616

ATROPHIES

GLOSSY SKIN

Synonyms.—Atrophoderma neuriticum; Fr., Peau lisse.

Symptoms.—It is to Paget,¹ Weir Mitchell, Morehouse, and
Keen² that we owe our chief knowledge of this affection, although,
according to Leloir,³ it was first described by Alexander Denmark in
case of a wound of the radial nerve. Its most common and usual site
is some part of the hand, and in almost all instances the fingers, rarely all
of them. The affected skin is at first noted to be a deep red or mottled or
red and pale in patches, and smooth and shining, giving it a glossy ap­
pearance, and hence the term commonly used to describe it—glossy skin.
It is dry, thinned, and with a pseudocicatricial aspect. The fingers,
from the varying, usually slight, associated atrophy of the skin and sub­
cutaneous tissue of the distal portion, are often tapering, with, as a rule,
the almost entire disappearance of the wrinkles, the skin appearing as if
tightly drawn over the subjacent tissues. The general effect, as Mitchell
expresses it, is: the surface of the affected part is glossy and shining, as
though it had been skilfully varnished, or in some instances presents the
characters of large, thin, and highly polished scars. Not infrequently,
especially in the beginning, as Paget states, its resemblance to chilblains
is often striking. The hair growth of the part usually wholly or partially
disappears. In places there may be a tendency to partial loss of the
overlying epithelium, the cutis being exposed, and cracking or fissuring
of the thinned skin is sometimes observed. The nails at the free border
are usually curved over both at the end and sides. Occasionally slight
retraction of the skin from the matrix occurs, and when about the toes,
painful fissures or ulcerations sometimes result. The atrophic condition
is also observed on the palm, and here the glossy thin area or spots are
noted to be slightly depressed. The malady is generally preceded and
accompanied by neuralgic or burning pain, of variable degree, but usually
severe; while commonly more or less limited to the affected region, it
may involve the whole limb. In Watson‘s⁴ case the neuralgia was ex­
treme, acute in character, lasting about a day, and shifted from one hand
to the other. While the skin is, as a rule, unnaturally dry, in some in­
stances increased sweat secretion has been observed.

Etiology and Pathology .—The malady is a trophoneurotic
one, and is due to any cause which brings about disease or injury of
the supplying nerves. A neuritis or injury from a gunshot or other
wound is the most common exciting factor. In nerve lesion the con­
dition, according to Mitchell, never appears before the second week,
usually coinciding with the beginning of the healing process. As a com­
plication it has also been observed in some general disorders, such as
chronic myelitis, leprosy, gout, and rheumatism. Watson‘s case was
apparently independent of any recognizable cause.

¹ Paget (Some Forms of Local Paralysis), Med. Times and Gazette, 1864, vol. i, p.

333-

² Mitchell, Morehouse, and Keen, Gunshot Wounds and Other Injuries of the Nerves,
Philadelphia, 1864, p. 77; Mitchell, Injuries of Nerves and their Consequences, Phil­
adelphia, 1872.

³ Leloir, Twentieth Century Practice, vol. v (Diseases of the Skin), p. 834.

⁴ Watson, Lancet, 1890, vol. i, p. 647.

ATROPHIA SENILIS

617

Prognosis and Treatment.—The duration is variable, from
weeks to years, although, according to MitchelPs observations, there
is final spontaneous disappearance. Treatment consists in removing
or modifying the cause, restoring the nerve tone of the part, and the use
of local protective measures of a soothing and oily character, and the
avoidance of exposure to cold.

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