Definition And Description

Seborrhoea is a functional affection of the sebaceous glands, characterized by an excessive formation and outpouring of usually somewhat altered sebaceous matter. The glands most frequently affected are those of the nose, cheeks, forehead, and scalp. From these the thin oily sebum may flow in abnormal quantity, and give to the skin a greasy, unctious, and shiny aspect, and prove a convenient trap for all the dust and dirt that may be floating in the atmosphere. If the fingers be passed over the affected parts, they will take up a considerable quantity of the secretion, and if a piece of paper or linen be applied, it is readily stained. Sometimes, when the secretion is abundant, it loses its watery parts by evaporation, and dries upon the surface into thin, greasy-looking scales, which must not, however, be mistaken for those of pityriasis. These scales are sometimes quite adherent, being glued fast, as it were, to the skin immediately surrounding the mouths of the sebaceous follicles. The affection is most frequent in young persons at and after puberty, and in women about the time of the menopause. A certain amount of sebaceous exudation is normal and useful, as it tends to keep the skin soft and pliant. Under these circumstances, however, it does not exist in sufficient quantity to be recognized on ordinary and cursory inspection. It is only when sufficiently abundant to attract the attention of the patient or of others, that it may be fairly called a disease. It frequently lasts, when untreated, for years.

Varieties

Two varieties are commonly recognized by authors, namely, Seborrhoea oleosa and S. sicca, the difference between them being due to differences in character of the secretion, which in the former is more oily, and usually more or less completely removed at each ablution, in the latter more watery and drying more quickly into scales or thin crusts.

Diagnosis

A little difficulty sometimes arises in making a differential diagnosis between Seborrhoea and certain cases of eczema, occupying the favorite seats of the former affection; but a careful attention to the characteristic features of the two affections will usually overcome it. When Seborrhoea is located on the scalp it may be mistaken for pityriasis, as both affections exhibit fine scales. In the former case, however, the scales are made up of dried sebum, entangling a few epithelial cells, derived chiefly from the sebaceous glands; in the latter the scales are chiefly composed of horny epidermic cells entangling a little sebum. Herba has unfortunately confounded these two conditions, embracing both under the same title (Seborrhoea). In this he has been blindly followed by his adherents, both here and abroad, but one modern Vienna writer (Auspitz) recognizing the essential difference that exists between the two affections.

Prognosis

The affection is of slight gravity, possessing little importance in itself except as a matter of inconvenience to the patient, or as an index of debility and depraved nutrition. It is usually curable, though often obstinate and tedious.

Etiology

It is a little hard to fix the causes of Seborrhoea, as the affection, in an aggravated form, is not very common. It is very distinctly not allied to pityriasis, but seems to the writer to be more closely connected on the one hand to acne, and on the other to hyperidrosis. As a rule, writers usually consider debility and depraved nutrition to be the principal etiological factors. The fact, however, that glandular activity, normal and abnormal, is so directly under the control of the ganglionic nervous system, would suggest that investigations in this direction might throw more light than we at present possess on this subject.

Treatment

It is but axiomatic to state that hygienic management is of prime importance in this as in so many other affections. As a rule, however, this is but little regarded, the physician usually thinking of some local application of an absorbent or astringent character. It is the almost exclusive employment of these that leads so many to regard the affection as a peculiarly obstinate one. If a permanent cure is to be af-fected, something else than this must be done. In the presence of debility, depraved nutrition, or any manifest general or local disease, whether the Seborrhoea can be plainly traced to them or not, it is clearly a wise proceeding to try to remedy them. This done we come to the direct or specific treatment of the affection itself. At the outset I must confess that I am unacquainted with any drug that, internally administered, acts with a specific or directly curative effect on Seborrhoea. We come then to local treatment, which is either palliative or curative. By palliative treatment we seek simply to lessen the inconveniences that the patient complains of. The simplest means to this end are frequent ablutions of the part with ordinary soapsuds, and, after drying, the application of some inert absorbent or a slightly astringent powder, the ingredients of which may be starch, rice-powder, lycopodium, oxide of zinc, subnitrate of bismuth, talc, tannin, etc. More frequently I direct patients to employ, instead of soap, a strong decoction of quillaya ( iv. - Oij. of water, boiled down to a pint), or the fluid extract of quillaya, to which a little water (five to ten per cent.) has been added. The absorbent powder then fol-lows. A combination of palliato-curative treatment much in vogue is the use of Sapo Viridis or Tinctura Saponis Viridis (Spts. Saponatus Kalinus of Hebra), followed by the use of lotions containing sulphur, or acetate of lead, or simply precipitated sulphur, diluted five or tenfold with an inert powder, and dusted on the parts with a powder-puff.

A more directly curative application, however, that has in my hands rendered good service, is a mixture of extract of ergot (ergotin), and hy-drated silica, with glycerine or rose-water ointment. To this a little precipitated sulphur may be added. This combination has certainly seemed to me to control the activity of the glands, and exert an unmistakable curative effect. This may be alternated with applications of Tincture of Sulphur.