Bumps and pumps, SERCA 1999

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Abstract

"There appeared lately at the clinic for cutaneous diseases a patient whose skin presented the following extraordinary manifestations: the whole surface, with the exception of the palms and soles, the genitals, and some portions of the flexor aspects of the arms, was thickly occupied by a variety of lesions which may be thus analyzed: minute papules, medium papules, larger papules, elongated, horny papules, and smooth, flattened blackish papules (bumps, bumps and more bumps). There is a nearly universal pruritis (itching) which leads to almost incessant violent scratching. An intolerable stench is given off by the patient, especially from the lower legs, characteristic of decomposing epithelium. The clothes are saturated with it. The horrible odor emanating from the skin has lately kept him from free intercourse with his fellow-men. What disease do all these extraordinary and multiple manifestations represent? It is easy to trace the intimate connection between the various lesions by their progressive development from the minute primary papule to the largest masses of horn-like concretion. The disease is then, evidently, in all its phases a keratosis, or modified cornification of the epithelial layers. It is also evident that its starting point is in or about the follicular openings. The anatomical characteristics suggest the adoption of the more appropriate name: keratosis follicularis."

—excerpted from James White, 1889 (ref. 1)

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