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skin, slowly and sometimes

SCROFULODERMA According to Lang the relative frequency of the occurrence of scrofuloderma and lupus, is in doubt. The origin of scrofuloderma is ordinarily in the superficial fascia anri its characteristic form is the scrofulous gummata or scrofulotuberculide. Even in early infancy, we find, particularly in the skin of the face, bluish red or brownish red nodules which may be seen more or less projected over the surface of the skin. These are softened in the centre and are not painful to the touch. The nodule lying subcutaneously, develops at times from a gland and raises slowly towards the surface of the skin which then becomes adherent to the subcutaneous infiltration. Sometimes after months of torpid existence, a subinvolution of the infiltration without perforation slowly develops. More frequently an eruption through the very much thinned skin takes place and au ulcer is formed. The floor of the ulcer is filled with easily bleeding, yellowish gray granulations or w-ith necrotic-like tissue. This is called .scrof uloderma lacerom Plates 60-61).

The proce.ss of healing, follow-s slowly with eicatrization. The scars are thin, delicate, and white; sometimes bluish on the edges and fre quently partially covered with a scale and healing in an irregular manner.

Besides appearing in very isolated areas, often over the seat of tuberculous glands in the neck, it may develop by spreading from a gumma or from a primary lupus arca. along the lymphatic vessels and so we have a new formation of scrofuloderma.

In a few cases we observe scrofulodermata spread over the whole body; which makes probable a harmatogenous invasion. We have observed this in a case after scarlet fever.

In its anatomical relations, scrofuloderma shows a sharply limited tuberculous infiltration, containing a great number of giant cells and generally only a few tubercle bacilli.

In making the differential diagnosis it is sometimes difficult to distinguish between this disease and erythema induratum rBazin); which also makes its appearance in subcutaneous nodules; this latter disease is localized in the lower extremities, and in contrast to scrofulodernia, it very seldom reaches the stage of perforation. Beside.s, the ervthema induraturn very rarely occurs before puberty.