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- -/ PHOTOGRAPHIC ATLAS 
OF THE 
DISEASES OF THE SKIN 
BY 
GEORGE HENRY FOX, A.M., M.D. 
PART V. 
SYCOSIS 
SCROFULODERMA 
SYPHILODERMA PAPULOt-SQUAMOSU M 
ECZEMA PAPULOSUM 
MORPHCEA 
(TWO ILLUSTRATIONS) PHOTOGRAPHIC ATLAS 
OF THE 
DISEASES OF THE SKIN 
A Series of Eighty Plates, comprising One Hundred I [lustrations 
Photographed from Life and Colored by Hand 
BY 
GEORGE HENRY FOX, A.M., M.D. 
CLINICAL PROFESSOR OF DISEASES OF THE SKIN, COLLEGE OF PHYSICIANS AND SURGEONS, NEW YORK; 
CONSULTING DERMATOLOGIST TO THE BOARD OF HEALTH, NEW YORK CITY; 
PHYSICIAN TO THE NEW YORK SKIN AND CANCER HOSPITAL ; 
ETC. 
NEW YORK 
THE WILLAN PUBLISHING COMPANY 
LONDON 
D. APPLETON & CO. 
Copyright, 1897, by George Henry Fox SYCOSIS 
Sycosis, a disease peculiar to adult males, is the result of an 
inflammatory process in and around the hair follicles. Deep suppu- 
ration usually occurs and the pus reaches the surface of the skin 
between the hair and the follicular wall. The characteristic lesion 
thus formed consists of a pustule in the centre of which is a 
loosened hair. The disease usually attacks the bearded portion of 
the face, although other hairy parts are sometimes affected. It differs 
from eczema in causing a loosening of the hair, and in not ex- 
tending from the bearded portion of the face upon adjacent regions 
which are not hairy. It is always non-parasitic, and the disease 
which is sometimes called sycosis parasitica is an entirely distinct 
disease, vi{., trichophytosis, or ringworm of the beard. 
In the accompanying illustration the limitation of the disease 
to a hairy part is well shown upon the cheek and chin. An unusual 
amount of scaling and crusting is seen in this case (the patient 
having gone several days without shaving), but a few of the char- 
acteristic pustular lesions may be noted. 
The cause of sycosis, especially when occurring upon the 
cheeks, is not always readily determined, but on the upper lip it is 
frequently the result of a chronic irritating nasal discharge. 
Epilation of the loose hairs and such others in the inflamed 
area as will yield to gentle traction is one of the most effective 
methods of treatment. It speedily relieves the tenderness and swell- 
ing in most cases, although the operation may prove extremely 
painful when a high degree of inflammation is present. COPYRIGHT 1898, BY GEORGE HENRY FOX 
ARTOTYPE, E. B1ERSTA0T, N. Y 
Sycosis. SCROFULODERMA 
Although the term scrofula has always had a somewhat vague 
significance and various skin diseases have been attributed to its 
influence, the name scrofuloderma has a more precise meaning. It* 
is applied to chronic suppurative inflammation occurring in strumous 
or tuberculous subjects, and usually in com lection with glandular 
inflammation of the neck or elsewhere. Though often classed as a 
form of cutaneous tuberculosis, it presents clinical features which 
differentiate it from the common forms of this disease. In place of 
the small nodules which are characteristic of lupus vulgaris and the 
papillomatous growth found in cases of tuberculosis verrucosa, we 
have in scrofuloderma an indolent undermining ulceration of the skin 
with more or less of crusting, and a marked tendency to the forma- 
tion of reticulated or puckered cicatrices. 
The subject of the accompanying portrait, a boy aged twelve, 
of German parentage, was brought to the Vanderbilt Clinic by Dr. 
H. J. Wallhauser. There was no evidence in the case of inherited 
tuberculosis, and the ulceration of the cheek and neck was attributed 
to a fall when four years of age. From this time the boy had been 
in delicate health, and extensive ulceration had occurred upon either 
side of face and near the elbows. He had suffered also from a 
dactylitis of the right index finger. The large patch upon the right 
cheek began as a suppurating tumor and the resulting ulceration pur- 
sued a characteristic indolent and obstinate course, extending up 
beneath the eyelid and down across the anterior surface of the neck. 
The illustration shows an ectropion of the lower eyelid and a slight 
deformity of the ear, produced by partial cicatrization.  
SCROFU LODERMA. SYPH1L0DERMA PAPULO-SQUAMOSUM 
While the small papular syphilide usually disappears without 
any desquamation, the large flat papular syphilide is apt to present 
scaly discs which bear a strong resemblance to psoriasis and were 
formerly designated as syphilitic psoriasis. These scaly lesions when 
numerous are apt to occur in groups, forming irregular patches 
like the tuberculo-squamous syphilide seen in a later stage of 
the disease. The scales do not cover the whole of the papule as 
they do in psoriasis, but usually leave a reddish peripheral margin 
of infiltrated skin. Furthermore, while they may occur upon the 
extensor aspect of the extremities, and even upon the elbow as 
seen in the illustration, they are more likely to occur upon the 
thinner skin of the flexor surface, and frequently are seen upon the 
bend of the elbow and the popliteal space, where psoriasis never 
occurs. While the infiltration of the skin in the papulo-squamous 
syphilide is very marked, the scaling is usually comparatively slight. 
In psoriasis, on the other hand, the scaling is commonly found 
to be greatly in excess of the infiltration. 
The eruption shown in the accompanying plate occurred several 
months after infection, as may be inferred from the grouping of the 
lesions which is never seen in the early lenticular syphilide. While 
the eruption presents a notable resemblance to psoriasis, its syphilitic 
nature might be inferred from the existence of lesions upon the 
nucha, where psoriasis is not commonly found, from the fact that 
the scaling is limited to the central portion of the infiltrated patches, 
and from their characteristic irregular border. In coalescing psoriatic 
lesions a circumscribed and scalloped border would be observed. COPYRIGHT 1898, BY GEORGE HENRY FOX 
ARTOTYPE, E. B1ERSTADT, N, Y. 
Syphiloderma papulo-squ amosu m ECZEMA PAPULOSUM 
While in most cases of eczema we find a diffused inflamma- 
tion of the skin, in the papular form of the disease the congestion 
begins in and is limited to the follicular plexus. A small red papule 
is thereby produced which is very apt to become excoriated by the 
finger nails, owing to the intense itching which is a prominent feat- 
ure of the disease in every form. When the lesions remain discrete 
the eruption is a dry one and to this condition the older dermatol- 
ogists applied the term “lichen." But in most cases of papular 
eczema the lesions tend to aggregate in groups and by increase in 
number to form diffused patches, which soon present the moist 
exuding surface, which is the most characteristic symptom of ecze- 
matous inflammation. It is for this reason that the old term lichen 
simplex has become obsolete, and the eruption is now generally 
recognized as a form of eczema. In scabies urticaria and prurigo 
the papular form of eczema is often artificially produced by the 
irritation of the skin resulting from continued scratching, but fre- 
quently the eruption is of internal origin and develops spontaneously. 
It may occur upon various portions of the body, and is often noted 
in the vicinity of an exuding patch. 
In the accompanying plate discrete papular lesions are seen 
scattered over the back, while in the interscapular region the tend- 
ency to grouping and the formation of inflamed patches is clearly 
shown. The eruption was of an acute character in this patient, and 
quickly yielded to zinc ointment locally, with twenty grains of 
acetate of potash taken in a tumbler of water before each meal. COPYRIGHT 1898, BY GEORGE HENRY FOX 
ARTOTYPE, E BIERSTADT, N. Y. 
Eczema paru losum. MORPHGEA 
Morphoea begins by the development of small spots which 
at first are smooth and of a dull whitish hue. These become 
wrinkled and of a horny character as they increase in size. The 
patches are usually surrounded by a faint zone of a peculiar vio- 
laceous tint. They develop slowly, persist indefinitely, and some- 
times disappear spontaneously. 
In the upper illustration is seen a rare form of morphoea 
occurring in circles upon a woman’s shoulder. The disease was of 
several years’ duration, having begun on the right forearm. Minute 
whitish spots soon were found on both arms. Many of these 
coalesced, forming irregular or oval patches. The rings upon the 
shoulder appeared as though sunken or inserted into the skin and 
were surrounded by a faint lilac hued halo. 
In the lower illustration a more common and typical form 
of the disease is shown upon the right hip of a man aged thirty- 
six. The patch was of eighteen months’ duration, having begun 
in the form of several small whitish spots, which multiplied and 
coalesced as they increased in size. This composite patch was 
irregular in form and presented the dense fibrous condition of the 
skin with the shrivelled surface which is usually characteristic of a 
well developed case. Upon the patient's right calf the disease 
had existed for two years. The skin in this region was slightly 
hidebound, as in cases of scleroderma, and presented an atrophied 
or cicatricial appearance. The galvanic current was used with 
beneficial effect in this case. COPYRIGHT 1898, BY GEORGE HENRY FOX 
ARTOTYPE, E. B1ERSTA0T, N, Y 
M O R PH CE A. TO MY COLLEAGUES 
OF THE 
NEW YORK DERMATOLOGICAL SOCIETY 
THIS WORK IS AFFECTIONATELY DEDICATED 
BY 
THE AUTHOR PHOTOGRAPHIC ATLAS 
OF THE 
DISEASES OF THE SKIN 
BY 
GEORGE HENRY FOX, A.M., M.D. 
PART VI. 
PITYRIASIS SEBORRHOICA 
CHROMOPHYTOSIS GUTTATA 
PSORIASIS GYRATA 
PITYRIASIS DIFFUSA 
FIBROMA 
(TWO ILLUSTRATIONS) PHOTOGRAPHIC ATLAS 
OF THE 
DISEASES OF THE SKIN 
A Series of Eighty Plates, comprising One Hundred Illustrations 
Photographed from Life and Colored by Hand 
BY 
GEORGE HENRY FOX, A.M., M.D. 
CLINICAL PROFESSOR OF DISEASES OF THE SKIN, COLLEGE OF PHYSICIANS AND SURGEONS, NEW YORK; 
CONSULTING DERMATOLOGIST TO THE BOARD OF HEALTH, NEW YORK CITY; 
PHYSICIAN TO THE NEW YORK SKIN AND CANCER HOSPITAL ; 
ETC. 
NEW YORK 
THE WILLAN PUBLISHING COMPANY 
LONDON 
D. APPLETON & CO. 
Copyright, 1897, by Georgf. Henry Fox PITYRIASIS SEBORRHOICA 
The disease portrayed in the accompanying plate is one to 
which has been applied a bewildering variety of names. It is most 
frequently found upon the scalp in varying degrees of severity, and 
in its mildest form is commonly recognized as “dandruff." The 
dermatologists have called it pityriasis, seborrhoea, erythema squa- 
mosum, eczema squamosum, eczema marginatum, eczema sebor- 
rhoicum, dermatitis seborrheica, etc., etc., and differ widely in their 
descriptions and views as to its precise nature. It is essentially 
a branny desquamation of the skin, associated with slight superficial 
inflammation, running an acute, subacute or chronic course, and 
presenting rounded discs, rings or diffused patches with either a 
marginate or an indistinct border. From a clinical aspect it should 
be differentiated from both eczema and psoriasis, to either of which 
it may bear a strong resemblance. 
Although pityriasis is always a dry eruption, it may become 
the seat of a secondary eczema, especially upon the legs and when 
occurring in patients with a disposition to the latter disease. Upon 
the scalp and also about the nasal, sternal and interscapular regions, 
where the skin is naturally oily, the desquamation is frequently of 
a greasy character. From this fact originated the erroneous idea 
that the eruption resulted from a perverted function of the sebaceous 
glands. The affection may be accompanied by moderate pruritus 
and usually yields to the application of mildly stimulating ointments. COPYRIGHT 1898, BY GEORGE HENRY FOX 
ARTOTYPE, E. B1ERSTADT, N. Y. 
Pityriasis seborrhoica. CHROMOPHYTOSIS GUTTATA 
Chromophytosis is a parasitic disease which may be regarded 
as being upon rather than in the skin, inasmuch as only the external 
layer of epidermic cells is affected by the growth of the fungus. 
The upper portion of the trunk is its ordinary seat. It is rarely, 
if ever, seen upon the face, and only in severe cases does the 
eruption extend down the abdomen to the pubic region. 
The eruption begins in the form of minute yellowish spots, 
which gradually increase in size and number. By their coalescence 
numerous guttate or irregular patches are formed. These macular 
lesions are of a light yellowish brown color and may be very 
slightly elevated above the surface of the skin. When scratched by 
the finger nail a moderate degree of scaliness or roughness of the 
epidermis is produced. A mild pruritus is sometimes present, but 
usually there is no subjective sensation, and in patients who bathe 
rarely the eruption may exist for a long time before it is accidentally 
discovered. 
The accompanying illustration represents a very common and 
typical form of the affection upon the anterior portion of the chest. 
The lesions, varying in size from a pin-head to a split pea, may be 
seen both isolated and coalescing into irregular patches. A few will 
be noted upon the shoulder and upper arm and distinguished by 
their pale chocolate or fawn color from the brownish freckles upon 
the extensor aspect of the forearms. The eruption was quite 
symmetrical, and in this case similar lesions existed upon the inter- 
scapular region. COPYRIGHT, 1898, BY GEORGE HENRY FOX 
ARTOTYPE, E. BIERSTADT, N, Y. 
CHROMOPHYTOS I S GUTTATA. PSORIASIS GYRATA 
The pioneers in dermatology were accurate observers and 
carefully noted the variations in clinical form which the common 
skin diseases are liable to present. While they may have laid 
undue stress upon certain peculiarities of configuration, we are cer- 
tainly indebted to them for many descriptive adjectives which are 
still in use and which convey to the mind a clear impression of the 
most striking clinical features of an eruption. Psoriasis is always 
of the same nature whatever form the eruption may assume, but 
for descriptive purposes, terms like punctata, guttata, nummulata, 
circinata, gyrata, and diffusa are of great convenience. 
While in many cases of psoriasis the lesions may retain a 
punctate or guttate form, there is usually a tendency of the scaly 
discs to enlarge peripherally. In this manner are produced the 
nummular or coin-like and the large rounded diffused patches. 
When small rounded patches coalesce an irregular patch with a 
scalloped border is formed. Frequently the psoriatic disc manifests 
a notable tendency to heal in the centre, like ringworm and syphi- 
litic lesions. In this manner is produced the circinate form of 
psoriasis, and when the ring develops in a serpiginous or creeping 
manner, part of the circle is apt to disappear, leaving a gyra or 
curved line of silvery scales. 
In the illustration may be noted both guttate, diffused, cir- 
cinate and gyrate lesions, and also the pigmentation of the skin 
which is frequently left after the disappearance of a psoriatic patch. COPYRIGHT 1898, BY GEORGE HENRY FOX 
ARTOTYPE, £. BIERSTADT, N, Y 
Psoriasis gyrata. PITYRIASIS DIFFUSA 
In the case of the patient who was the subject of the accom- 
panying illustration, the eruption was of four months’ duration, 
having begun in the form of numerous small, scaly, punctate and 
guttate patches. These coalesced and formed diffused marginate 
patches of a purplish red hue and with a very slight amount of 
mealy desquamation. The eruption was found upon the scalp, 
face, arms, axillae and pubis, and especially upon the sternal and 
spinal regions. There had been considerable scaling and itching 
at the outset, but there was little at the time the photograph was 
taken. 
The diagnosis in this case was perplexing. The peculiar 
purplish hue was a notable feature and was strongly suggestive of 
lichen planus, but there were no angular, flattened lesions typical of 
this disease. The eruption presented certain features suggestive of 
both eczema and psoriasis, but there was no tendency to exudation, 
no evidence of scratching, nor any formation of silvery scales. A 
diagnosis of eczema seborrhoicum, eczema marginatum or sebor- 
rhoea pityriasiformis might have been made, but after a careful study 
of the case it seemed evident that the smaller lesions were essen- 
tially the same as those found in cases of pityriasis maculata sen 
rosea, and hence the diagnosis of pityriasis was made and a de- 
scriptive adjective appended which would suggest the occurrence of 
large, smooth patches, instead of the branny discs and rings which 
are more commonly observed in this disease. COPYRIGHT 1898, BY GEORGE HENRY FOX 
ARTOTYPE, E. BIERSTAOT, N. Y. 
Pityriasis diffusa. FIBROMA 
Fibroma cutis is a growth of connective tissue which gives 
rise to tumors of varying size and appearance. These are painless 
and benignant in character. A very common form of the disease 
is the small, hemispherical nodule of firm consistence, often seen 
upon the face and known as. nasvus fibrosus. Multiple fibromata 
of larger size are commonly found upon the trunk. The smaller 
tumors are rounded and sessile, but as they increase in size they 
manifest a tendency to grow pedunculated, and the larger ones, on 
account of their weight, become pendulous. While some of the 
smaller tumors present a certain degree of firmness, the larger ones 
are always flaccid and pouch-like, and pressure with the finger 
shows that there is a thinning of the corium at the base. Occa- 
sionally a pendulous fibroma increases gradually and forms a pyriform 
tumor of enormous size. Its surface may be smooth and white 
or appear dotted with enlarged sebaceous glands, with more or less 
redness of the dependent portion. Sometimes the skin hangs in 
one or more folds from a broad base, a condition which has been 
termed pachydermatocele and dermatolysis. 
The negatives taken of the patient shown in the accompany- 
ing plate were kindly sent to me by Dr. W. A. Gibson, of Michigan. 
The man was a laborer and the tumors had been slowly multiplying 
for many years. Though having no effect upon his general health, 
their number and size interfered seriously with ordinary manual work. ;OPYRlGHT 1898, BY GEORGE HENRY FOX 
Fibroma 
ARTOTYPE, E. BIERSTADT, N, Y. TO MY COLLEAGUES 
OF THE 
NEW YORK DERMATOLOGICAL SOCIETY 
THIS WORK IS AFFECTIONATELY DEDICATED 
BY 
THE AUTHOR PHOTOGRAPHIC ATLAS 
OF THE 
DISEASES OF THE SKIN 
BY 
GEORGE HENRY FOX, A.M., M.D. 
PART VII. 
IMPETIGO CONTAGIOSA 
LUPUS SERPIGINOSUS 
SYPHILODERMA PUSTULOSUM 
PURPURA 
ECZEMA CRURIS 
(TWO ILLUSTRATIONS) PHOTOGRAPHIC ATLAS 
OF THE 
DISEASES OF THE SKIN 
A Series of Eighty Plates, comprising One Hundred I I lustrations 
Photographed from Life and Colored by Hand 
BY 
GEORGE HENRY FOX, A.M., M.D. 
CLINICAL PROFESSOR OF DISEASES OF THE SKIN, COLLEGE OF PHYSICIANS AND SURGEONS, NEW YORK; 
CONSULTING DERMATOLOGIST TO THE BOARD OF HEALTH, NEW YORK CITY; 
PHYSICIAN TO THE NEW YORK SKIN AND CANCER HOSPITAL ; 
ETC. 
NEW YORK 
THE WILLAN PUBLISHING COMPANY 
LONDON 
D. APPLETON & CO 
Copyright, 1897, by George Henry Fox IMPETIGO CONTAGIOSA 
Contagious impetigo is an acute affection characterized by 
the development of flattened vesico-pustules which usually reach the 
size of a nickel in about a week, become umbilicated, and finally dry 
and form yellowish crusts. When these lesions are scratched and 
irritated, as often happens, dark blood-stained crusts and superficial 
excoriations are commonly present. If not torn by the finger-nails, 
the yellowish crusts appear as though they were stuck upon a normal 
skin, and after falling leave a slightly reddened surface. The disease 
is most common in childhood, and usually affects the face and hands. 
More or less itching is always present, and wherever the skin is 
abraded by the finger-nails the germs of the disease are carried, and 
at this point a characteristic lesion develops and runs its usual course 
unless this is modified by scratching or prevented by treatment. 
In the accompanying portrait the most typical lesion will be 
noted below the right angle of the mouth. This has not as yet reached 
its full size, hut shows plainly the depressed center and the vesicular 
periphery. The other lesions have been scratched and torn by the 
nails, but still show the superficial character of the eruption. Although 
some of the lesions have coalesced through proximity, there appears 
no tendency to the formation of a group or patch, as would be the 
case in pustular eczema (impetigo simplex), in which disease the 
crusting is always the result of an aggregation of small pustules, 
which pour out a yellowish, honey-like exudation. COPYRIGHT 1898, BY GEORGE HENRY FOX, 
ARTOTYPE, E. B1ERSTA0T, N, Y. 
Impetigo contagiosa. LUPUS SERP1G1N0SUS 
Lupus vulgaris commonly attacks the face, the isolated nodules 
slowly coalescing and forming a raised patch. In exceptional cases, 
however, it may appear also upon the neck, trunk, and extremities. 
Though usually a disease of very slow development, it may occa- 
sionally run a comparatively acute course, though never spreading 
with the rapidity which characterizes the development of a tubercular 
syphilide, to which it often bears a strong clinical resemblance. 
Although lupus vulgaris usually presents a definite type, there are 
variations in its clinical appearance which have given rise to various 
names, such as lupus disseminatus, lupus verrucosus, lupus exedens, 
lupus serpiginosus, and others. 
In the serpiginous form of the disease the nodules coalesce 
and gradually disappear from the central portion of the patch, either 
with or without ulceration, and leave a cicatricial area which may be 
dotted here and there with islands of lupus tissue. The margin of 
the slowly spreading patch is raised and often covered with crusts, 
resulting from the softening and ulceration of the peripheral nodules. 
This form of the disease is very apt to occur upon the neck, espe- 
cially in strumous or tuberculous subjects, and is more likely to 
occasion pain, or discomfort, than is lupus of other regions. 
In the case of the patient portrayed in the accompanying 
illustration, aged thirty, the disease began at fifteen, as a group of 
small reddish nodules. This gradually increased in size, and in ten 
years involved the greater portion of the neck anteriorly. A patch 
on the left hand was of eight years’ duration, and one on the tip 
of the nose of subsequent development. COPYRIGHT 1898, BY GEORGE HENRY FOX 
ARTOTYPE, E, BIERSTADT, N, Y 
Lupus serpiginosus SYPHILODERMA PUSTULOSUM 
Pustules of various size and form occur in the early dissemi- 
nate eruptions of syphilis and constitute the true pustular syphilide. 
The softening tubercles and suppurating dermatitis occurring in the 
later eruptions are conveniently described in accordance with custom 
as the pustulo-crustaceous syphilide, although well-developed pus- 
tules rarely occur at this stage.- 
The pustular syphilide, like the papular form of the disease, 
may consist of small or large lesions. In the former case they are 
usually numerous and may be conical (acne-form) or rounded (variola- 
form). In the latter case they are fewer in number and manifest a 
tendency to increase in size and to become crusted (ecthyma-form). 
The pustular syphilide may occur as a relapsing eruption a few 
months after the earliest secondary outbreak, but generally it develops 
from a small or large papular syphilide through suppuration of the 
individual lesions. Frequently macules, papules, and a few pustules 
are found to co-exist and constitute a mixed eruption. 
The accompanying plate shows an early pustular syphilide in 
which the lesions, instead of being small and rounded, manifest a 
tendency to remain flattened as they increase in size. The photograph 
was not taken until the eruption was beginning to disappear, and while 
a few lesions are still typical and ecthymatous in character, the older 
ones have mostly dried in the center, leaving a crusted, serpiginous 
ring. COPYRIGHT 1898, BY GEORGE HENRY FOX 
ARTOTYPE, E. BIERSTADT, N, Y. 
Syphiloderma pustulosum. PURPURA 
Hemorrhage into the cutaneous tissues, when spontaneous 
and superficial, gives rise to an eruption of smooth lesions of vary- 
ing size known as purpura simplex. These are bright blood-red 
spots at the outset, becoming dull or purplish after a few days. In 
some cases they do not increase in size, but usually they enlarge 
and often coalesce into patches. When the hemorrhage occurs in the 
follicles the lesions may be elevated (purpura papulosa). In severe 
cases there is usually more or less bleeding from some of the 
mucous membranes (purpura hemorrhagica). When this hemorrhagic 
purpura is the result of a prolonged abstinence from vegetable food, 
the disease is commonly known as scurvy (purpura scorbutica). 
The accompanying plate shows a well-marked case of purpura 
in its most common form. The man was a patient in my service 
at the Skin and Cancer Hospital and had suffered from recurring 
attacks of purpura of the lower extremities. The present eruption 
began with numerous small bright-red spots, such as are seen 
around the popliteal space and above the ankle. Upon the middle 
portion of the legs they rapidly increased in size, coalesced into 
irregular patches, and assumed a dull purplish hue. With rest in bed 
and the administration of the tincture of the chloride of iron in full 
doses the eruption faded away in about two weeks’ time, the patches 
passing through those gradations of color which are characteristic 
of a disappearing bruise. &Of>YRlGHT 1898 BY GEORGE HENRY FOX 
ARTOTYPE, E. BlERStAOT, N. Y. 
Purpura. ECZEMA CRURIS. 
To the student of physiognomy not alone the face but nearly 
every portion of the body presents characteristic features which 
indicate the temperament and general physical condition of a patient. 
The color of the skin, the contour of the joints, the firmness or 
flabbiness of the subcutaneous tissue—all may furnish unmistakable 
indications of systemic conditions which determine the clinical form, 
the chronicity, and often the therapeutic indications in a case of 
crural eczema. 
The accompanying plate shows two legs belonging, respect- 
ively, to two female patients and presenting a contrast which makes 
them well worthy of study apart from their dermatological interest. 
Compare the knees for an instant and see how easy it is to recognize 
what the older physicians were wont to describe as the nervous 
and the phlegmatic temperaments. As a natural result of this tem- 
perament, diathesis, general physical condition or whatever it may 
be termed, we have in the one case a typical neurotic eczema—a 
dry, scaly, pruriginous, chronic and rebellious patch; while in the 
other case we have a typical exuding eczema—a moist, swollen, 
acute, and crusted patch far more amenable to local treatment. In 
the former case a five per cent, ointment of chrysarobin was used 
locally while every effort was made to improve the health of the 
patient. In the latter case the application of vulcanized rubber cloth 
quickly removed the crusts and checked the discharge. COPYRIGHT 1898, BY GEORGE HENRY FOX 
ARTOTYPE, E. BIERSTAOT, N. Y 
Eczema cruris TO MY COLLEAGUES 
OF THE 
NEW YORK DERMATOLOGICAL SOCIETY 
THIS WORK IS AFFECTIONATELY DEDICATED 
BY 
THE AUTHOR PHOTOGRAPHIC ATLAS 
OF THE 
DISEASES OF THE SKIN 
BY 
GEORGE HENRY FOX, A.M., M.D. 
PART VIII. 
CHLOASMA 
CHROMOPHYTOSIS DIFFUSA 
PSORIASIS CIRCINATA 
LICHEN PLANUS HYPERTROPHICUS 
.TUBERCULOSIS VERRUCOSA 
(TWO ILLUSTRATIONS) PHOTOGRAPHIC ATLAS 
OF THE 
DISEASES OF THE SKIN 
A Series of Eighty Plates, comprising One Hundred Illustrations 
Photographed from Life and Colored by Hand 
BY 
GEORGE HENRY FOX, A.M., M.D. 
CLINICAL PROFESSOR OF DISEASES OF THE SKIN, COLLEGE OF PHYSICIANS AND SURGEONS. NEW YORK ; 
CONSULTING DERMATOLOGIST TO THE BOARD OF HEALTH, NEW YORK CITY; 
PHYSICIAN TO THE NEW YORK SKIN AND CANCER HOSPITAL ; 
ETC. 
NEW YORK 
THE WI LEAN PUBLISHING COMPANY 
LONDON 
D. APPLETON & CO. 
Copyright, 1897, by George Henry Fox CHLOASMA 
Chloasma is an abnormal pigmentation of the skin usually upon 
the forehead, cheeks and neck. It appears in the form of irregular 
brownish patches and is commonly bilateral, if not symmetrical. 
Its cause is obscure in most cases. The common name of 
“liver spots,” which is often applied to this affection as well as to 
chromophytosis, is based upon surmise rather than upon any de- 
monstrable relation to hepatic derangement. It occurs often during 
pregnancy and in connection with uterine derangement, but not with 
sufficient frequency to warrant the use of the name chloasma 
uterinum which was formerly in vogue. 
It is sometimes difficult to distinguish the affection from 
vitiligo which is due to an opposite condition, viz., a loss of normal 
pigmentation. The skin surrounding patches of vitiligo is always 
darker than normal, and on the face this affection may look very 
much like chloasma. On the other hand, the normal skin surround- 
ing a patch of chloasma is apt to look white by comparison and 
thus suggest vitiligo. It has been claimed that in the latter affection 
it is the pigmented skin, while in the former it is the white or 
normal skin, which shows a concave border, the abnormal patch 
having always a convex margin. This rule applies generally, but 
the accompanying illustration furnishes an exception to it, as the 
pigmented skin has a concave border and there was certainly no 
vitiligo in this case. 1^ 
ARTOTYPE, E. BIERSTAOT, N 
Chloasma. CHROMOPHYTOSIS DIFFUSA 
The accompanying plate shows a case of chromophytosis in 
which the eruption was of long standing and of an unusual extent. 
The punctate and guttate spots which were undoubtedly present 
upon the upper portion of the chest at the outset are now seen 
only upon the lower portion of the abdomen. Elsewhere they have 
coalesced and formed smooth, yellowish, diffused patches with a 
marginate border. A notable feature of this case is the entire absence 
of the eruption over the sternum—a region in which it is commonly 
found and to which it is frequently confined. This is the result of 
excessive perspiration which tends to destroy the parasitic growth, 
while a moderate amount of persistent cutaneous moisture conduces 
to its development. This will account for the usual absence of the 
eruption in the axillary region. 
It is quite uncommon to find such well marked patches upon 
the arms as are seen in the illustration, and only in exceptional cases 
does the eruption extend down upon the thigh. In severe cases a 
few small patches often exist unnoticed beneath the hair of the 
pubic region, and the frequent tendency of the disease to relapse 
after an apparent cure may be justly attributed to the fact that how- 
ever vigorously the treatment may be applied to the rest of the 
affected skin, this region is very apt to be neglected or overlooked. COPYRIGHT 1898, BY GEORGE HENRY FOX 
ARTOTYPE, E BIERSTAOT, N, Y. 
CH ROMOPHYTOSIS DIFFUSA. PSORIASIS CIRCINATA 
The circinate form of psoriasis results from a tendency of the 
rounded, marginate patches to heal in the center while the border 
remains thickened and scaly. This is noted in certain cases par- 
ticularly of the nummular or diffused type. The small lesions do 
not develop in a circle and enclose a healthy area, as sometimes 
happens in the tubercular syphilide, but as the patch enlarges in a 
serpiginous manner the raised scaly border often breaks into small 
guttate segments. 
The accompanying plate shows a case of psoriasis which had 
lasted for many years, increasing in extent at times and then almost 
disappearing. This increase and decrease of the eruption, which is 
a characteristic feature of psoriasis, is due partly to the change of 
seasons and partly to the change of food which this involves. It 
also depends upon accidental conditions which exert an influence 
upon the health and vigor of the patient. The eruption is com- 
monly worse in winter than in summer, and many patients note a 
marked tendency to an exacerbation in either the spring or autumn 
months. While it is true that the victims of psoriasis are, as a rule, 
robust and well nourished individuals, it is also to be noted that in 
a given case the tendency to the outbreak of new lesions depends 
largely upon conditions which tend to impair the health or to pro- 
duce mental or physical exhaustion. COPYRIGHT 1898, BY GEORGE HENRY FOX 
ARTOTYPE, E BIERSTADT, N, Y. 
Psoriasis circinata. LICHEN PLANUS HYPERTROPHICUS 
Since lichen planus even in its most typical form is apt to 
pass unrecognized by the physician with limited dermatological ex- 
perience, it is not surprising that the unusual forms of the disease 
must furnish of necessity a severer test of diagnostic skill. Acute 
general lichen planus is liable to be mistaken for a papular eczema, as 
many of the lesions may be congested and elevated instead of being 
flattened and shiny. When covering the entire trunk the eruption 
may bear a strong resemblance at first glance to a papular syphilide, 
or on account of its unusual development, it may be regarded as a 
lichen ruber. 
The hypertrophic form of the disease is commonly observed 
upon the lower extremities and occurs in raised patches. Upon the 
tibial region these often present a greyish, roughened surface and 
have a peculiar harsh feeling when rubbed with the finger. About 
the knee and inner aspect of the thighs the irregular patches are apt 
to be smoother and of a dull crimson or lilac hue, as seen in the 
accompanying plate. When of long standing these lesions are 
usually more or less pigmented, and often the seat of a pruritus 
which is almost intolerable. As a result of this, the lesions may be- 
come excoriated, and therefore bear still less resemblance to ordinary 
lichen planus. COPYRIGHT 1898 BY GEORGE HENRY FOX 
ARTOTYPE, E. BIERSTAOT, N. Y. 
Lichen planus hypertroph icus. TUBERCULOSIS VERRUCOSA 
Like lupus vulgaris, the somewhat rare affection known as 
tuberculosis verrucosa is the result of infection of the skin by the 
tubercle bacillus. It has been termed by some writers lupus verru- 
cosus, although the characteristic tubercles of lupus are never present. 
In one patient, I have noted this eruption upon the dorsum of the 
foot, while a patch of typical lupus vulgaris was present upon the 
arm. The hands are most frequently affected, and the disease usually 
begins as a small warty growth over one or more of the knuckles. 
Its course is a slow one and there is no tendency to spontaneous 
recovery, although the central portion of the patch may be converted 
into a cicatricial area. Fissures and raw spots may be noted but 
there is never any extensive ulceration. 
The accompanying plate presents three illustrations of the 
disease. The upper hand, that of a young man, shows the simplest 
and most frequent form. The patch has become flattened and mani- 
fests a slight serpiginous tendency. The lower hand, that of a man 
aged forty-five, shows an extensive and typical form of the disease. 
The eruption in this case improved under treatment at the outdoor 
department of the Skin and Cancer Hospital, but after the patient 
had allowed eight years to elapse between visits it was found to 
have increased considerably in extent. Curetting beneath a spray of 
ethyl chloride is a plan of treatment which in such cases promises 
the best results. The boy, nine years old, whose leg is portrayed, 
had no eruption save the patch in the popliteal space which was of 
eighteen months’ duration. ARTOTYPE, E. BIERSTADT, N. Y. 
Tuberculosis verrucosa. 
COPYRIGHT 1898 BY GEORGE HENRY FOX TO MY COLLEAGUES 
QF THE 
NEW YORK DERMATOLOGICAL SOCIETY 
THIS WORK IS AFFECTIONATELY DEDICATED 
BY 
THE AUTHOR