| Reprinted from the Journal of Cutaneous and Genito-Urinary Diseases 
for April, 1896.] 
AX UNUSUAL CASE OF UNIUS LATERIS. 
CHARLES C. RANSOM, M. D 
New York, 
PATIENT, 13. M., female, aged twenty, is a native of Germany, 
although she has lived in this country since early childhood. 
The general health has always been good, although she is rather 
thin, and of a nervous temperament. 
At birth the skin was perfectly smooth, and free from eruption of 
any kind. When about six months of age small areas of warty growths 
appeared on the chest and left side of the neck. These gradually and 
very slowly spread until puberty, when for a couple of years their 
growth was rapid. Since the fifteenth year the patches have not 
spread to any extent, but have grown darker and much more pro- 
nounced. 
The eruption consists of various-sized and irregularly shaped patches, 
made up of slightly elevated growths, brown or black in color, dis- 
tributed from the border of the scalp to the upper portion of the calves, 
and for the most part upon the left side of the body. 
The most prominent patches consist of numerous isolated warty 
growths, closely aggregated, and distributed for the most part in the 
form of vertical lines or hands. 
On the forehead, in the border of the hair, more especially on the 
right side, are numbers of very small, slightly elevated warty growths, 
isolated and scattered over the entire region. These are so light in 
color as to be scarcely perceptible except on close scrutiny. They ex- 
tend down over the left cheek, and are scattered over the eyelid and 
ear on this side. 
Over the left side of the chin are aggregated patches of the growths, 
the color being that of the normal integument; from these patches 
four or five strings of individual lesions extend down underneath the 
chin and on to the neck. 
The neck is covered in front, on both sides of the median line, with 
similar isolated growths, which at the lower segment tend to become 
aggregated and are darker in color. 
oo “ 
Copyright, 1896, by D. Appleton and Company. 2 
Original Communications. 
At the upper border of the sternum are several patches of closely 
•aggregated light-brown growths, which extend in bands of the same 
Fig. 1. 
character down over the sternum to the ensiform cartilage, at which 
point is a large irregularly shaped patch. 
Over the left side of the chest, anteriorly, are large patches made An Unusual Case of Ncvvus Unius Lateris. 
3 
up of an aggregation of these vertical bands, together with isolated 
lesions. 
The entire left breast, with the exception of a small segment on its 
lower side, and including the nipple, is covered by a dark-brown patch 
of the growths, so closely packed as to leave no normal skin visible. 
This patch extends in a hand three inches wide up into*the left axilla, 
the lower border becoming continuous with a band which extends 
around the side to meet a patch in the back, the upper border ending 
in a patch of large-sized, darker-colored lesions situated at the border 
of the hair in the axillary space (Fig. 1). Here the growths are nearly 
black in color, the individual lesions much larger and more papilloma- 
tous in character. From the excessive sweating in this region the 
growths are often macerated, and give rise to a great deal of discomfort. 
From the upper part of the breast other narrower bands extend up 
over the face of the shoulder and encircle the axilla anteriorly, being 
continuous with a bandlike patch which extends down the arm. On 
the right side of the chest are numerous more or less isolated lesions, 
lighter in color than the preceding, and extending outward in an irreg- 
ular band to the anterior border of the right axilla, which it encircles 
as on the other side, and becomes continuous with a band extending 
down the right arm. 
From both axillae, but more marked on the left side, band-shaped 
patches extend down the inner side of the arm to the bend of the elbow, 
and on the left arm from the elbow to the wrist. 
Over the left shoulder are numerous small groups and many indi- 
vidual lesions, light brown in color. From the shoulder small light- 
colored bands extend down the external aspect of the arm to the elbowx 
On the right side is a large irregular patch in front, and numerous 
scattered individual lesions behind. 
In the. median line, over the epigastric region, is a string of dark- 
brown individual lesions extending nearly to the umbilicus. Over 
the left inguinal region are scattered a few light-brown isolated 
lesions. 
In the left groin are several small groups of large, dark-colored 
growths extending down on the thigh in broken lines. 
On the inner side of the thigh is a large patch of closely aggregated 
blackish growths of large size. On the integument of the left labium 
major is a patch extending down on to the thigh. Those covering the 
labium are similar in appearance to the ones in the left axilla. From 
this patch bands of growths extend down the inner side of the thigh ta 
the knee. From the inner border of the left popliteal space two strings 
of lesions extend down on to the calf. 4 
Original Communications. 
! On the back, in the infrascapular region, and just to the left of the 
median line, are several irregular patches of large, dark-colored lesions, 
closely aggregated ; from these, similar patches extend out over the 
Fig. ‘2. 
scapula to the point of the shoulder, thence down the arm to the 
•elbow. An Unusual Case of JVcevus Unius Lateris. 
5 
Below this patch, and beginning to the left of the median line, is 
another similar patch, which extends outward across the lower border 
of the scapula to join the lower border of the band coming from the 
breast (Fig. 2). 
A third patch, very dark and irregular in outline, is situated below 
this one over the spinal ends of the tenth, eleventh, and twelfth ribs. 
Over both sides of the median line, in the lower lumbar region, are scat- 
tered several small patches. Over the right sacro-iliae junction is a small 
Fig. 3.— x 75. (Photomicrograph by Dr. J. A. Fordyce.) Section of one of the warty 
growths, showing the hypertrophy of the epidermis. 
irregular patch, and another is situated over the right side of the 
coccyx. 
A large group of scattered lesions over the middle of the left but- 
tock extends in numerous lines out across the thigh and down its 
anterior surface. 
There never have been any subjective symptoms connected with 6 
Original Communications. 
these growths, except in the case of those in the left axilla, as above 
mentioned, but the disfigurement of the body is distressing to the 
patient. 
The photomicrograph (Fig. 3) shows the irregular development ot 
the epidermis; all the layers have undergone hypertrophy. The ab- 
normal formation of horny tissue can be readily seen in a number of 
places in the illustration. The basal layer of the epidermis is deeply 
pigmented, and the connective tissue of the derma presents a uniform 
light-brown color under the microscope. 
She came to me to see if they could not in some way be removed. 
I tried various methods of removing the growths: curetting with and 
without the use of chromic acid ; afterward electrolysis, the galvano- 
cautery, the application of nitric, acetic, or chromic acids ; but the most 
satisfactory procedure, both from the patient’s standpoint of comfort 
and in the results obtained, was the use of a flat-pointed scissors. rl he 
skin was picked up between the thumb and fingers, and the top of the 
ridge so made was snipped off, the cut being superficial and extending 
not quite through the skin proper.