Definition And Description

This affection was first differentiated by Hebra. The following is an abridgment of his description:

The affection consists in an eruption of papules, which always remain such, never changing into vesicles or pustules, and never undergoing any modification except when the eruption of new papules changes a discrete into a confluent lesion. The papules always present an intense red color except when covered with scales. In the beginning the papules are miliary, and each covered with a fine scale. They never increase in size, but preserve their original volume throughout the whole course of the disease.

Fresh papules may arise between the original ones, or at a distance from them. hen the papules are in contact, they form continuous patches of variable size and contour, red, infiltrated and covered with scales. The entire surface may be invaded in this manner. In advanced cases the pruitus may be intense. The condition of the general health varies with the extent of the eruption. At the beginning it may not be appreciably affected, but as the disease advances the organic functions deteriorate and nutrition suffers. The appetite or sleep may not be much disturbed, but the subcutaneous fat gradually diminishes, until, finally, the patient falls into a state of marasmus and at last dies. The disease is more rarely met with in England and this country than in Germany.

Diagnosis

The diagnosis of Lichen ruber is sometimes attended with difficulty, especially to one not very familiar with cutaneous dis-eases. In the early stages there is a certain resemblance to the papular syphilide, and in the later to an ordinary diffuse psoriasis. The practised eye will detect the differences, but the less experienced must be guided by the history of the case, and the effect of treatment, which in Lichen ruber will probably be nil, while in the other affections it ought to be promptly successful.

Prognosis

The prognosis is decidedly bad, thirteen out of the first fourteen cases seen by Hebra having terminated fatally. Occasional success, however, may be expected, and consequently the patient should not be permitted to give himself up to despair.

Etiology

The causes of this disease are entirely unknown. The view, held by some, that Lichen planus and Lichen ruber are but stages of a single disease, I believe, for reasons given elsewhere (87, 333), is untenable.

Treatment

Hebra recommends large doses of Arsenic continued as long as the patient survives, or possibly gets well. Sherwell (210), however, has obtained decided benefit from the internal use of Linseed, and this latter treatment appears to be the most successful yet proposed.