Diagnosis

The diagnosis of lupus is in general easy. When we consider the location of the disease, the color of the lesions, their slow development, the absence of subjective symptoms, the presence of citatrices in cases of long standing, and the repeated relapses after even vigorous attempts at treatment, we ought not to be often led astray. A question may sometimes arise as to whether certain tubercles or ulcerations are lupous or syphilitic. The length of time they have existed will usually settle this, when we remember that syphilitic lesions may reach a degree of development in a few weeks that might hardly be accomplished by lupus in years. The single tubercle of lupus exedens is to be distinguished from sarcoma and epithelioma. In sarcoma the development of the lesion is much more rapid, while in epithelioma, the tubercle is hard, but in lupus exedens it is soft.

In no disease of the skin is the prognosis more dependent on the character of the treatment. In early cases it is absolutely good if sufficiently vigorous treatment be instituted, while lack of appreciation or lack of vigor on the part of the physician is responsible for most of the extensive and long-standing cases that we meet with.