LUPUS ERYTHEMATOSUS AND FOCAL INFECTION

MILTON B. HARTZELL
1920 Archives of Dermatology and Syphilology  
PHILADELPHIA REPORT OF A CASE Mrs. B., 35 years old, was referred to me in May, 1918, for the treatment of an erythematous lupus of one year's duration. The eruption, while presenting a wholly characteristic appearance, was distributed over an unusually large area; coin-sized and smaller patches were scattered over the cheeks, the upper and lower lids, behind the ears, in the scalp, on the upper chest, the arms and forearms and in the interscapular region. Some of the larger patches, especially
more » ... patches, especially those on the malar eminences, the upper lids and the back, were decidedly thicker and more scaly than usual. Before coming under my care a diagnosis of syphilis had been made and antisyphilitic remedies had been employed for some months, of course without influencing the disease. Under the local use of a 2 to 3 per cent, alcoholic solution of salicylic acid and the internal administration of quinin in considerable doses, there was a steady but slow improvement in all the patches ; on the back and arms the improvement was especially noticeable, the disease disappearing in these regions in the course of a few months. Other local remedies were tried from time to time, but the salicylic acid seemed by far the most effective. After nearly a year of this treatment, improvement ceased and as there had been no new patches, trichloracetic acid was applied to the thicker lesions at intervals of some weeks, the intervals between the applications being longer than was desirable because of the dis¬ tance at which the patient lived from Philadelphia. These applications were of undoubted value, but as the patient found them extremely painful they were discontinued and phenol every few days substituted, the patient making the applications herself. Two months later a decided improvement was noted, and the treatment was continued. In the latter part of January of this year a most extraordinary change was observed in the disease-all of the patches were apparently undergoing rapid involution and some of the smaller and less pro¬ nounced ones had almost entirely disappeared. It was then learned that this remarkable improvement had followed immediately on the extraction of a "capped" tooth which a roentgen-ray examination had shown to have an abscess at the root, although it had not given the patient any trouble for years. On extraction the roots of the tooth were found to be badly necrosed. Unfortu¬ nately, under the circumstances, a bactériologie examination of the abscess was impossible; this is greatly to be regretted since it leaves us in entire ignorance of the character of the organism concerned in the infection. I had hoped to see this patient again before the completion of this paper, but cir¬ cumstances have made that impossible. In a recent, letter, however, she states that there has been further improvement. This case is reported simply for what it is worth-not as proving or disproving anything as to the etiologic relationship of focal infec-
doi:10.1001/archderm.1920.02350100029003 fatcat:hyd3od475vhd5pp32q4yf2skzq