COLLOID DEGENERATION OF THE SKIN

Synonyms.—Colloid milium (Wagner); Hyaloma; Fr., Dégénéréscence colloide
du derme; Colloidome miliaire (Besnier); Colloid milium; Hyalome (Vidal and Leloir);
Ger., Hyaioma der Haut (Auspitz); Colloide Degeneration.

Definition.—An affection characterized by pin-head­ to split-
pea-sized nodules, of a yellowish color, having a translucent appearance,
and usually observed on the upper part of the face, and due to colloid
degeneration of the dermal connective tissue. The literature¹ of this

¹ Literature: Wagner, Arch, der Heilkunde, 1866, p. 463; Besnier, Annales, vol. x
(1877-80), p. 461; Balzer, ibid., p. 468 (histologic examination of Besnier‘s case);
Feulard-Balzer, ibid., 1885, p. 342; Liveing, Brit.Med. Jour., 1886, i, p. 586; Philipp-
son, “The Relationship of Colloid Milium (Wagner), Colloid Degeneration of the
Skin (Besnier), and Hydradenoma (Darier-Jacquet) to One Another,” Brit. Jour. Derm.
1891, p. 35, and Monatshefte, 1890, vol. xi, p. 1 (a histologic and clinical study with
case citations and references); Perrin-Reboul, Trans. Second Internat. Dermat. Cong.,
Vienna, 1892, pp. 435 and 438 (with references); G. H. Fox‘s case, Jour. Cutan. Dis.,
1893 (with illustration), seems more probably a case of disseminated lupus, which
Dr. Fox was at first inclined to believe, and which is supported by Elliot‘s histologic
examination. The curet was used in some lesions; others disappeared spontaneously.
C. J. White, ibid., 1902, p. 49, reports a case, with histologic examination and cut, and
concludes, from an analytic study of cases on record, that, including his own, there
seem to be only 5 which can be considered genuine cases of this malady; Bossellini
(Annales, 1906, p. 751, 2 cases; brothers, histologic, and review, with bibliography)
found the disease a degenerative process primarily, and involving the collagenous and
elastic connective tissue of the subpapillary zone.

Hardaway, ibid., 1884, P. 169, records 5 cases (4 children, 1 adult) of “an unusual
papular eruption,” in which the lesions, pseudovesicular in appearance, but solid in
character and lemon-yellow in color, were suggestive of colloid milium, but upon punc-
ture simply a drop of blood could be pressed out. They were not numerous, and
variously seated upon the face, neck, or arms, and had been of months’ duration, and
some with associated itching, although slight. An ointment containing 1 dram (4.)
each of ammoniated mercury and liquor picis alkalinus to the ounce (32.) of vaselin,
rubbed in, proved effectual in a few weeks.

C. J. White, Jour. Cutan. Dis., 1908, p. 295, under the title, "Dermolysis—an Un-
described Dissolution of the Skin,” reports a case (with case illustrations and histologic
cuts, and review of resembling cases, with references) seemingly distinct, and yet having
some histologic resemblance to colloid degeneration; consisting, clinically, of pea-sized,
dome-shaped, cherry-colored papules, which evolve into hitherto underscribed flattened,
muddy-white lesions, isolated or grouped around a relatively depressed, bluish-red,
velvety center; these features, of long standing, developed on non-exposed regions and
without subjective symptoms.

COLLOID DEGENERATION OF THE SKIN               679

rare malady is scanty, but few unquestioned cases being recorded, of
which the first was described by Wagner. Besnier, Balzer, and Feulard
have done most to give the disease the stamp of individuality.

Symptoms.—The favorite sites are the forehead, about the orbits,
the nose, and cheeks—usually the upper half or two-thirds of the face.
In one of Liveing‘s patients the rueck and arms were also the seat of the
growths. In Perrin‘s patient, in addition to the upper part of the face,
some were seen on the ocular conjunctiva, near the inner canthus, and
on the backs of the hands. In C. J. White‘s case the growths were on the
backs of the hands and face. The lesions are of slow development,
commonly appearing in groups of two or more, and occasionally two or
three may tend to fuse together, but the individual character of such
component tumors remains recognizable. In size they vary from that
of a pin-head to a small split-pea, rarely larger, and while well seated in
the derma show elevation, although usually slight, above the surface.
They are lemon-yellow or yellowish-white in color, and are translucent
in appearance, suggestive of a vesicular formation. They are, however,
of firm consistence; if punctured or incised, only a small amount of gelat­
inous material and a droplet of blood can be pressed out. With some
there is surrounding capillary dilatation, giving a reddish hue. There
are no subjective symptoms. The malady is persistent; in only one in­
stance—one of Liveing‘s cases—did the disease disappear spontaneously.
In some lesions involution has been noticed, beginning in the central
surface portion, giving rise to central depression, and the growths thus
gradually pass away, leaving a slight depression. In one instance
(Liveing) some of the growths became inflamed, crusted over, and dis­
appeared, leaving an atrophic or scar-like mark. Jarisch¹ exhibited before
the German Dermatological Society a case he thought to be an example
of this disease, in which destructive action was also noticed, but the cor­
rectness of the diagnosis was questioned, and Jarisch himself has since
spoken of it with implied reservation.²

Etiology and Pathology.—The youngest case (Liveing) of the
few reported was over fifteen; the others were adults of various ages.
Sex apparently has no influence. Beyond the possibility of weather
exposure, to which most of the patients were subjected, and precursory
and associated headache or neuralgia in 2 instances being of some influ­
ence, no cause could be assigned. Wagner called the disease colloid
milium, believing that it was allied to ordinary milium, and that it
was a degeneration of the sebaceous gland structure. His observations
were, however, purely clinical. The careful histologic studies—by
Balzer of the 2 cases of Besnier and Feulard, by Reboul of Perrin's case,
and by C. J. White of his case—show clearly that the disease is independ­
ent of the glands and epithelial structures, and that it is purely a degen­
erative process, involving the connective-tissue bundles and cells of the
corium and the fibers surrounding the blood-vessels and nerves—the
degenerative process changing this tissue into so-called colloid matter.

¹ Jarisch, “Colloidoma ulcerosum,” Verhandl. d. V. Cong. Deutsch. dermatolog.
Gesellsch., Vienna, 1896 (case demonstration).

² Jarisch, Die Hautkrankheiten, 1900, p. 927.

68o

NEW GROWTHS

Although Philippson has endeavored to show that the cases described
variously as hydradenoma, benign cystic epithelioma, etc, and colloid
degeneration are the same histologically, such a conclusion is not war­
ranted by the investigations of the several careful observers referred to,
and whose opinion is supported by Besnier,¹ who has observed examples
of both affections, and who is firmly convinced of their non-identity,
presenting a clear exposition of the clinical and pathologic differences.

Diagnosis.—The disease is to be distinguished from xanthoma,
hydrocystoma, and benign cystic epithelioma. The soft character,
non-translucent appearance, and the practical limitation to the eyelids
of xanthoma will serve to prevent error with this latter disease. The
distribution alone of xanthoma multiplex is essentially different. The
lesions of hydrocystoma lack the yellow or yellowish color of collpid
degeneration, and, moreover, contain fluid which can readily be demon­
strated by pricking. Benign cystic epithelioma may show some re­
semblance, but the latter is usually lacking any yellowish color, generally
appears early in life,—in most cases about puberty,—and is sometimes
seen in more than one member of the family, and while often on the face,
may be elsewhere, especially about the clavicular region and upper trunk,
In some instances a histologic examination would be necessary for a
positive conclusion. The color of ordinary milium, its commonly much
smaller size, and its cystic character will prevent a mistake in this direc­
tion. The possibility of confusion with disseminated lupus is also to be
kept in mind.

Treatment.—As the lesions show no tendency to disappearance
(Liveing‘s 1 case an exception), their removal, if desired, must be effected
by operative measures, such as the curet, as successfully employed in
Feulard‘s patient, or by electrolysis. This latter certainly deserves a
trial before other more positive procedures are adopted.

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