class iv-hypertrophies

LENTIGO

Synonyms.—Freckles; Ephelides; Fr., Lentilles; Taches de rousseur; Ephélide
lentiforme solaire; Ger., Sommersprossen; Linsenflecken.

Definition.—Freckles are yellowish, brown, or blackish pig­
mentary, circumscribed, cutaneous macules, varying in size from a pin-
head to that of a pea or larger, and appearing, for the most part, arid
often exclusively, on exposed regions, as the face and hands.

Symptoms.—This affection is, as well known, characterized
by pigmentary spots, which are round or irregular in contour, and vary
in size from a pin-head to a pea, and in color from yellow to yellowish-
brown or black. Their most usual color is a yellowish-brown. The
affection is of frequent occurrence, and not only shows, as stated, great
variation in degree of development, both as to size and color, but also
as to number. In some cases there may be only a few scattered macules,
in others exist in greater or less profusion, and, indeed, a large area, as
the face, or some parts of it, may be thickly studded with them. They
are usually met with only on exposed parts, such as the face, especially
on nose and cheeks, neck, and dorsal surfaces of the hands, but they
may also exist on covered regions of the body, more particularly the upper
part of the back. Crocker mentions a case of a young woman, in whom
they first appeared, and in some profusion, on the thighs, and later on
the front part of the trunk, and only finally, after several years, a few
on the face. Duhring has seen several instances in which they were
also to be seen on the buttocks and penis. Exceptionally, as in Rob-
inson‘s case, the lesions may be in great part or wholly limited to one
part of the face. While they are observed almost at any time of life,
they are, however, rarely met with before the fourth year, and are most
common between the ages of ten and twenty. Their appearance may
be slow and insidious, or may be somewhat rapid, as quite frequently
observed after continued sun exposure. In fact, they usually appear
first on the approach of or during the summer season, and always fade
away more or less as the cool weather comes on, often completely, reap­
pearing or becoming more numerous and darker upon the return of sunny
weather. Beyond the disfigurement they cause they do not give rise
to any trouble, as there are no subjective symptoms.

Lentigo occurs also as an early symptom of that rare affection of
the skin known as xeroderma pigmentosum, and is, moreover, observed
in atrophia cutis senilis (old age of the skin); in the latter they some­
times become, after a time, seborrheic, covered with thin greasy scale,
and later may undergo slight degenerative change either directly or
after first becoming somewhat warty and elevated (seborrheic wart).

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LENTIGO

503

According to Crockers observation, they are occasionally observed
following eczema in those advanced in years.

Etiology and Pathology.—The affection is common to both
sexes and to all ages, but, as already remarked, is generally seen in its
greatest development during adolescence, the disposition to its appear­
ance becoming less marked as age advances. Those of light complexion,
and especially those with red hair, are its most common subjects, and
in whom it usually reaches its greatest development. On the other
hand, it is also seen in brunettes, and even mulattos are not wholly
exempt, although the blemish is naturally much less conspicuous in those
of dark complexion. Exposure to the sun or sunlight is a potent factor,
and often the only recognizable cause. This does not, however, explain
the lesions upon covered parts. Heat of any source, however, and winds
are also etiologic. For obvious reasons, therefore, freckles are more
common in the summer, and during cold weather they fade somewhat
or disappear entirely, to reappear as soon as the exciting cause again
becomes operative.

Their occurrence on protected parts of the body, sometimes appear­
ing and remaining even in cool weather, would indicate that there may
be also other causes than those named, and of which we have no cogni­
zance; such freckles are sometimes spoken of as “cold freckles.’' An
inherited tendency is generally to be noted. Congenital freckles, occa­
sionally reported, are more probably of the nature of pigmentary nævi,
although the latter are, in reality, in their slightest development a similar
formation, except, as a rule, the pigmentary disturbance involves the
upper part of the corium as well.

Freckles consist of a circumscribed amount of pigment in the rete
mucosum—merely, in fact, a localized increase of the normal pigment,
differing from chloasma only in the size and shape of the pigmentation.

Treatment.—The management of this affection is practically
the same as for chloasma, and ordinarily just about as unsatisfactory.
Like the latter, in many instances freckles may be readily, though often
only temporarily, removed by treatment; in others, while this effect
may be accomplished, the blemishes prove somewhat rebellious, although
their removal is possible in all cases. Unfortunately, however, in the
vast majority of cases they soon make their reappearance. Treatment
instituted on the approach of autumn is sometimes rapidly effective,
and there may be no return until the following summer.

The various applications employed have in view the removal of the
corneous epidermis and upper rete cells, and, with these, the contained
pigmented spots. It is to be remarked, however, that all drugs which
exert such action are not therapeutically efficient, for some, as mustard,
cantharides, and others, will often cause a deposit of pigment. The most
efficient and most generally used remedy for this purpose is mercuric
chlorid, and this is the active ingredient in most patent freckle and com­
plexion lotions. This is applied as a lotion, in the strength of from ½ to
4 grains (0.035-0.26) to the ounce (32.) of water or alcohol and water;
this should be dabbed on two or three times daily, and a mild degree of
furfuraceous desquamation brought about. A compound lotion, consist­

504

HYPERTROPHIES

ing of mercuric chlorid from 4 to 8 grains (0.26-0.52), 2 drams (8.) of tinc­
ture of benzoin, from 20 to 40 grains (1.33-2.65) of zinc sulphate, and
equal parts of alcohol and water to make up 4 ounces (128.), acts more
satisfactorily. Hydrogen peroxid solution, full strength or weakened,
will sometimes lessen the discolorations, and occasionally promote their
disappearance. Lactic acid, diluted with from 6 to 20 parts of water
and applied freely and often, will sometimes prove satisfactory, caution
being exercised at first that too vigorous action does not result, for with
some skins this drug occasionally acts with unexpected energy; or the
stronger applications may be made to the spots themselves. An oint­
ment of 1 dram (4.) each of bismuth subnitrate and white precipitate to
the ounce (32.) of cold cream, lard, or petrolatum is effective in some cases.
When patients can give themselves up to the treatment, a 10 to 25 per
cent, salicylic acid plaster applied to the entire face, worn constantly,
and replaced when it loosens, for five to ten days will usually produce
active exfoliation and a disappearance of the pigment. Such a plaster
is rendered still more active with the addition of 5 to 20 per cent, of
resorcin. The so-called peeling paste (see Acne) acts in like manner.
This energetic plan, which is the one adopted at some of the “toilet
parlors,” usually provokes, however, a variable degree of dermatitis,
sometimes mild, sometimes quite severe, which takes several days or
more to subside, and for which mild soothing lotions or ointments are
to be used. It should not, therefore, be employed except very cautiously
in those of irritable skin.

Electrolysis may be tried when the spots are few in number, pricking
the epidermis superficially, and using a mild current ( ½ to 2 milliampères),
scarcely more than one or two seconds to each freckle, in order that there
may be no possibility of scars.

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