Definition And Description

This affection, first clearly described by Hebra, consists in an eruption of miliary papules of a pale yellow or reddish brown color, though sometimes the normal hue is preserved. The papules are disposed in groups, sometimes forming circles or segments of circles, beyond which pigmentary macules, marking the site of earlier papules, may occasionally be seen. The little elevations are always covered with fine scales. Pruritus is insignificant. The papules promptly attain their maximum development, but then persist unaltered for a long time. At last they gradually undergo resolution after having existed for months or even years. Sometimes tubercles, resembling those of acne, and which may go on to suppuration, develop in the neighborhood of the papules. The horny layer of the epidermis between the groups of papules exfoliates in fine scales. Each papule is situated at the orifice of a hair-follicle and forms an elevation consisting of a mass of horny cells. These cells contain a larger amount of entangled fatty matters than usual. After removal of the semiglobular epidermic mass, which constitutes the papule, the open mouth of the piliferous follicle may be perceived with the naked eye. The eruption may occur upon any part of the body, and be more or less generalized. In about ninety per cent. of the cases met with by Hebra, other scrofulous lesions, as enlarged lymphatic glands, periostites, caries, etc., were encountered.

Diagnosis

This disease, I should judge, is exceedingly rare in this country, as I have met with but two well-marked cases. In these, how-ever, the affection was readily diagnosticated in consequence of the typical character of the lesions, recalling, in the most exact manner, the de-scription given above. I know of no other affections with which it might be confounded.

Prognosis

The prognosis is good. All of the cases treated by He-bra recovered, as did the two under my own observation.

Etiology

Except that the eruption appears to be developed under the influence of the scrofulous diathesis, little can be said concerning its etiology.

Treatment

Hebra recommends the use of cod-liver oil, both internally and externally. He commences with an ounce, morning and night, on an empty stomach. Locally, he applies the oil with a liberal hand, so as to keep the affected parts constantly saturated with it. At the commencement of treatment four frictions a day should be employed, and the parts covered with flannel; later, two in the twenty-four hours will be sufficient. He found warm baths and vapor baths prejudicial. The diet should be nutritious and highly nitrogenous, and proper hygienic conditions should be enforced. I have nothing to add to this except the addition of other autistrumics, as iodide of iron, etc.