s deeper and the discharge copious and often offensive; the
scarring is soft, and, compared to the amount of ulceration, but
slightly disfiguring; and it is, for obvious reasons, a disease of adult
or late life. The history, together with other evidences of previous or
concomitant symptoms of syphilis, will often aid in the differentiation.

#How does epithelioma differ from lupus vulgaris?#

The edges of the epitheliomatous ulcer are hard, elevated and waxy; the
base is uneven, the secretion thin, scanty and apt to be streaked with
blood; the ulceration usually starts from one point, and is often
painful; the tissue destruction may be considerable; there is little, if
any, tendency to the formation of cicatricial tissue; and, finally, it
is usually a disease of advanced age.

#In what respects does lupus erythematosus differ from lupus vulgaris?#

Lupus erythematosus has no papules, tubercles or ulceration.

#How does acne rosacea differ from lupus vulgaris?#

Acne rosacea is characterized by hyperaemia, dilated vessels, papules,
pustules, the absence of ulceration, and a different history.

#State the prognosis of lupus vulgaris.#

Lupus vulgaris is always a chronic disease, often exceedingly rebellious
to treatment, and one that calls for a guarded opinion. Relapses are not
uncommon.

[Illustration: Fig. 46.
Galvano-cautery Needle, Knife and Spiral Points. (_As devised by
Besnier._)]

The general health usually remains good, but in some instances death by
tuberculosis of the lungs has been noted.

#Is external or internal treatment called for in lupus vulgaris?#

Always external, and not infrequently constitutional also.

#What is the constitutional treatment?#

The general health must be cared for; good, nutritious food, fresh air
and out-door exercise, together with, in many cases, the administration
of such remedies as cod-liver oil, potassium iodide, iron and quinine,
are of therapeutic importance. Tuberculin may be tried in severe and
obstinate cases, but its use is not without danger.

#State the object of local treatment.#

The destruction or removal of the diseased tissue.

#May milder methods of treatment sometimes prove beneficial and even
curative?#

Exceptionally, mercurial plaster, corrosive-sublimate lotion and
ointment (gr. j to [Oz]j), a plaster containing five to fifteen per
cent. of salicylic acid and creasote, repeated paintings with carbolic
acid, and the