Essentials of Diseases of the Skin Part 52

Lupus erythematosus has no papules, tubercles or ulceration.

How does acne rosacea differ from lupus vulgaris?

Acne rosacea is characterized by hyperaemia, dilated vessels, papules, pustules, the absence of ulceration, and a different history.

State the prognosis of lupus vulgaris.

Lupus vulgaris is always a chronic disease, often exceedingly rebellious to treatment, and one that calls for a guarded opinion. Relapses are not uncommon.

[Ill.u.s.tration: Fig. 46.

Galvano-cautery Needle, Knife and Spiral Points. (_As devised by Besnier._)]

The general health usually remains good, but in some instances death by tuberculosis of the lungs has been noted.

Is external or internal treatment called for in lupus vulgaris?

Always external, and not infrequently const.i.tutional also.

What is the const.i.tutional treatment?

The general health must be cared for; good, nutritious food, fresh air and out-door exercise, together with, in many cases, the administration of such remedies as cod-liver oil, pota.s.sium iodide, iron and quinine, are of therapeutic importance. Tuberculin may be tried in severe and obstinate cases, but its use is not without danger.

State the object of local treatment.

The destruction or removal of the diseased tissue.

May milder methods of treatment sometimes prove beneficial and even curative?

Exceptionally, mercurial plaster, corrosive-sublimate lotion and ointment (gr. j to [Oz]j), a plaster containing five to fifteen per cent. of salicylic acid and creasote, repeated paintings with carbolic acid, and the constant application of lead plaster containing twenty per cent. of ichthyol, are valuable.

[Ill.u.s.tration: Fig. 47. Double Curette.]

Of the milder methods, those most in vogue to-day are the _Finsen light_ and _x-ray_. Either proves extremely valuable in some cases, but the Finsen method is the favorite method.

What methods are commonly employed for the rapid removal or destruction of lupus tissue?

Cauterization, scarification, erasion and excision are variously practised; the particular method depending, in great measure, upon the extent of the disease, the part involved, and other circ.u.mstances.

Name the several caustics, and state how they are employed.

_Pyrogallic acid_, used as an ointment:--

[Rx] Ac. pyrogallici, ..................... [dram]ij Emplast. plumbi, ..................... [dram]j Cerat. resinsae, ...................... [dram]v. M.

It is applied for one or two weeks. Every several days the parts are poulticed, the slough thus removed, and the ointment reapplied, and so on until the diseased tissue has been destroyed. It is useful in those cases in which a mild and comparatively painless caustic is advisable.

In most cases several repet.i.tions of this plan are necessary.

_a.r.s.enious acid_, employed as an ointment--

[Rx] Ac. a.r.s.eniosi, ...................... gr. xx Hydrarg. sulphid. rub., ............. gr. lx Ungt. aquae rosae, .................... [Oz]i.--M.

It is painful but thorough; it is spread on lint and renewed daily. The action is usually sufficient in three days, and the parts are then poulticed until the slough comes away, after which a simple dressing is employed. Its application is advisable for a small area only--not more than four square inches--as absorption is possible.

_Galvano-cautery._--The diseased tissue is destroyed by numerous punctures with a red-heated point or by linear incision with a red-heated knife. It is often a practicable and satisfactory method. The Paquelin cautery and liquid air and carbon dioxide also have their advocates.

Describe the operative measures employed in the removal of lupus tissue.

_Linear Scarification._--The parts are thoroughly cross-tracked, cutting through the diseased tissue, and subsequently a simple salicylated ointment applied. The operation is repeated from time to time, and as a result the new growth undergoes retrogressive changes, and cicatrization takes place.

_Punctate Scarification._--By means of a simple or multiple-pointed instrument numerous closely-set punctures are made, and repeated from time to time, usually with the same action and result as from linear scarification.

_Erasion._--The parts are thoroughly sc.r.a.ped with a curette, and a supplementary caustic application made, either with caustic potash or several days' use of the pyrogallic-acid ointment. The result is usually satisfactory.

The dental-burr is also useful in breaking up discrete tubercles.

_Excision._--This is an effective method if the disease consists of a small pea- or bean-sized circ.u.mscribed patch.

Of these various operative methods those now most favored are erasion and excision, punctate and linear scarification methods are now rarely employed.

Tuberculosis Cutis.[D]

(_Synonym:_ Scrofuloderma.)

[Footnote D: The most important clinical variety of this cla.s.s is lupus vulgaris, which is considered above, separately, at some length.]

What do you understand by tuberculosis cutis?

The term is applied to those peculiar suppurative and ulcerative conditions of the skin due to the tubercle bacilli.

How does the common type of tuberculosis cutis begin?

The most common type of tuberculous ulceration or involvement of the skin usually results by extension from an underlying caseating and suppurating lymphatic gland; or it may have its origin as subcutaneous tubercles independently of these structures. It tends to spread, and may involve an area of one or several inches.

[Ill.u.s.tration: Fig. 48. Tuberculosis Verrucosa Cutis (Negro).]