#Describe the earlier symptoms of lupus vulgaris.#
The disease begins by the development of several or more pin-head to small pea-sized, deep-seated, brownish-red or yellowish tubercles, having their seat in the deeper part of the corium, and which are somewhat softer and looser in texture than normal tissue. As the disease progresses, variously-sized and shaped aggregations or patches result, covered with thin and imperfectly-formed epidermis.
#What changes do the lupus tubercles or infiltrations undergo?#
The lesions, having attained a certain size or development, may remain so for a time, but sooner or later retrogressive changes occur: the matured papules or tubercles, or infiltrated patches, slowly disappear by absorption, fatty degeneration, and exfoliation, leaving a yellowish or brownish pigmentation, usually with more or less atrophy or cicatricial-tissue formation--_lupus exfoliativus_; or disintegration and destruction result, terminating in ulceration--_lupus exedens, lupus exulcerans_. This latter is the more usual course.
#Describe the clinical appearances and behavior of the lupus ulcerations.#
They are rounded, shallow excavations, with soft and reddish borders. In exceptional instances exuberant granulations appear--_lupus hypertrophicus_; or papillary outgrowths are noted--_lupus verrucosus_. The ulcerations secrete a variable amount of pus, usually slight in quantity, which leads to more or less crust formation; later, however, cicatricial tissue, generally of a _firm and fibrous_ character, results.
#In what manner does the disease spread?#
The patches spread by the appearance of new tubercles, or infiltrations at the peripheral portion. New islets and areas of disease may continue to make their appearance from time to time, usually upon contiguous parts.
#Are the mucous membranes of the mouth, throat and larynx ever involved?#
In some instances, and either primarily or secondarily.
#Is the bone tissue ever involved in lupus vulgaris?#
#What course does lupus vulgaris pursue?#
It is slowly but, as a rule, steadily progressive. Several years or more may elapse before the area of disease is conspicuous.
It is now known to be due to the invasion of the cutaneous structures by the tubercle bacillus; in short, a tuberculosis of the skin. It is not infrequently observed in the strumous and debilitated. It is entirely independent of syphilis.