KERATOSIS BLENORRHAGICA²

Synonyms.—Keratosis blenorrhoica; Keratodermia blenorrhagica; Fr., Kérato-
dermie blenorrhagique.

This rare condition associated with gonorrheal arthritis was first
described (1893) by Vidal; and later by Jeanselme and Ghika, Chauf-
fard, Robert, and others in France, Buschke, Stanislawsky, Baermann,
Roth, and Sabotka in Germany and Austria, Sequeira, Williams, Graham
Little and Douglas in England, Swift in Australia, and Simpson in our
own country. Several eruptive conditions, such as erythema, urticaria,
erythema nodosum, hemorrhagic and bullous lesions have been, from
time to time, observed associated with gonorrhea and systemic gonor-
rheal infection; these have been variously attributed to coincidence, to
the gonorrheal poison, to the occasionally associated septicemia, and
to the drugs used or administered. There is nothing special or char­
acteristic, moreover, in these cases. The rare, more or less symmetric,

¹ Klotz, Jour. Cutan. Dis., 1899, p. 373 (society discussion).

² Literature: Vidal Annales, 1893, p. 3; Jeanselme, ibid, 1895, p. 525; Jacquet and
Ghika, Soc. med. hôp. de Paris, Jan. 22, 1897; Chauffard, ibid., April 23, 1897; Robert,
Thèse de Paris, April 28, 1897; Lannois, Soc. méd. de hôp. de Paris, July 21, 1899;
Buschke, Archiv, 1899, xlviii, pp. 181 and 385; Stanislawsky, Monatsbericht f. Urol.,
1900, v, p. 643; Malherbe, Gaz. méd. de Nantes, 1901, No. 6; Baermann, Archiv, 1904,
1xix, p. 363; Roth, München. med. Woehenschr., May 30,1905, p. 104; Chauffard and
Froin, Arch, de méd. exper., Sept., 1906, p. 609; Chauffard and Fiessinger, Bull, de l.
soc. Fr., de Derm, et Syph., May 1909, p. 162, also Ikonographia Dermatologica, 1910,
H. 5, p. 193; Rivet and Bricout, Bull, méd., 1909, p. 851; Sequeira, Brit. Jour. Derm.,

1910,  p. 139; Williams, ibid., 1910, pp. 361-369; Waelsch (Arthropathia psoriatia),
Archiv, 1910, civ, pp. 195 and 453; Graham Little and Douglas, Brit. Jour. Derm.,

1911,  p. 360; Arning and Meyer-Delius, Archiv, 1911, cviii, p. 3; Rost, Dermatolog.
Zeitschr., 1911, xviii, H. 3; Simpson, (case report, review, and bibliography; apparently
first American case), Jour. Amer. Med. Assoc, Aug. 24,1912, p. 607; Swift, Australasian
Med. Gaz., Nov. 30, 1912 (first case recorded in Australasia); Arning, Archiv, 1912,
cxiii, p. 50; Buschke, ibid., 1912, cxiii, p. 223; Gennerich, München. med. Wochenschr.,

1912,  p. 811; Zieler, Med. Klinik. 1912, No. 6; Sabotka, Dermatolog., Wochenschr.,
Feb. 15,1913, p. 181, and Feb. 22, p. 218 (with review and bibliography). I am especially
indebted to Simpson‘s and Sabotka‘s papers.

KERATOSIS BLENORRHAGICA                           533

keratodermic conditions, however, to be described are apparently
peculiar and distinctive. Two varieties are usually observed: (1) a
localized form involving the hands and feet, more especially the palms
and soles; and (2) a more or less generalized form, in which, however,
the brunt of the malady is usually upon the extremities, with the legs
and forearms involved, frequently the thighs and arms also, and some­
times the trunk—rarely the face and scalp. The former is the common
one; and in this there is noted thickening, often quite marked, of the
palmar and plantar epidermis with irregular and uneven horny-looking,
sometimes waxy or translucent-looking, or brownish crusts or projec­
tions giving the appearance of a relief map; the eruptive condition may
extend to the dorsum of the hands and feet, with somewhat horny crusts,
or scab-like crusts resembling rupial crusts; and there may be here and
there some pea- to larger-sized waxy nodules, and horny-capped pustules,
with but relatively insignificant inflammatory base or areola. In fact,
the hyperemic element is generally insignificant. When the waxy
nodules are scraped off or rubbed off, a rather succulent-looking
slightly reddish surface is disclosed; the waxy formation is, as a rule,
soon reproduced. The under part of the nails is usually packed with
horny, waxy crust accumulation, sometimes slightly purulent, and fre­
quently the nails are cast off. The eruption may involve hands only,
or both hands and feet. The lesions when fully developed are apt to
remain stationary for a long time. Recovery gradually, after several
weeks or more, ensues. There are no positive subjective symptoms,
beyond a feeling of stiffness, moderate soreness, and discomfort.

In the generalized form the hands are usually involved as described,
with eruptive elements on other parts partaking of the nature of small to
moderate-sized horny papulopustules, and waxy, horny, irregular crust
accumulation, with usually a hyperemic border. When the crust falls
off a reddish or pigmented surface is left, which in time disappears.
Scarring does not seem to result. The subjective symptoms in the gen­
eral cases are practically the same as in the local variety, with the dis­
comfort naturally much greater. The associated systemic gonorrheal
infection and gonorrheal arthritis give rise to the most discomfort; the
latter has been present in all except 2 cases.

The belief seems fairly general that the malady is dependent upon
the gonorrheal systemic infection and that possibly the gonococcus
invades the skin and is directly responsible for the eruption of keratotic
crusts—but positive proof is wanting. The histologic conditions have
been studied by Chauffard, Baermann, Sequeira, Simpson, and others,
but have disclosed nothing characteristic; the distinguishing features
seem to be “deep, and epidermic leukocytic infiltration, composed of
polynuclear leukocytes and mast cells, together with parakeratosis.”
Arning and Meyer, Delius and Sabotka concluded that the first stage
was vesicle formation, the hyperkeratotic ‘ condition being secondary
to this. The horny formations characteristic of the disease are ap­
parently, however, not true keratosis but the result of parakeratosis.
The striking features, the waxy, horny-looking nodules and crusts, and
the epidermic thickening of the eruption, together with the associated

534

HYPERTROPHIES

general gonorrheal infection doubtless permit of a diagnosis without
much difficulty. There is slight suggestiveness of the hard crustaceous
syphiloderm, and in the instances (in several of the reported cases) in
which an iritis developed, such suspicion might be strengthened, but
this possibility seems to have been ruled out by the observers of the cases
—all trained men. There is also some suggestive resemblance in places
to dermatitis seborrhoica, and also to the cases usually described as
“psoriasis ostreacea,” which is also usually associated with arthritic
symptoms.

Prognosis and Treatment.—Spontaneous involution of the
eruption takes place with the subsidence of the arthritic symptoms.
Soap and hot water washings, and hot water embrocations are said to
have a macerating effect upon the lesions. Simpson found a “resorcin
and sulphur’' ointment of benefit. Sequeira used gonococcal vaccine
with favorable influence.

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