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THE TREATMENT OF LUPUS VULGARIS

1934; BMJ; Volume: 2; Issue: 3841 Linguagem: Inglês

10.1136/bmj.2.3841.291

0959-8138

S Lomholt,

Systemic Lupus Erythematosus Research

Lupus vulgaris does not b3long to the common diseases.Stiuhmer thinks that in Germany the frequency of patients with lupus vulgaris (pr2sent or cured) is about 1 per 1,000 inhabitants.The incidence is much the same in Denmark, where from a population of about three millions we receive some 100 new cases each year.The serious character of the disease is due to the following features: (1) its extremely chronic course- patients who havei once contracted lupus hardly ever get rid of it without treatment; (2)-the fact that it attacks young persons, spoiling the years of their youth and marking them for the rest of their life -and (3) its localization, in a great majority of cases, to the face, where it produces permanent and markedly disfiguring destruction of tissues, often so extensive-that even if the disease itself is cured the tracks it leaves behind are so unsightly as considerably to handicap the patient in obtaining employment. General Features of the DiseaseLupus, as is well known, may arise in three different ways.(1) By direct inoculation, which is rare and only of slight practical significance, as the lesions produced in this way are generally small, benign, and most ofteln localized to the hands, where they are comparatively easy to cure.(2) By extension, as a rule in one of the following three ways: (a) from suppurating lymphadenitis involving the skin, most often from cervical or pre-auricular lymph glands; (b) from colliquative tuber- culosis involving the skin-this is seen most often in children; and (c) around a tuberculous fistula-for example, tuberculous osteitis, arthritis, etc. (3) By haematogenous (or lymphogenous) transplants from tuber- culous foci elsewhere in the body (lungs, lymph glands, or mucous membrane of the nose) this latter is by far the most prevalent.From these facts it obviously follows that the most rational procedure for the prevention of lupus is to combat the spread of tuberculosis as a whole.To this end main stress should be laid on reduction of the number of infection-carrying persons rather than on the treatment of the individual tuberculous patients.It is not persons infected with a clintcally serious form of tuberculosis- for example, pulmonary tuberculosis-who develop lupus; on the contrary, these patients seem to be fairly immune.On going through the data in respect of all new lupus patients admitted to the Finsen Institute during the decade of 1922-31, we have found that out of a total of 757 patients (224 men, 533 women) only twenty-six showed sigris of active tuberculosis.Among the re- mainder, fifty-five showed signs of old tuberculosis,