Lupus

LUPUS (wolf disease, wolf ringworm, eroding ringworm), a term first encountered in medical literature in the 13th century by Rogerius (1230) and then frequently appearing mainly in descriptions of ulcerative processes on the lower extremities; with respect to facial lesions, it was first mentioned significantly later (17th century). The name L. was definitively introduced for ulcerative diseases of the face, described as a separate disease, only in the early 19th century (Willan, Bateman), and from this time it became established in dermatological literature. The name L. apparently arose from the impression produced by the external appearance of patients as if "gnawed by wolves". At the same time, it can be considered quite established that under this name were previously combined the most varied diseases, for example syphilis, leprosy, malignant neoplasms and others. Especially often L. was associated with tuberculosis, syphilis and "scrofula", since the latter was considered a separate disease. For a long time in the literature there appeared the term "lupus syphiliticus", which was finally rejected by Kaposi, Hebra and others (Kaposi, Hebra). The first precise clinical description of L. was given by Hebra; he also pointed out that the numerous clinical pictures described represent only different stages of its development. Regarding the etiology of lupus, Friedlender in 1872, even before the discovery of the tubercle bacillus, based on patho-anatomical studies, expressed the view of the tuberculous nature of the disease. Despite the fact that Friedlender's research was confirmed by the work of other authors (Neisser), the question of the final recognition of the tuberculous etiology of L. long remained unresolved, since tuberculous structure was also found in a number of other processes (leprosy, syphilis, etc.). The failure of most of the first experiments with the inoculation of lupous material into animals also played a certain role in this, and the tuberculous etiology of L. could be established with certainty only after the discovery of the tubercle bacillus. The first to find the tubercle bacillus in lupous tissue was Demme. (For details, see Tuberculous diseases of the skin and Lupus erythematodes.)

I. Shimanco.

LUPUS PERNIO (from Latin pernio - frostbite), a dermatosis first described by Besnier (1889). Clinically characterized by limited swelling of lilac color, occupying simultaneously, symmetrically or separately, the nose, cheeks, earlobes, the back of the hands and the pads of the fingers of the hands, in the depth of which sharply delimited, very dense nodes of infiltrate the size of a pea to a pigeon's egg are palpable, and against the background of lilac-colored skin, yellowish-rust colored nodules stand out, especially clearly noticeable under diascopy. In addition to the skin, the pathological process can affect mucous membranes, nails and bones. In the case of phalanx involvement, thickening of the fingers is noted, as in spina ventosa. On X-ray examination in these cases, foci of osteoporosis of the terminal phalanges in the form of cavities are found. At the same time, an increase in lymph glands, tonsils and spleen is noted. The disease is rare. The course of the disease is chronic with remissions in the warm season. On histological examination in old foci of lesions in the proper skin, sharply delimited nodes are found, consisting in the peripheral parts of round-cell infiltrate, and in the center - of epithelioid cells and a small number of giant cells; the infiltrate is surrounded by a thick fibrous capsule. In younger foci, round-cell infiltrate predominates, and the boundaries of the foci are not as sharply expressed as in older foci. - Chilblain lupus Hutchinson is also referred to as L. p. This form initially resembles chilblains, and later acquires an appearance very similar to lupus erythematosus, differing only in color. The pink-orange nodules are absent. According to Darier, chilblain lupus is lupus erythematosus that has developed in people suffering from acroasphyxia, which is supported by the similarity of the histological picture. The question of the etiology of chilblain lupus seems to be resolved in favor of establishing a connection of this dermatosis with tuberculosis (Peter). The question of the etiology of L. p. is completely unclear. There are supporters of tuberculous etiology (Jadassohn), but a significantly larger number of authors (Kreibich, Lewandowsky and others) consider L. p. an infectious granuloma of unknown origin. Schaumann, who worked for a long time on the question of the etiology of L. p., considers it identical to Boeck's sarcoid, i.e., a dermatosis which, according to his own research, is one of the forms of manifestation of benign lymphogranulomatosis. Experimental work so far has given nothing definite in terms of clarifying the etiology. In Russian literature, L. p. was first described in 1891 by Murzin as a case of "cutaneous tuberculosis". - The second case was described in 1903 by Ya. Sokolov as a case of "rare cutaneous tuberculosis".