DERMATITIS NODOSA RUBRA 



2249 



DERMATITIS NODOSA RUBRA. 



Historical and Geographical. — This condition has been described 

 by Castellani in Ceylon. 



etiology.— This is unknown. 



Symptomatology.— The first impression received on seeing a 

 patient suffering from this pecuHar disease is that he is suffering 

 from smallpox in the papular stage of the eruption, but the absence 

 of fever and the closer inspection of the eruption will exclude small- 

 pox at once. In a well-marked case the patient presents on his 

 face, arms, chest, back, and practically on the whole body, numerous 

 large papules and nodules. 

 The colour of the eruptive 

 elements is an angry red; 

 the shape, hemispherical or 

 roundish; the size, from a 

 small split -pea to a large 

 pea. The surface of the 

 papules and nodules is 

 smooth, does not show 

 umbilication, nor scales : 

 their consistency is hard; 

 most of the papules are not 

 follicular. There is unbear- 

 able pruritus, but the 

 malady has no urticarial 

 element whatever. Several 

 of the superficial lymphatic 

 glands are enlarged and 

 hard. In several cases a 

 well-marked enlargement of 

 the parotid gland is present. 

 The blood shows a certain 

 degree of eosinophilia. The 

 course of the disease is long Fig. 881.— Dermatitis Nodosa Rubra. 

 — six months to a year, and 



sometimes much longer ; the nodules become gradually smaller, 

 and may disappear completely ; they leave no scar or zones of hyper- 

 pigmentation, but occasionally the skin may take a shghtly scaly 

 or eczematoid appearance. Recurrences may be observed. 



Diagnosis. — From a syphilide by the extreme pruritus and the 

 inefficacy of mercury and potassium iodide. 



From smallpox, the papular stage of which it closely resembles, by 

 the absence of fever, by the chronic course, and by the fact that the 

 papules never undergo a purulent change nor leave scars on healing. 



From lichen planus by the papules being very large, and by their 

 not being flattened, umbilicated, nor polyhedric. 



From pityriasis rubra pilaris by the papules being very large, and 

 most of them not follicular, and by the absence of plugs and scaling. 



