Vagabonds' Disease

VAGABONDS' DISEASE (vagabonds' disease—among English authors), a name used primarily by English and French physicians for a syndrome caused by many years of body lice infestation, which, for obvious reasons, is most frequently observed in homeless people and vagrants living in horrifying conditions of poverty and filth. The thickened skin, covered with dry and finely-scaling epidermis, is pigmented to a dirty-brown color, especially dense on the back in the scapular region, on the nape, shoulders, inner surface of the thighs, and around the waist. Against this background, white stripes of scars—traces of old scratches—stand out sharply, along with fresh scratches and impetigo-sanguineous crusts of various ages as a consequence of pyoderma complicating the scratching. Sometimes the pigmentation takes on a universal character (melanodermia phthiriasica) and in the form of brown and violet-lilac spots spreads to the oral mucosa. This melanoderma sometimes remains even after the lice infestation is cured. The presence of this syndrome in cachectics or elderly people with nutritional decline, asthenia, and intestinal disorders can sometimes make the differential diagnosis with Addison's disease not easy. In recognizing such cases, one must also take into account the 'pseudo-Addisonian syndrome of old tuberculous alcoholics' described by Roch (Roch, 'Presse medicale', 1922, № 68), in which melanoderma, cachexia, and acutely progressing pulmonary tuberculosis with caseous decay come to the forefront, with normal adrenal gland function but insufficient liver function.