careful application of carbon-dioxid snow (q. v.) often
acts surprisingly well in these keratoses. If unyielding as to complete
obliteration, if stationary, nothing further need be done; but should
the patient desire removal or should epitheliomatous changes have
presented, then one of the various plans for superficial epitheliomata
can be resorted to, or Röntgen ray exposures can be tentatively tried.
For the treatment of seborrheic warts and other senile cutaneous changes,
the same plans are practised; the treatment of the former is also con­
sidered under warts.

But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy!

Also, please consider sharing our helpful website with your online friends.