2. TUBERCULOSIS DISSEMINATA

Under this head (tuberculosis disseminata) it is convenient to class
those rare cases in which the eruption consists of small, scattered discrete
lesions, regional or more or less generalized, and of an acute or subacute
character. Several variations are encountered, and almost always in chil­
dren. Heller and Gaudier² have described an acute tuberculosis of the
skin in which the lesions were of multiform character, consisting of mac-
ules, papules, vesicles, blebs, and pustules, undergoing ulcerative changes,
forming ulcers of a deep, irregular, circinate type, usually crusted, and
associated with caseation and suppuration of the neighboring lymphatic
glands; the tuberculous character of the eruption was demonstrated by
the presence of the bacilli and by inoculation experiments. Another
type is that of which an example was recently recorded by Pelagatti³
in a child two years old, in which the eruption, seated on the regions of
the loins, buttocks, thighs, and legs, consisted of recent pin-head-sized
papules, hemp-seed-sized papules of longer duration, both with slight
central crusting, and larger papular lesions undergoing ulceration.
They were pale yellow in color, somewhat elevated, and without areola.
The characteristic bacilli were found in abundance. Death ensued from
pulmonary and intestinal tuberculosis.

¹ Ehrmann, “Zur Casuistik der tuberculösen Geschwüre des äussern Genitales,^,,
Wien. med. Presse, 1901, p. 202.

² Quoted from Hyde and Montgomery, Diseases of the Skin.

³ Pelagatti, Giorn. ital., 1898, No. 6; abs. in my review of dermatology in Hare’s
Progressive Medicine, Sept., 1899, p. 225.

TUBERCULOSIS CUTIS

711

Another phase is presented by the small to large pea-sized papulo-
squamous, papulopustular or papulonecrotic lesions, representing Duhr-
ing’s small pustular scrofuloderm¹ and several of the types described under
Acne varioliformis. “The face and extremities, especially the face and
the upper extremities, are its usual sites. The lesions are disseminated,
and, as a rule, not abundant. They begin as pin-head to small pea-
sized papulopustules, resembling somewhat closely the small papulo-
pustular syphiloderm. The pustular character is often slight and oc­
cupies the central part of the summit, the outer portion of the lesion
being slightly hard, and in the beginning with an insignificant areola.
The formation is superficial, not extending deeply into the derma.
“They crust over gradually in the course of from one to several weeks,
with depressed, shrunken, hard or horny, yellowish or grayish, adherent
crusts, which in time drop off, leaving marked, punched-out-looking,

Fig. 157.—Represents Prof. Duhring’s small pustular scrofuloderm, and can be
also viewed, clinically at least, as an unusual acne varioliformis of peculiar distribution;
as folliclis; as necrotic granuloma, tuberculide, and other variously named like or allied
affections; the lesions are of a papulopustular necrotic type.

indelible scars, resembling those of variola. The lesions are further
characterized by a sluggish, chronic course, and may last weeks or months.
They appear at irregular periods, new ones coming out as the older ones
disappear, so that the patient is rarely free from them. The disease
may continue for years” (Duhring).

Another variety—exanthematic tuberculosis—presents, in its clinical
features, a rough resemblance to flat lupus tubercles, to sluggish acne
papules, to lichen scrofulosorum, and to the form just described. It
usually follows the exanthematous fevers, especially measles. The
lesions are indolent and of a dull, brownish-red hue; not infrequently
they are noted to be connected with the follicles. The eruption is more or

¹ Duhring, Amer. Jour. Med. Sci., 1882, vol. lxxxiii, p. 70; Wallis, “Cutaneous
Tuberculosis: A Report of a Series of Cases of Small Pustular Scrofulide” (Duhring),
Jour. Amer. Med. Assoc., 1907, vol. xlix, p. 134, reports a series of 9 cases—2 in one
family and 4 in another family. Cases all, with one exception, Hebrews, foreign born.
Lesions also appeared readily on the sites of trivial injuries, such as a scratch.

712

NEW GROWTHS

less disseminated, but is commonly seen on the face, arms, and legs;
when the trunk is invaded it is only to a slight degree. It consists of
variously sized lesions from a small papule to small patches of a frac­
tional part of an inch in diameter; the latter usually resulting from an
aggregation or confluence of several of the smaller ones. They are more
or less persistent, but may undergo involution, and may or may not
leave scars. Other symptoms of tuberculosis are commonly present,
such as glandular enlargements, suppurating glands, chronic otitis, hip-
joint disease, or scrofulous gummata, etc. Subjective symptoms are
generally wanting. The tuberculous nature of the disease is usually
demonstrable by inoculation experiments, and the lesions have also been
noted in some instances to contain bacilli. The manifestation is rare,
although several cases of allied but varying character have been recently
reported, following measles, by Colcott Fox,¹ Haushalter,² DuCastel,³
and Adamson.⁴

Treatment.—There is nothing special to be said on this point
other than that the manifestations are to be treated as outlined later,
basing constitutional measures upon general principles, and the selec­
tion of the local treatment according to the character, extent, and type
of the lesions; salicylic acid, mercurial and pyrogallol applications
usually being the best, as well as least painful, the curet and galvano-
cautery playing, in certain lesions, a possible secondary role.

But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy!

Also, please consider sharing our helpful website with your online friends.