_Punctate Scarification._--By means of a simple or multiple-pointed
instrument numerous closely-set punctures are made, and repeated from
time to time, usually with the same action and result as from linear
scarification.

_Erasion._--The parts are thoroughly scraped with a curette, and a
supplementary caustic application made, either with caustic potash or
several days' use of the pyrogallic-acid ointment. The result is usually
satisfactory.

The dental-burr is also useful in breaking up discrete tubercles.

_Excision._--This is an effective method if the disease consists of a
small pea- or bean-sized circumscribed patch.

Of these various operative methods those now most favored are erasion
and excision, punctate and linear scarification methods are now rarely
employed.

#Tuberculosis Cutis.#[D]
(_Synonym:_ Scrofuloderma.)

[Footnote D: The most important clinical variety of this class is lupus
vulgaris, which is considered above, separately, at some length.]

#What do you understand by tuberculosis cutis?#

The term is applied to those peculiar suppurative and ulcerative
conditions of the skin due to the tubercle bacilli.

#How does the common type of tuberculosis cutis begin?#

The most common type of tuberculous ulceration or involvement of the
skin usually results by extension from an underlying caseating and
suppurating lymphatic gland; or it may have its origin as subcutaneous
tubercles independently of these structures. It tends to spread, and may
involve an area of one or several inches.

[Illustration: Fig. 48. Tuberculosis Verrucosa Cutis (Negro).]

#What are the clinical appearances and behavior of this type of
tuberculous ulceration?#

It is usually superficial, has thin, red, undermined edges of a
violaceous color, and an irregular base with granulations covered
scantily with pus. As a rule, it spreads gradually as a simple
ulceration, with but slight, if any, outlying infiltration. Subjective
symptoms of a painful or troublesome character are rarely present. Its
course is usually progressive but slow and chronic.

Other symptoms of tuberculosis are commonly to be found.

#Are other forms of tuberculosis cutis met with?#

A papulo-pustular eruption is sometimes observed, especially on the
upper extremities and face; sluggish and chronic in character and
leaving small pit-like scars; has been known as the _small pustular
scroful