Description

The typical lesion of Lupus vulgaris in its early stage is a soft, indolent, elastic tubercle of a yellowish or brownish violet color, and with a somewhat translucent aspect. This tubercle may exist alone, or may form one of a group of eight or ten. A single group may be present, or several others may be present on different parts. The lesion is exceedingly chronic, but gradually enlarges, and after attaining a certain size may persist indefinitely in that condition, and finally undergo resolution and disappear, leaving after it a depressed cicatrix. More commonly, however, superficial ulceration "occurs, and the lesion becomes covered with a darkish adherent crust or scab. When this is removed the ulceration is revealed. In a short time it is covered with a fresh crust, and each time that this is removed - and some patients have a habit of frequently picking them off - the ulceration is found to be more extensive than before. The ulceration extends superficially, involving, perhaps, the entire thickness of the skin, but, in this form of Lupus, not going beneath it.

Occasionally a good deal of infiltration occurs beneath the group of tubercles, and newly formed connective tissue makes its appearance, the whole giving rise to an elevated or protuberant mass, to which the name of hypertrophic lupus has been applied.

Sometimes, on the other hand, well-defined tubercles do not appear to have time to form, but degenerative action commences early, and we have a group of pustules soon crusting over and covering an ulceration of considerable extent. This process goes on more rapidly in this than in the other form, and the floor of the ulcers are sometimes covered with irregular granulations simulating a warty or papillomatous growth. To this condition the name verrucous Lupus is sometimes given.

Diagnosis

The only disease with which Lupus vulgaris is liable to be confounded is Syphilis. In the latter disease the lesions are more apt to be generalized, and their progress is much more rapid. In a few weeks Syphilis might entail a loss of tissue that would require months or years of lupous ulceration to effect. The ulcers of Syphilis have much more sharply cut margins than those of Lupus, and the amount of discharge is usually greater, and it possesses a peculiar diagreeable odor not met with in the latter disease.

Prognosis

The prognosis is much the same as that of the erythema-tous. If taken in hand early, it may be eradicated without very much difficulty. The tendency to relapse, either at the site of the original lesion, or at other points, is not so great, I think, as in the other form. On the other hand epithelioma sometimes develops on the site of a longstanding lupous ulceration. In the transition period it is not always easy to determine * the actual presence of epithelioma. When, however, this disease is frankly developed, its characters are too distinct to be mistaken.

Histology

The lupus tubercle consists in an aggregation of small cells among which larger poly-nucleated ones, known as "giant-cells," are sometimes found. The treatment of Lupus vulgaris will be considered later.