PROGNOSIS AND TREATMENT OF TUBERCULOUS DISEASES OF THE SKIN It is atiVisabie in discussing the prognosis of tuberculous diseases of the skin, to use the old division, separating the older known forms of skin tuberculosis from the tuberculide. While the prognosis of the former, particularly in case of lupus, is more or less unfavorable, for if left to itself, it may cause the most severe and irreparable destruction of tissue; in the latter, the tuberculide, the prognosis is much more benign. Here even the disseminated forms may eventually result in spontaneous healing. The disease, spreading in patches or in deep ulcers, has never been observed. Therefore, while these last forms are not, very dangerous to the individuals affected, they are of considerable importance in regard to prognosis, for they point to the existence of tuberculous foci and stamp the patient as tuberculous.
As regards the treatment of these tuberculides, lupus occupies an exceptional position, no matter whether only isolated nodules are present or only a few disseminated areas of the disease, we have only one proper therapeutic measure and that is the speedy removal of the lupus areas.
The best method is early excision, which may be employed with success, even when numerous areas are present. In one of my cases more than fifty were removed. If in the removal of the larger diseased areas there should occur considerable loss of tissue; skin grafting after Thiersch's method may be done. Krause uses long incisions, thus making pecluneulated flaps, easily stretched.
The Vienna school (Lang) particularly deserves great praise for the elaboration of these methods.
The other therapeutic measures, while they occupy a secondary place, nevertheless are followed by good results. They consume too
much valuable time. Among these may be mentioned the Rontgen rays and Finsen's light therapy treatments. Sometimes the tuberculin injection which Neisser has used with success gives good service in aiding us to recognize the lupus nodules.
Surgical treatment is also the best for eases of serofuloderma.
Here we get the desired results by- enucleation done with a sharp spoon, the resulting wounds being covered with salves. Boro-vaselin, dermatol or iodoform vaselin may be used.
In this connection it would be wise to mention, that in rare cases an outbreak of miliary tuberculosis is observed after operative procedure.
In the remaining forms of skin tuberculosis, general treatment holds the foremost place and must be eonstantly borne in mind.
With all these remedies at our disposal, we must strive for an im provement in nutrition. We often notice that after a short stay in the hospital, under suitable care of the skin and proper nourishment, tuber culides heal quickly and the child gains in weight. In other eases of a more torpid character, we only see good therapeutic results after a long course of treatment with salt and iodine baths, after giving creosote and codliver oil preparations and after prolonged stay in the country or at the sea-side.
As a matter of course, the healing of any particular tuberculide is not always identical with the healing of the primary tuberculous organ and after a shorter or longer interval a fresh outbreak of the skin tuber culosis may occur.