LICHEN SCROFULOSORUM I now desire to mention some forms of tuberculosis of the skin which frequently occur in childhood and which formerly were separated from the original forms of tuberculosis on account of the negative findings of bacilli and which were counted as belonging to the closer group of the tubcreulides.
Lichen. scrofNlos.nruni is characterized by groups of follicles, appear ing as noclur,s of a pale yellow or yellowish brown color; which project only a little above the surface of the skin; and which are often covered with fine scabs. These are found particularly upon the trunk, sometimes upon the extremities and in one of my CaSeS, upon the scalp.
This disease is found in young individuals in about ninety per rent. of all eases suffering with scrofillosis, tumors of the glands or other forms of scrofulous tuberculosis, according to Hebra.
Histological examinations, and also positive animal inoculations, have proved the tuberculous nature of the disease (Jacobi, Wolf, Pellizari, Bettroarm).
The view originally held, was that this exanthem represented nothing more than the expression of a general cachexia.
Lichen serofulosorum, like the rest of the tubereulicles, appears after the acute exanthema or in conjunction with exacerbated tubercu losis. In this connection, we saw a boy who developed a lichen scrof ulosorum, which spread over the whole body, even over the scalp; and at the same time showed an exacerbation of a spondylitis. The tuber culin injection (0.0001 old tuberculin) resulted in a slight rise in tem perature, and also in a local reaction of the lichen arca which appeared larger and more vividly red.
Further, we observed a case in conjunction with measles, in a child two and a half years of age. There appeared large grouped areas of lichen scrofulosorum on the trunk and extremities, three weeks after measles, for which the child had been treated in our hospital. Besides this, the child showed numerous papillary necrotic nodules on the extremities, follicles, swelling of the glands of the neck, conjunctivitis, eczema and rhinitis. The general health was very bad for weeks, the
more so as there was besides a Memorrhagic diathesis forming dot and splash-like skin hcemorrhages. The evening temperature ranged about 39° C. (103° F.) It was interesting to observe that in the follicular nodules in whit+ the bleeding occurred, the necrosis made deeper prog ress and ulceration developed. (Hee Plate 99. Lichen serofulosortun folliculitis with ulceration and purpura).
After lasting for months the process slowly healed; the folliculitis leaving shallow scars. The tuberculin injection (0.0001 old tuberculin) which was given before the child left the hospital, resulted in a rise of temperature and a slight deterioration of the general health.
The combination of lichen scrofulosorum on the trunk with papillary necrotic tuberculide on the extremities which was well demonstrated in the foregoing case occurs quite often.
Where the nodule is found in a subcutaneous or intercutaneous position the extremities are found to be covered to a more or less degree, with an exanthem, whose primary effloresence represents inflammation of the nodule. Gradually these nodules, which are of a bluish red or yellowish red color, rise from the deeper layers of the skin ancl show small indentations on their surface, which are covered either with white scabs or small crusts. The nodules remain for months, slowly flattening, then gradually become paler in color and at last disappear, leaving behind a somewhat depressed, flat scar; which seems to be surrounded by a slightly raised peripheral wall. Folliculitis, therefore, may be said to consist of an inflammation resulting in necrosis, scars and some atrophy. This condition is generally localized; mostly on the extrem ities, over muscles of extension, on the outer surfaces of the arms, on the backs of the hands and fingers, on the upper surfaces of the feet, on the backs of the ankles and legs and on the ears.