Lupus Exedens

This form of lupus was recognized by all the older writers; but those of recent times seem disposed to deny it a place in nosology, or declare that the cases described under this name were not lupus at all, but were epitheliomata. This is not in accord with Dr. Piffard's observations, and he describes in this place a variety of lupus characterized by the development of usually a single good-sized soft tubercle. This slowly increases in size, until after a lapse of years, perhaps, ulceration sets in, which extends both in width and depth, involving the tissues beneath the skin. The margins of the ulcer are uneven, ragged, and burrowed under. The edges, however, are soft, not presenting any hardness or induration. After an indefinite period, however, at one or more points on the periphery of the ulcer hard nodules may and usually do develop, and which can easily be recognised as unmistakable epithelioma. This epitheliomatous process may extend until the greater part of the ulcer is involved. The only contention concerning the nature of this disease is whether it is a true epithelioma ingrafted on a lupous basis. Whatever may be the true pathology of the disease, the practical outcome is the same, and this is usually a fatal termination, unless the lesions be early vigorously dealt with.


Lupus may occur in the throat, and may make its appearance at any time of life. It occurs in men oftener than in women. It may occur in any constitution but seems to   prefer   the   lymphatic   temperament.   Inheritance   has nothing to do with it. Sometimes the mucous membrane assumes a purplish color, swells up and becomes granular and one or two of the granulations develop so much as to reach the size of a pea, or even that of a hazel-nut. Occasionally, the tubercles become prominent in the throat previous to alteration in the mucous membrane, and without differing from its normal color. They may be either superficial or deep. Their surface is smooth and brilliant, but if several of them become intimately united they appear as a single mass, rounded, cloven, and anfractuous. When the tubercles develop exuberantly in the larynx, breathing becomes embarrassed, and even stridulous. There is no alteration in the sensitiveness of the affected parts. Finally, the tubercles soften and become ulcerated. This melting down does not take place in a complete manner. In some cases, only the surface, of the tumor becomes fissured or excavated as a margin to simple excoriations. In others, the destructive process attacks a greater or smaller portion of the tubercle in its entire depth, producing ulcers which dip out of sight in the midst of the tissues. The cure of these cases is difficult and is followed by indelible scars. In some cases, the ulcers are developed in a slow but fatal manner; in others, they spread with astonishing rapidity; while in some others, they stop in the beginning, but how far their ravages may extend it is impossible to predict.

Instead of appearing in its usual idiopathic form, lupus, at times, develops subsequent to other skin lesions, for instance, a traumatism. In such cases it affects one or more localities, but always where formerly an injury, ulceration or scar has been.


If the disease attacks the fingers it can completely destroy them, but never the nails or the matrix. As the finger is shortened by the disease the nail maintains its position at the end of the stump, and may finally reach a position over the head of the metacarpal bone, where it remains in apparently as healthy a condition as in its normal condition.

The family history of the great majority of patients suffering from lupus reveals the important fact that phthisis pulmonaris is met among the near relations to a surprising extent, and we are forced to the conclusion that the same constitutional condition that predisposes one subject to the invasion of tuberculosis of the lungs predisposes another to tuberculosis of the skin, but the exact role played by the tubercle bacillus is no more known to us in the one case than in the other.