Part 72

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:--

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

(This is to be rubbed in, in small quantity, 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.#

Cauterization--with nitrate of silver, with applications of pyrogallic acid in ointment or in liquor gutta-perchæ, fifteen to thirty per cent. strength, and with solutions (cautiously employed) of caustic potash, and exceptionally with the galvano-cautery.

Operative--scarification, either punctate or linear, and erosion with the curette. (See treatment of lupus vulgaris.)

#Lupus Vulgaris.# (Synonyms: Lupus; Lupus Exedens; Lupus Vorax; Tuberculosis of the Skin.)

#What do you understand by lupus vulgaris?#

Lupus vulgaris is a cellular new growth, characterized by variously-sized, soft, reddish-brown, papular, tubercular and infiltrated patches, usually terminating in ulceration and scarring.

#Upon what region is lupus vulgaris usually observed?#

The face, especially the nose, but any part may be invaded. The area involved may be small or quite extensive, usually the former.

#At what age is the disease noted?#

In many cases it begins in childhood or early adult life, but as it is persistent and tends to relapse, it may be met with at any age.

#Describe the earlier symptoms of lupus vulgaris.#

The disease begins by the development of several or more pin-head to small pea-sized, deep-seated, brownish-red or yellowish tubercles, having their seat in the deeper part of the corium, and which are somewhat softer and looser in texture than normal tissue. As the disease progresses, variously-sized and shaped aggregations or patches result, covered with thin and imperfectly-formed epidermis.

#What changes do the lupus tubercles or infiltrations undergo?#

The lesions, having attained a certain size or development, may remain so for a time, but sooner or later retrogressive changes occur: the matured papules or tubercles, or infiltrated patches, slowly disappear by absorption, fatty degeneration, and exfoliation, leaving a yellowish or brownish pigmentation, usually with more or less atrophy or cicatricial-tissue formation--lupus exfoliativus; or disintegration and destruction result, terminating in ulceration--lupus exedens, lupus exulcerans. This latter is the more usual course.

#Describe the clinical appearances and behavior of the lupus ulcerations.#

They are rounded, shallow excavations, with soft and reddish borders. In exceptional instances exuberant granulations appear--lupus hypertrophicus; or papillary outgrowths are noted--lupus verrucosus. The ulcerations secrete a variable amount of pus, usually slight in quantity, which leads to more or less crust formation; later, however, cicatricial tissue, generally of a firm and fibrous character, results.

#In what manner does the disease spread?#

The patches spread by the appearance of new tubercles, or infiltrations at the peripheral portion. New islets and areas of disease may continue to make their appearance from time to time, usually upon contiguous parts.

#Are the mucous membranes of the mouth, throat and larynx ever involved?#

In some instances, and either primarily or secondarily.