persistent patches of lupus erythematosus.#

Cauterization--with nitrate of silver, with applications of pyrogallic
acid in ointment or in liquor gutta-perchae, fifteen to thirty per cent.
strength, and with solutions (cautiously employed) of caustic potash,
and exceptionally with the galvano-cautery.

[Illustration: Fig. 43. Single Scarifier.]

[Illustration: Fig. 44. Multiple Scarifier.
(_As modified by Van Harlingen._)]

Operative--scarification, either punctate or linear, and erosion with the
curette. (See treatment of lupus vulgaris.)

#Lupus Vulgaris.#
(_Synonyms:_ Lupus; Lupus Exedens; Lupus Vorax; Tuberculosis of the
Skin.)

#What do you understand by lupus vulgaris?#

Lupus vulgaris is a cellular new growth, characterized by
variously-sized, soft, reddish-brown, papular, tubercular and
infiltrated patches, usually terminating in ulceration and scarring.

#Upon what region is lupus vulgaris usually observed?#

The face, especially the nose, but any part may be invaded. The area
involved may be small or quite extensive, usually the former.

#At what age is the disease noted?#

In many cases it begins in childhood or early adult life, but as it is
persistent and tends to relapse, it may be met with at any age.

#Describe the earlier symptoms of lupus vulgaris.#

The disease begins by the development of several or more pin-head to
small pea-sized, deep-seated, brownish-red or yellowish tubercles,
having their seat in the deeper part of the corium, and which are
somewhat softer and looser in texture than normal tissue. As the disease
progresses, variously-sized and shaped aggregations or patches result,
covered with thin and imperfectly-formed epidermis.

#What changes do the lupus tubercles or infiltrations undergo?#

The lesions, having attained a certain size or development, may remain
so for a time, but sooner or later retrogressive changes occur: the
matured papules or tubercles, or infiltrated patches, slowly disappear
by absorption, fatty degeneration, and exfoliation, leaving a yellowish
or brownish pigmentation, usually with more or less atrophy or
cicatricial-tissue formation--_lupus exfoliativus_; or disintegration
and destruction result, terminating in ulceration--_lupus exedens, lupus
exulcerans_. This latter is the more usual course.

#Describe the clinical appearances and behavior of the lupus ulcer