Rhagades

RHAGADES, rhagades (from Greek rhagas—crack, tear), linear, bleeding, and often quite painful tears that have formed due to a breach in the integrity of the epidermal, and sometimes the connective tissue layer of the skin, or more rarely, the mucous membranes, under the influence of certain pathological changes in the skin. Depending on the nature of the process causing them and the force of the traumatic impact, rhagades take on various forms, sizes, and depths. Apart from accidental trauma from excessive stretching, the main cause is infiltration of the skin with a loss of its normal elasticity and flexibility in areas of extensive movement or stretching. Additional causes include: thickening and dryness of the horny layer (e.g., keratomas or hyperkeratotic eczema of the palms and soles; old psoriatic disks on the extensor side of the elbows and knees, etc.) or, conversely, its extreme thinning and incomplete keratinization (e.g., intertriginous or eczematous dermatitis in skin folds, corners of the mouth, eyelids, at the edge of the nostrils, etc.). They often give rise to the development of 'paratraumatic' eczema (Darier), for example, in the vicinity of an erysipelatous process or deep purulent-inflammatory diseases of the skin due to the introduction of pyogenic microorganisms, for example, mastitis in the case of fissures at the base of the nipple. Deeply penetrating rhagades heal with linear scars. Therapy consists of eliminating the underlying skin affliction (avoiding strongly drying agents); deep rhagades can be cauterized with a 2–5% silver nitrate solution, and a dressing with 5–10% xeroform or boric ointment applied on top, or the skin can be fixed with adhesive plaster. Syphilitic rhagades (rhagades, s. fissurae syphiliticae) form in congenitally syphilitic children, especially in the first months of life, under the influence of a specific infiltrative process both on the red border of the lips or around the mouth, and on the adjacent skin of the cheeks and chin, which is facilitated by constant traumatization during the act of sucking, during crying, frequent regurgitation, constant salivation, and discharge from the nose during syphilitic rhinitis. The infiltrated skin is easily subjected to tears running perpendicular to the direction of stretching. Upon healing, the rhagades, which are arranged radially in relation to the corners of the mouth, form fan-shaped shiny Parrot's lines or Robinson-Fournier 'purse-string' scars, which serve as a reliable diagnostic sign of congenital syphilis. Similar phenomena are observed on the buttocks, genitals, flexor surfaces of the thighs, in the anal region, and in other parts of the body. Milian's chronic lip rhagade is a crack located most often on the lower lip, usually transverse to the long axis, and often quite deep, especially in the winter season. It can arise against a background of an unchanged or elephantiasically thickened lip. It was first described by Milian in 1925 as an almost pathognomonic sign of late congenital syphilis. It responds well to antisyphilitic therapy.