In all of these lesions the tubercle bacilli can be usually demonstrated. There are other skin lesions in which no bacilli can be demonstrated, which are supposed to be due to the toxins generated in tuberculous foci elsewhere. Hallopeau suggests calling all tuberculous skin lesions tuberculides and to group them as follows: (a) Those in which bacilli are present, bacillary tuberculides, and (b) those arising from tuberculous toxins, toxic tuberculides.
Fig. 102
Lupus of skin (hypertrophicus et exulcerans). Finally healed by excision and plastic operation. (Lexer.)
Fig. 103
Lupus vulgaris. (Hardaway.)
Among the latter he describes what he calls folliculitis, i. e., small papules, firm, at first red, then elevated, becoming nodules, appearing on the extremities, and gradually producing crater-form ulcers covered with black crusts, leaving small pock-like scars. This condition is chronic, lasting years. In these patients the skin is furfurated, showing a sluggish circulation.
Treatment.
—Inasmuch as tuberculous skin lesions tend to spread and to recur, they need radical treatment—i. e. the sharp spoon, the scissors, and caustic. Ordinarily it is best to scrape the affected surface, to trim away all unhealthy edges, and then to apply a strong caustic for a brief space of time, thereby sterilizing it and searing the mouths of the absorbents which may have been opened by the scraping. Treatment for two or three days with brewers’ yeast will usually suffice to put the surface in a healthy condition, after which it may be skin-grafted or treated by any of the ordinary plastic methods.