LUPUS VULGARIS.
Constitutional treatment is indicated, as the disease in all its types is due to the presence of the tubercle bacillus in the cells of the skin. This should proceed upon the lines indicated in phthisis—as overfeeding, cod-liver oil, open-air life and improved hygiene.
Vaccine treatment is useful, though very rarely, if ever, curative when used alone. In conjunction with various plans of local treatment it is often invaluable, and in a considerable number of cases which have resisted all local methods, cure can only be achieved by the judicious employment of tuberculin in combination with these, so that, notwith standing the popularity of light treatment, vaccine therapy in lupus must always be recognised as an agent of unquestionable value.
Thyroid feeding in some cases appears to act in a similar manner, but in less satisfactory degree, and is also worthy of a trial where from any reasons tuberculin injections are inadmissible. For similar reasons the internal use of such agents as Iron, Arsenic, Phosphorus, Creosote, Iodine or Iodoform, Hetol and Cinnamylic Acid occasionally proves a useful adjunct to local treatment by strengthening the depressed vital resistance of the tissues.
has been employed with success by Dewar, who injects 15 mins. intravenously of an ethereal solution with liquid paraffin every second day, the local ulcerating lesions being simultaneously treated by fydrogen Peroxide.
The writer, before the introduction of photo-therapy, witnessed striking results in the hands of Fournier and Richet from the injection of the blood-serum of healthy dogs.
Sea-water injections have been extolled by Robert-Simon, who states that he has observed cure follow after the failure of all other constitutional and local treatments.
Local will vary with the site, type of the affection, amount of irritation or ulceration present, activity of the disease, &c. A destructive agent may be indicated at one part of the lupus patch, whilst a soothing ointment may he indicated at another part.
Light light is the most reliable routine method of treating lupus of the face, and the best results are obtainable in nodular and ulcerating lupus. The great advantage over the older surgical methods lies in the final cosmetic effects produced, as scarring is entirely prevented or reduced to a minimum. Unfortunately the method is most expensive and tedious, requiring the skilful supervision of the professional expert and a complicated apparatus, together with the services of experi enced nurses, and cannot possibly he carried out at the house of the patient. Installation places are usually provided with lamps arranged
so that several patients can be treated at the same time by the light proceeding from a single lamp.
A powerful electric arc lamp is employed and the heat rays are inter cepted by passing them through rock crystal lenses and a solution of copper sulphate, which does not stop the blue rays. The heating effects are still further minimised by causing the rays to pass through cylinders of water placed between the concentrating crystal lenses. A small area only can be submitted to the action of the concentrated light at each sitting, which should last for about one hour, and in order to permit the actinic rays to penetrate the lupoid nodules it is necessary to compress the area operated upon by a flat transparent substance in order to render the part bloodless. The best compressor for this purpose consists of two layers of quartz, with a space between filled with water, which can be kept cool by continuous circulation to still further minimise the heat effects of the red rays which have escaped through the copper solution; by the use of such a compressor the copper filter may sometimes be entirely dispensed with.
The best procedure in nodular lupus is to commence at the circum ferential part of the patch, leaving the centre to be attacked last. Upon the termination of each hourly sitting the part should be covered by lint smeared over with vaseline, and a soothing ointment or lotion may be afterwards necessary to remove the vesication or oedematous redness which usually follows some hours after the application of the concen trated light. Thus one portion of the patch will require the soothing treatment suitable for lupus erythematosus whilst recovering from the reaction caused by the lights when a new area is being submitted to exposure. From time to time the old areas are to be examined under the compressor in order to determine whether the apple-jelly nodules have all been dissipated, and re-exposure of every portion must be resorted to as long as any nodules can he discerned.