The immediate effect upon the small area treated is slight, but after a few hours the part becomes erythematous, swollen, puffy, and tender; a small ves icle or bullet may appear. A small portion of the diseased surface being treated at each sitting, and the same part requiring sometimes two or three exposures, the method is somewhat slow; but it is effective, and the light having no destructive action upon the tissues themselves, the resulting cica trices are few as compared to other measures. Unfortunately lupus of the mucous membranes cannot be satis factorily reached.
Case of verrueose lupus vulgaris of the hand which had been much improved by applications of radium. The first appli cation was made during seventy-two hours, and produced a lasting discolora tion; fifteen days later ulceration fol lowed. Two months later another appli cation of radium was made, lasting one hundred and twenty hours; this pro duced a loss of substance which still per sisted. Seven other applications were made of twenty-four hours' duration; these left no trace. Compared with the condition presented during former visits to the hospital, the improvement was very considerable. The verrucous eleva tions had disappeared, leaving a smooth cicatrix of healthy aspect. Hallopeau and Gadaud (Annals de Derm. et de Syph., No. 71, 1902).
According to J. Rudis-Jicinsky (Amer. X-ray Jour., Oct., '9S), the Roentgen rays constitute the best means for producing artificial inflammation, and converting unhealthy ulcerations into open healthy granulations, followed by cure. Lupus Erythematosus.
This form of lupus is not believed to be tuberculous, as a rule, but the tuber cle bacillus has been found in some cases and the disease can therefore be consid ered in this section.
The earliest appearance of lupus ery thematosus, as described by L. A. well, is a patch of redness around the opening of a sebaceous gland. This gradually spreads in size, and the sur face becomes scaly, the margin is defined, and slightly raised; the spots coalesce, and new ones form which, in their turn, join the older ones. When of any size the patch becomes covered at its centre by thick shagreen-like scabs, which, when forcibly detached, bear on their under surface dried columns of epidermic cells which have been pulled out of the dilated openings of the sebaceous glands. The disease often becomes stationary after spreading to a considerable extent; the margins then lose their bright hue, and a depressed punctate scar remains.
When hairy parts have been affected, permanent baldness results from destruc tion of the hair-follicles. (See colored plate.) This form of lupus is seen on the face more often than elsewhere, and tends to be symmetrical. Starting on the nose or one cheek, it spreads in both directions, and in severe cases resembles a butterfly, the wings on the cheeks and the body on the nose. Other patches appear on the lobules of the ears, and occasionally on the forehead; they also are seen on the backs of the hands, but seldom on the feet.
Lupus erythematosus attacks people with feeble circulation such as are liable to chilblains, etc., and it chooses for its starting-point a part where the blood supply is poor and where there is little subcutaneous fat: e.g., the nose, or ear. The eruption can sometimes be traced to exposure, to great heat, or to cold. It is more common in females than in males.
Diagnosis. — Hallopeau (Annales de Derm. et de Syph., Nos. S and 9, '96) states that the tuberculous nature of any cutaneous affection may be affirmed from the presence of any one of the four fol lowing characteristics: (1) the possibility of transmitting tuberculosis by the serial inoculation of morbid products; (2) the presence of the characteristic bacilli in the affected tissue; (3) intra-inoculation —i.e., the production of a dermatosis by the proliferation of alterations clearly tuberculous, and, reciprocally, the pro duction of tuberculosis consecutively to the development of this dermatosis; (4) the appearance of differential eruptions, such as lichen scrofulosorum, under the influence of inoculations of tuberculin. The forms of cutaneous tuberculosis due to bacilli are the sclerotic lupus, or tuberculosis verrucosa (Riehl and Paltauf); anatomical tubercle; tubercu lous gumma; tuberculous tumor; tu berculous ulcer; suppurative tubercu loses.
Treatment.—Many cases of lupus ery thematosus can be cured, according to Unna (Jour. Cut. and Oenito-ITrin. Dis., Oct., '98) by the sole use of external ap plications. Among the external remedies which he has seen to do most good is the following prescription: 4 Zinci ox., Boli rubrte, of each, 30 grains. Boli albsc, Magn. carbon., of each, 45 grains. Amyli, 2 V, drachms.—M.