(7) A case of Lichen pigmentosus verrucosus in a girl aged 12 years. The condition started five years ago on the forehead, and extended to the neck, trunk, groins, and the front and inner aspects of the thighs. There were innumerable slightly pigmented, warty lesions, irregular in outline, and varying in size from that of a pin’s head to that of a split pea. They were composed of a soft, friable substance that could be easily picked off with the finger-nail. He was not aware of ever having seen or heard of a similar case. A portion had been removed for histological examination, and he would endeavour to show a section before the Society on a future occasion.
This case excited considerable interest, but the majority of the members preferred to reserve their diagnosis until after the microscopic examination.
Mr. Spencer Hurlbutt showed a case for diagnosis. The patient was a delicate-looking woman, aged 22 years, with a symmetrical eruption affecting both legs. The disease first appeared three months ago as a brownish-coloured spot on the outer side of the right calf, which was followed at intervals by similar ones on each leg, and these had gradually enlarged until the present time. There were now ten to twelve patches of varying sizes up to that of a florin situated upon the back and outer surface of the legs. The lesions consisted of fairly well-defined, non-indurated, circular, dull-red patches, with thin adherent scales, their general appearance being suggestive of psoriasis which had undergone treatment. The usual situations affected by that disease were, however, free from the eruption, and severe itching, especially toward night-time, was a prominent symptom.
The general opinion was that this was a case of seborrhœic dermatitis of a psoriasiform type.
Dr. Graham Little showed (1) a case of Tinea cruris in a private patient, a Japanese gentleman, an exponent of the art of ju-jitsu. The patient had noticed the eruption for about a month and a half, but could not be certain that he had not the first trace of it before he left Japan, six months ago. He was engaged in teaching the national form of wrestling, and in his exercises had to strip almost entirely, so that he might well have contracted the disease from a pupil. There were now large patches of scaly dermatitis occupying the perineum and groins with extensions on to the scrotum. On the left side of the cheek there was a circinate patch the size of a florin, having a somewhat intricate whorled pattern, suggesting tropical ringworm. On the outer side of the ankle just below the external malleolus there was a small patch the size of a sixpence, which was fading. No treatment had been applied to any of the lesions. There was no history of infection among his pupils, with the exception of one, a friend, who stated that he had some patches on his skin which he noticed while on the voyage from Japan. The patch on the groin was scraped, and in the scales thus obtained a very large-spored mycelium with unusually long branches was demonstrated.
(2) A case of Pityriasis rosea in a girl aged about 12 years, with very characteristic pale pink patches, in size about one quarter by half an inch, appearing first upon the upper part of the trunk above the clavicles, and arranged in lines directed obliquely from the summit of the shoulder to the clavicle. Upon the back in the intervertebral groove there were numerous similar patches and also smaller papules, round and faintly scaly. The eruption had made its appearance two days previously, and it was not now present upon the limbs or lower upon the body than the groin. It itched slightly. There was no similar eruption in any member of the family. This was the second case the exhibitor had seen of the disease this week, and it was probably true that the malady was an exanthem occurring in epidemic form during certain periods of the year.
Dr. Wilfrid Warde agreed as to the epidemic character of the disease, and he remarked upon the general good health of the patients. He thought that the so-called “herald-patch” was frequently missed, both by the patient and the physician.
(3) A case of Lupus vulgaris of the nose and cheek in a little weakly East-end child who had had a remarkably complete series of tubercular affections, commencing with a tubercular ulcer upon the right conjunctiva and cornea for which the eye had been enucleated eight years ago. Six years afterwards she developed lupus of the nose, which had run a very acute course and had speedily ulcerated, producing considerable loss of tissue in the cartilaginous portion of the nose. She was treated at first with cod-liver oil and thyroid extract for some months, and later with X-rays, which had been continued for many months with apparently no good effect. After several months of this treatment sudden improvement took place up to a certain stage, but there it stopped, the nose being still the seat of active disease. The application of Finsen light by the Finsen-Reyn lamp was then tried, and, in all, sixty exposures had been given of an hour and a quarter at a sitting, at daily intervals. The result had been satisfactory beyond belief to those who had seen the case at its worst. It was also an interesting fact that this patient had been the subject of an acute attack of typical Lichen scrofulosorum of the trunk, and she had been shown with this eruption at the Dermatological Society of London, in the Transactions of which it was fully recorded.[[7]]