Part 73

#Is the bone tissue ever involved in lupus vulgaris?#

No.

#What course does lupus vulgaris pursue?#

It is slowly but, as a rule, steadily progressive. Several years or more may elapse before the area of disease is conspicuous.

#What is the cause of lupus vulgaris?#

It is now known to be due to the invasion of the cutaneous structures by the tubercle bacillus; in short, a tuberculosis of the skin. It is not infrequently observed in the strumous and debilitated. It is entirely independent of syphilis.

#What is the pathology of lupus vulgaris?#

According to recent investigations, the infiltrations of lupus are due chiefly to cell-proliferation and outgrowth from the protoplasmic walls and adventitia of the bloodvessels and lymphatics. The fibrous-tissue network, vessels and a portion of the cell infiltration are thus produced, the fixed and wandering connective-tissue cells of the inflamed stroma of the cutis being responsible for the other portion of the new growth (Robinson).

#State the diagnostic features of lupus vulgaris.#

In a typical, developed patch of lupus are to be seen:--cicatricial formation, usually of a fibrous and tough character; ulcerations; the yellowish-brown tubercles and infiltration; and the characteristic soft, small, yellowish or reddish-brown, cutaneous and subcutaneous points and tubercles.

#How does the tubercular syphiloderm differ from lupus vulgaris?#

The tubercular syphiloderm is much more rapid in its course, the ulceration is deeper and the discharge copious and often offensive; the scarring is soft, and, compared to the amount of ulceration, but slightly disfiguring; and it is, for obvious reasons, a disease of adult or late life. The history, together with other evidences of previous or concomitant symptoms of syphilis, will often aid in the differentiation.

#How does epithelioma differ from lupus vulgaris?#

The edges of the epitheliomatous ulcer are hard, elevated and waxy; the base is uneven, the secretion thin, scanty and apt to be streaked with blood; the ulceration usually starts from one point, and is often painful; the tissue destruction may be considerable; there is little, if any, tendency to the formation of cicatricial tissue; and, finally, it is usually a disease of advanced age.

#In what respects does lupus erythematosus differ from lupus vulgaris?#

Lupus erythematosus has no papules, tubercles or ulceration.

#How does acne rosacea differ from lupus vulgaris?#

Acne rosacea is characterized by hyperæmia, 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.

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 constitutional also.

#What is the constitutional 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, potassium 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?#