This sad condition was much more frequent in the early days of x-ray therapy than it is at present. In those days the operators took no precautions to shield either themselves or patients from long continued exposure to the soft rays, and the result was that there were very many sufferers. The condition is in every way analogous to the conditions just described, and is undoubtedly caused by the actinic rays of the Roentgen tube. The backs of the hands are well known to be the most susceptible portions of the body, and here it is that this condition is most often seen.
Again, we see the developing of an excess of pigment, usually in freckle-like spots, then there appear superficial telangiectases; the skin becomes dry and rough, and loses its secretions, and the hairs fall out. The nails frequently become stunted and roughened. Small horny growths appear, usually upon the site of the freckles. These later develop into either ulcers or carcinomata. The cancers may be either of the basal-celled or the prickle-celled type, or a mixture of the two. In the case of the squamous-celled cancers the spread is usually rather rapid, and local removal nearly always followed by recurrence, and at times by metastases. Even the basal-celled carcinomata usually grow fairly fast.
Pathologically it is conceded that the first changes manifest themselves in the corium and not in the epithelium. The sweat and sebaceous glands become atrophied, the blood vessels are dilated, and there are signs of an inflammatory process, with round-celled infiltration.
*Hyde: Amer. Jour. Med. Sc., 1906, cxxxi, 1.
*Lawrence: Trans. 7th Internat. Congress Dermat. and Syphil., Rome, 1912, 1219.
*Porter and White: Ann. of Surg., 1907, xlvi, 649.
In dealing with this very serious malady an ounce of prevention is worth many pounds of cure, and fortunately this fact is now recognized by every x-ray worker. The hands of the physician should never be exposed to the emanations of the tube. Prevention is now thoroughly dealt with in all of the excellent works now existing on the subject of the practical use of this therapeutic remedy. The callosities should be removed either by the use of the knife or by the cautery and curette. To the author it seems illogical to use either the Roentgen tube or radium, for he cannot help feeling that there is grave danger of thereby aggravating the condition, recalling that the trouble is caused by light. Whenever an ulcer appears, it should be excised and skin-grafted, and cancers should be excised with an ample margin. If they are of the spino-cell type, amputation and removal of the neighborly glands should be seriously considered.