Lupus

“ Lupus is more frequently found on the extremities than on the trunk. The surface of the skin is found to be tense and glossy on a firm base which is affected by lupus.
Deep ulcerous formations of lupus are sometimes observed on the fingers and toes, particularly on the finger-joints, these may at times penetrate into the inner parts of the joints, secreting whitish pus and covered with a thick rind.
[62] As regards the difference between lupus and syphilitic diseases it has been found that lupus commonly developes before puberty while syphilis appears in the mature age. ”

“ The cause of lupus still eludes investigators, but promising leads into its relationship to the immune system, as well as to other factors, may yield new understanding of the origin of this chronic inflammatory disease, which afflicts an estimated fifty thousand new victims annually. ”

“ By the President of the United States of America
A Proclamation
Systemic lupus erythematosus (also known as lupus or SLE) is a potentially serious, complicated, inflammatory connective tissue disease that can produce changes in the structure and function of the skin, joints, and internal organs. More than 500,000 Americans are estimated to have lupus; approximately 90 percent of these are women. One of the most frequent serious disorders of young women, lupus is characterized by periods when the disease is active alternating with periods of remission. ”

“ Almost 90 percent of its victims are young women.
In the systemic form, lupus can affect almost any part of the body, often producing abnormalities in the kidney, heart, skin, joints, and other internal organs.
The outlook for victims of lupus has vastly improved in recent years. In 1955, the survival rate for lupus victims was only 50 percent four years after diagnosis. Now, more than 80 percent of lupus patients are alive 10 years after their disease has been identified. ”

“ Lupus erythematosus is an increasingly serious connective tissue disease, affecting 500 thousand Americans, mostly young women. There are an estimated 50,000 new victims each year stricken by this disease. ”

“ In an advanced stage the nodules and patches of lupus become somewhat scaly and not infrequently soften and ulcerate. In chronic cases seen in adult life the disease is often found to have spread over the greater portion of the face, producing a marked ectropion and a partial disappearance of the nose and ears. Such an extensive development of the disease is rarely if ever observed in childhood. Although the face is the most common site of lupus, the trunk and extremities may also be affected, either independently or with the face. ”

“ Less often lupus developes after complete development [63] of manhood. It is more frequent with women than with men. Sometimes some of the knots remain isolated and disappear again after a time; in other cases additions appear in the course of time, which may affect larger portions of the body and lead to more or less dangerous ulcers. As a rule the course of lupus, even of great extent, is not malignant and at the most the alliance with traumatic erysipelas and possibly the appearance of pulmonary consumption may succeed the affliction. ”

“ The medical challenge which the disease lupus erythematosus presents is the subject of many research projects in hospitals and medical centers throughout the United States. The disease most often strikes during its victims' most active and productive years, and can affect many organs of the body with inflammation and changes in structure and function. ”

“ In recent years, the outlook for lupus patients has improved due to extensive and vigorous research. Positive results have emerged from studies uncovering several diverse defects of the immune system and from research on genetic and environmental factors influencing the disease. ”

“ It rarely extends to the lymph glands, and of all tuberculous lesions is the least dangerous to life. The commonest form of lupus—lupus vulgaris—usually commences in childhood or youth, and is most often met with on the nose or cheek. The early and typical appearance is that of brownish-yellow or pink nodules in the skin, about the size of hemp seed. Healing frequently occurs in the centre of the affected area while the disease continues to extend at the margin. ”

“ Lupus, though it may make its appearance at any age, is developed most commonly at puberty, and is most destructive in its results from fifteen to twenty-five or thirty. It attacks the face, nose and neck, and it usually destroys the fauces, palate and pharynx; the soft palate is entirely destroyed, and the only remains of the pillars of the fauces are scars of cicatricial tissue. The mouth then appears as a vast cavern instead of being filled with the usual structures, and the nose may be entirely eaten away. The disease is commoner among women than among men. ”

“ Lupus is a chronic disease in which there is always the potential threat of serious illness and disability. The disease can occur in men, but women in their childbearing years are the majority of its victims. Minorities, especially blacks, are particularly vulnerable; lupus is three times more prevalent in black women than in white women.
Ordinarily, the immune system protects against infection by producing antibodies that successfully combat foreign substances. In people with lupus, the immune system produces abnormal antibodies that react harmfully against the individual's own tissues. ”

“ Describe the symptoms of lupus erythematosus.
Usually the disease begins as one or several rounded, circumscribed, pin-head- to pea-sized lesions; slightly scaly, somewhat elevated, and of a pinkish, reddish or violaceous color. They slowly, or somewhat rapidly, increase in area, and after attaining variable size remain stationary; or they may progress and coalesce, and in this manner sooner or later involve considerable surface. The patches are sharply defined against the sound skin by an elevated border, while the central portion is somewhat depressed and usually atrophic. ”

“ Genetic studies suggesting the role of heredity in the occurrence of lupus have begun to provide important information. The study of immunity, the body's ability to resist disease, is now pointing the way to an understanding of the relationship to lupus of abnormal immune reactions of the body. Although a cure must await further knowledge of the basic cause, presently available forms of treatment can frequently delay the often grave consequences of the disease. ”

“ The treatment of lupus has principally been a local one. Caustics were applied to destroy lupous tubercles by direct action, and furthermore recourse has been taken to the so-called mechanical treatment, in which the ringworm was scraped out.
Our experiences relating to the mechanical treatment of lupus have taught us the following.
Lupus can not be cured without destroying and removing the diseased and affected tissue. That method which effects the most radical destruction, protects most from relapses. Therefore the best method of treating lupus is to cut out the diseased skin. ”

“ Thanks to recent research progress, lupus has become more a chronic disease than the acute and often fatal disorder it was decades ago. Nevertheless, deaths do occur, and new research findings and new approaches to diagnosis and treatment are needed to eliminate lupus. A concerted Federal-private research effort is working to ultimately uncover the cause and cure for this distressing disease. ”

“ With a longitudinal patch on the nose and spreading symmetrical patches on each cheek the appearance is usually that of a large butterfly. It is slow in disappearing, but does not leave a scar. Lupus is more frequently seen in women than in men ”

“ Lupus is often fatal but even if not, its victims still endure pain and anguish.
We have made progress in understanding lupus in the last few years. Thousands of sufferers can look forward to improved treatment and the opportunity to live more productive and happier lives. Today's outlook is far from bleak, but we still need new research and alternative approaches to treatment and diagnosis if we are to eliminate lupus as a cause of human suffering and to improve life for its victims. ”

“ Lupus vulgaris may be excluded by the absence of papules, tubercles, and ulceration. The sebaceous involvement and the peculiar atrophy and superficial scarring are, moreover, not seen in lupus vulgaris. Erythematous lupus begins, as a rule, during adult life; lupus vulgaris usually in childhood. In psoriasis the course and symptoms peculiar to that disease will distinguish it from lupus erythematosus. It is scarcely possible to confound the disease with eczema or syphilis. In some cases in the beginning of the affection it may resemble seborrhoea ”

“ An illustration of the caution displayed by the authors is shown in the section on lupus, in which reference is made to the fact that, while that disease is a form of tubercular inflammation, it is not unlikely that in the clinical group of diseases called lupus there may be lesions that are not caused by the tubercle bacillus, a point that must be decided by more exact bacterial studies. This same caution is shown in accepting the bacillus described by Lustgarten as the cause of syphilitic inflammation. ”

“ At times the patches retrogress, involution taking place with or without slight sieve-like atrophy or scarring.
State the causes of lupus erythematosus.
The etiology is obscure. Some observers believe it to be a variety of cutaneous tuberculosis. It is essentially a disease of adult and middle age; is more common in women, and more frequent in those having a tendency to disorders of the sebaceous glands. It may, in fact, begin as a seborrhœa. ”

“ In many cases it begins in childhood or early adult life, but as it is persistent and tends to relapse, it may be met with at any age.
Describe the earlier symptoms of lupus vulgaris.
The disease begins by the development of several or more pin-head to small pea-sized, deep-seated, brownish-red or yellowish tubercles, having their seat in the deeper part of the corium, and which are somewhat softer and looser in texture than normal tissue. As the disease progresses, variously-sized and shaped aggregations or patches result, covered with thin and imperfectly-formed epidermis. ”

“ Of all diseases based on tuberculosis only ringworm or lupus is perceivable by the eye, as it is a disease of the skin, all other tuberculous diseases take their course in the internal parts of the body, and therefore are not perceptible to the eye. The symptoms that follow an injection of Koch's liquid can be best observed in the case of lupus. ”

“ The occurrence of this latter disease in lupus tissue, in association or as a sequela, has been noted by several observers. According to the latest investigations the infiltration of lupus is due chiefly to cell-proliferation and outgrowth from the protoplasmic walls and adventitia of the blood-vessels and lymphatics. The fibrous-tissue network, vessels, and a portion of the cell-infiltration are thus produced, the fixed and wandering connective-tissue cells of the inflamed stroma of the cutis being responsible for the other portion of the new growth. ”

“ Lupus erythematosus is, moreover, a superficial disease, pinkish or violaceous in color, showing itself in circumscribed patches covered with thin adherent scales, and with usually evident involvement of the sebaceous glands. It rarely begins before adult age, whereas lupus vulgaris, as a rule, first appears in childhood. Attention to the ordinary characters of acne rosacea—the hyperæmia, the dilated vessels, comedones, acne papules and pustules, its advent at or after maturity, and the history—will prevent an error in diagnosis. ”

“ The disease progresses slowly, healing in some places and spreading at others. The patient complains of a burning sensation, but little of pain, and is chiefly concerned about the disfigurement. Nothing is more characteristic of lupus than the appearance of fresh nodules in parts which have already healed. In the course of years large tracts of the face and neck may become affected. ”

“ Lupus erythematosus is seen most frequently about the face, one or several patches, varying in size from a pea to a silver dollar, ordinarily being present. The nose and the cheeks are favorite localities, and, seated here, the disease is apt to be symmetrical, extending from one cheek across the nose to the other cheek, in shape representing rudely the outline of a bat or butterfly with outstretched wings. The lips, ears, scalp, and other parts of the body are often affected. ”

“ The mucous membrane of the mouth, gums, velum and larynx may even be primarily the seat of the lupus infiltration, considerable destruction eventually resulting. The face, especially the nose, is the most common site of the disease. Occurring about the eye, the process may eventually destroy that organ. The ears are likewise frequently attacked. Not infrequently the extremities, and occasionally the trunk, are invaded. The disease begins, as a rule, in childhood. It is always a destructive process, usually resulting in disfiguring cicatrices. ”

“ The disease in nowise compromises the general health. In those rare instances of generalized disease the patient has usually died from an intercurrent tuberculosis.
How is lupus erythematosus to be treated?
The general health is to be looked after and systemic treatment prescribed, if indicated. As a rule, constitutional remedies exert little, if any, influence, but exceptionally, cod-liver oil, arsenic, phosphorus, salicin, quinine, or potassium iodide proves of service. ”