ECZEMA CHRONICUM VOLAE MANUS

On account of the frequency with which the
hands are exposed to mechanical, thermal, and more
especially to chemical irritation, they are extreme-
ly common sites for eczema. The list of substances
whose action at times is responsible for the pro-
duction of eczema is exceedingly long and includes
almost all the acids, alkalies, salts, dyes, volatile
oils, etc., employed in the various trades. Among
working women the frequent and prolonged use of
water, alone or in combination with strongly alka-
line soaps or cleansing powders, is a familiar cause of
eczema of the hands. The disease is sometimes
associated with some constitutional disorder, such
as anemia, gout, diabetes, chronic nephritis, etc.,
and is then usually exceptionally rebellious to
treatment. Eczema of the hands may be part of a
general eczema. Not infrequently it arises inde-
pendently without any assignable cause. Both
hands are nearly always involved, though in right
handed persons the right hand is often the more
severely affected. The lesions usually appear first
upon the wrists or fingers and later involve the
palms. Owing to the thickness of the epidermis on
the volar surface of the hand, the vesicles, when
they are present, often persist for a long time with
the appearance of little sago grains embedded in
the skin. From some of them the fluid may be ab-
sorbed and the roofs form scales and desquamate;
others rupture spontaneously or as the result of
scratching, and leave the skin more or less ragged
and worm eaten. The skin of the involved area

becomes reddened, thickened by infiltration, and
loses its pliability so that it often cracks, in the
natural creases especially, but also away from these,
and the fissures that form are usually very painful.
The borders of a patch are nearly always ill defined,
though occasionally they may be fairly sharp. The
itching is sometimes intense. **DIAGNOSIS:** The
occurence of such a lesion on only one hand should
arouse suspicion of syphilis. The *palmar syphilid*,
however, does not itch as a rule, rarely involves the
finger tips, is not associated with eczematous
patches on the forearms and dorsal surfaces of the
hands, is usually sharply circumscribed and circi-
nate or serpiginous in contour and is often ac-
companied by a definite history of earlier syphilitic
symptoms. **TREATMENT:** This is one of the
most obstinate forms of eczema to treat. When
the causative factor can be determined its influence
of course should be removed. The wearing of rub-
ber gloves, for example, may be necessary to keep
the hands out of water. In every case they should
be washed as infrequently as possible and always
promptly and thoroughly dried. An ointment con-
taining a drachm of oleum cadini or oleum rusci to
the ounce of zinc oxid ointment should be freshly
applied and well rubbed in several times a day. If
the response is slow a ten per cent salicylic acid
salve or plaster (unguentum salicylatum extensum)
may be kept on the thickened skin constantly for
several days to soften the dry horny epidermis, and
the tar treatment then resumed.

HST.OOO.OO.I