Essentials of Diseases of the Skin Part 50

Rhinoscleroma.

Describe rhinoscleroma.

Rhinoscleroma is a rare and obscure disease, slow but progressive in its course, characterized by the development of an irregular, dense and hard, flattened, tubercular, non-ulcerating, cellular new growth, having its seat about the nose and contiguous parts. The overlying skin is normal in color, or it may be light- or dark-brown or reddish. Marked disfigurement and closure, partial or complete, of the nasal orifices gradually results. It is met with chiefly in Austria and Germany.

Treatment, consisting of partial or complete extirpation, is rarely permanent in its results, the disease tending to recur.

Lupus Erythematosus.

(_Synonyms:_ Lupus Erythematodes; Lupus Sebaceus; Seborrh[oe]a Congestiva.)

What is lupus erythematosus?

Lupus erythematosus may be roughly defined as a mildly to moderately inflammatory superficial new-growth formation, characterized by one, several, or more circ.u.mscribed, variously sized and shaped, pinkish or dark red patches, covered slightly, and more or less irregularly, with adherent grayish or yellowish scales.

Upon what parts is lupus erythematosus observed?

Its common site is the face, usually the nose and cheeks, with a tendency toward symmetry; it is often limited to these parts, but may occasionally be seen upon other regions, more especially the lips, ears, and scalp. In rare instances a great part of the general surface may become involved.

Describe the symptoms of lupus erythematosus.

Usually the disease begins as one or several rounded, circ.u.mscribed, pin-head- to pea-sized lesions; slightly scaly, somewhat elevated, and of a pinkish, reddish or violaceous color. They slowly, or somewhat rapidly, increase in area, and after attaining variable size remain stationary; or they may progress and coalesce, and in this manner sooner or later involve considerable surface. The patches are sharply defined against the sound skin by an elevated border, while the central portion is somewhat depressed and usually atrophic. More or less thickening and infiltration are observed. _There is no tendency to ulceration_. The scaliness is, as a rule, scanty. The gland-ducts are enlarged, patulous or plugged with sebaceous and epithelial matter.

The subjective symptoms of burning and itching are usually slight and often wanting.

What course does lupus erythematosus pursue?

As a rule, the disease is persistent, although somewhat variable. At times the patches retrogress, involution taking place with or without slight sieve-like atrophy or scarring.

State the causes of lupus erythematosus.

The etiology is obscure. Some observers believe it to be a variety of cutaneous tuberculosis. It is essentially a disease of adult and middle age; is more common in women, and more frequent in those having a tendency to disorders of the sebaceous glands. It may, in fact, begin as a seborrh[oe]a.

What is the pathology?

It was formerly considered a new growth, but recent opinion tends toward regarding it as a chronic inflammation of the cutis, superinducing degenerative and atrophic changes. Variable [oe]dema of the p.r.i.c.kle layer and of the cutis is found. There is no tendency to pus formation.

[Ill.u.s.tration: Fig. 42. Lupus Erythematosus.]

Is there any difficulty in the diagnosis of lupus erythematosus?

As a rule, not, as the features of the disease--the sharply circ.u.mscribed outline, the reddish or violaceous color, the elevated border, the tendency to central depression and atrophy, the plugged up or patulous sebaceous ducts, the adherent grayish or yellowish scales, together with the region attacked (usually the nose and cheeks)--are characteristic.

State the prognosis of lupus erythematosus.

The disease is often capricious and extremely rebellious to treatment; some cases, up to a certain point at least, yield readily, and occasionally a tendency to spontaneous disappearance is observed; a complete cure is, however, it must be confessed, rather rare. The disease in nowise compromises the general health. In those rare instances of generalized disease the patient has usually died from an intercurrent tuberculosis.

How is lupus erythematosus to be treated?

The general health is to be looked after and systemic treatment prescribed, if indicated. As a rule, const.i.tutional remedies exert little, if any, influence, but exceptionally, cod-liver oil, a.r.s.enic, phosphorus, salicin, quinine, or pota.s.sium iodide proves of service.

Locally, according to the case, soothing remedies, stimulating applications and destruction of the growth by caustics or operative measures are to be employed. (_Try the milder applications first._)

Mention the stimulating applications commonly employed.

Washing the parts energetically with tincture of sapo viridis, rinsing and applying a soothing ointment, such as cold cream or vaseline.

A lotion containing zinc sulphate and pota.s.sium sulphuret thoroughly dabbed on the parts morning and evening:--

[Rx] Zinci sulphatis, Pota.s.sii sulphurati, .... [=a][=a] ... [dram]i-[dram]iv Glycerinae, ........................... [minim]iv Aquae, ................................ f[Oz]iv. M.

The calamine-and-zinc oxide lotion used in acute eczema is also often extremely valuable.

Lotions of ichthyol and of resorcin, five to sixty grains to the ounce; ichthyol in ointment, five- to twenty-per-cent. strength, is also useful.

Painting the patches with pure carbolic acid; repeating a day or two after the crusts have fallen off.

The continuous application of mercurial plaster.

Sulphur and tar ointments, officinal strength or weakened with lard, and also the following:--

[Rx] Ol. cadini, Alcoholis, Saponis viridis, ..... [=a][=a] ...... [dram]iiss. M.

(This is to be rubbed in, in small quant.i.ty, once or twice daily, and later a soothing remedy applied.)

In recent years both the _x_-ray and Finsen light have been used with variable success. Repeated applications of the high-frequency current, with the vacuum electrode, have also proved serviceable. Cautious applications of liquid air or carbon dioxide have also been used with some success in the past few years.

When are destructive and operative measures justifiable?

In obstinate, sluggish, and long-persistent patches, and then only after other methods of treatment have failed. (Remember that a patch or patches of the disease _may_ disappear in course of time spontaneously, and occasionally _without leaving a scar_.)

State the methods of treatment commonly used in obstinate, sluggish and persistent patches of lupus erythematosus.