Definition And Description

Lupus is a chronic, non-contagious, destructive disease of the skin, characterized by extreme obstinacy and liability to relapse. Of this disease there are three principal forms, differing from each other in certain particulars, but yet presenting several important features in common. These are color, configuration, location, course, absence of pain and pruritus, difficulty of cure, and termination.

The prevailing color of lupous lesions, or Scrofulides, as the French call them, is not the frank red of an acute congestion or inflammation, nor the coppery red of syphilis, but rather a violaceous red, with a shade of copper. It disappears under the finger, revealing, the instant the finger is removed, a somewhat yellowish hue, to be replaced a moment later by the color that was present before pressure was applied. The color is that which we would expect in a part containing more than the normal quan-tity of blood, but in which the circulation was sluggish, without, how-ever, absolute stasis. Sometimes the lesions present a somewhat translucent appearance, like that which characterizes gelatinous bodies.

In configuration, lupous lesions usually exhibit a circular form, extending centrifugally not with the absolute circularity of Trichophytosis, but showing a strong tendency to it whenever the anatomical form of the parts on which the lesion is located will permit. Irregularity of configuration, dependent on location, is sometimes markedly shown in connection with some forms of lupus of the nose, in which the entire lesion may as-sume the appearance of a butterfly with extended wings. On the upper eyelid the lesion takes a linear or oval form, the long diameter corresponding with furrows of the lid. On the ear the patch is very irregular in outline.

The favorite location of Lupus is the face. The nose, cheeks, neighborhood of the eyes, temples, forehead and ears, may be primarily affected or become the seats of later lesions. I have also met with it on the scalp and on the penis. It may also appear on various parts of the general surface, usually, however, in connection with, or subsequent to the develop-ment of the disease on the face.

With a rare exception, to be mentioned later, the course of the disease is essentially chronic, and cases will be met with in which it has continued for five, ten, twenty, and even a greater number of years.

As a rule, there is neither pain nor pruritics. Sometimes the patient, on being asked, will state that there is slight itching, but I have never seen scratch-marks or other evidence of severe pruritus. If the lesion be extensive, a sensation of local heat is sometimes complained of.

The difficulty of cure is proverbial, and has been recognized from the earliest times. There is no known internal remedy that can be depended on to stop the progress of the affection in its various forms. Cures by internal medication have been reported, but the failures have far outnumbered them. External treatment is more promising, and of late years has been brought to a degree of perfection that enables the surgeon to state that the great majority of cases seen within a reasonable period after their commencement are permanently curable, except those in which the underlying diathesis is so pronounced that fresh outbreaks on parts other than those first affected, continually occur, to the great annoyance of the surgeon and the discouragement of the patient.

Except when the affection terminates in death, there is always a scar * left to indicate the site of the previous lesion. This is true both of the ulcerative and non-ulcerative forms.

The three principal forms of lupus are Lupus erythematosus, L. vulgaris, and L. exedens, the first two of which present certain sub-varieties.