DERMATITIS CUPOLIFORMIS 



2035 



Symptomatology. — The disease begins as superficial, dusky red, 

 follicular, or perifollicular slightly itching macules on the feet and 

 legs. Some of these spots disappear, while others become slowly 

 larger, raised, hard, infiltrated, and cupoliform, reaching the size of 

 a pea or a small cherry. After a time the centre of the nodule 

 breaks down and forms an ulcer, with a reddish floor and undermined 

 edges. 



These ulcers are somewhat painful and very slow to heal, and when 

 this does take place it produces patches of hyperpigmentation. 

 The course of the disease is very long, lasting at times more than 

 a year. 



Diagnosis. — The characteristic features of the eruption are the 

 presence of raised, hard, rather large cupoliform nodules, some of 

 which show a central ulcer with undermined edges. 



Fig. 800, — Dermatitis Cupoliformis of the Foot. 



The differential diagnosis has to jbe made from Oriental sore by 

 the absence of Leishman-Donovan bodies. 



From ecthyma it may be distinguished by the absence or rarity of 

 the pustular lesions with a brownish crust. In ecthyma the initial 

 lesions are always pustular, there beingj^generally discrete flat 

 pustules; when these rupture a brownish crust is formed beneath 

 which suppuration goes on. In the condition known as ' ecthyma 

 gangrenosum/ occasionally met with in cachectic children, especially 

 during convalescence from varicella and other exanthemata, the 

 initial lesions are vesicular or pustular, and no nodules are present. 



In pyosis tropica the ulcers do not show undermined 'edges, and 

 pustular lesions are present. 



