A Clinical Study of the Treatment and Early Prognosis of Lupus Erythematosus Discoides

346 Pages·014.155 MB·English

by  Cochrane, Thomas

A CUBICAL STUDY OF THE TREATMENT AND EARLY
PROGNOSIS OF LUPUS ERYTHEMATOSUS DISCOIDES.
BY
THOMAS COCHRANE M.B. Ch.B.
ProQuest Number: 13870148
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I.
A CLINICaL STUDY OP THE TREATMENT AND EARLY
PROGNOSIS OF LUPUS ERY THILL AT OS US DISCQIDES.'
■CONTENTS.
Introduction to Thesis i
PART I .
Intro d u ctio n............................................................................................................................ 1
Chapter 1 .............. ............................................. ..................... 2
C linical aspects of Lupus Erythematosus Discoides.
Chapter 11................................................................................................................................. 6
Hi stopathology.
Chapter 111.............................. 8
Introduction to Kapharside therapy.
Chapter I V .. .. ........................... 10
Chemistry, Pharmacology and Mode of action of
Hap he r si de .
Chapter V.................................................................... 13
Contraindications fo r Mapharside treatm ent.
Chapter V I............................................................ 15
Technique observed in treatm ent.
Chapter V ll................................................................................................................................18
analysis of cases.
Chapter VH1................................................................................................................................26
R esults of treatm ent.
Chapter 12..................................................................................................... .43
Complications and reactions.
Chapter 2 ..................................... 49
Treatment w ith Gold.
Chapter X I................................................................................... 66
Comparison of Gold and Mapharside.
Chapter Z ll............................ 71
Treatment with Bismuth.
Chapter XH1................................................................................................................................85
C omp ari s on of Bi smut h and Map harside.
IT.
- age
Chapter X1Y................................................................................................................... 90
Conclusions.
PART II.
I n tr o d u c tio n .................................................................................................................. 94
Chapter 1................................................................................................................. 95
Aetiology of Lupus Erythematosus Discoides.
Chapter 11...................................................................................................................................107
C linical Analysis of Cases.
Chapter 111.................................................................................... ..125
Discussion on C linical Observations.
Chapter IV........................................................ 137
Ointment Therapy.
Chapter Y................................... 147
Treatment of Cases.
Chapter VI................................................................................... 165
Discussion.
Chapter Y ll.................................................................. 181
Conclusions.
BIBLIOGRAPHY..............................................................................................................................184
APPENDIX........................................................................................................................Volume 2.
INTRODUCTION TO THESIS
The object of th is thesis is to advance the treatment
of Lupus Erythematosus Discoides and to indicate a method of
forecasting an early prognosis of the disease.
A series of 56 cases of the disease, which have been
c lin ic a lly investigated and then treated with Mapharside,
w ill be presented in an attempt to assess the efficiency of
arsenic in the treatm ent of Lupus Erythematosus Discoides.
Another series of 74 cases w ill be described, in
which fu rth er c lin ic a l investigations of the disease were
carried out and treatm ent given by methods of therapy
selected by the reaction of the lesions to certain ointments.
An endeavour also has been made in th is series to forecast
an early prognosis in cases of Lupus Erythematosus Discoides.
PART I.
1
PART I .
IFTRODUaTION
In part 1 of the th e s is , 56 oases of Lupus Erythematosus
Discoides treated with Mapharside and the resu lts thereof w ill
he described and discussed. A comparison w ill then he drawn
between these findings and those reported by w riters using
gold and bismuth, the two metals most commonly used in the
treatm ent of the disease.
The above investigations w'ere carried out in an
attempt to assess the efficiency of arsenic in the treatm ent
of Lupus Erythematosus Discoides and to determine what place,
if any, the arsenical compound Mapharside should occupy in
the l i s t of valuable therapeutic agents in the treatment of
the disease.
2
Chapter 1.
CLINICAL ASPECTS OP LUPUS ERYTHEMATOSUS DISCOIDES.
Lupus Erythematosus Disooides was given this t i t l e
"by Cazenave (1851). Previous to this date, the condition
had been described under the headings of Erytheme Centrifuge
by B iette in 1828, and Seborrhoea Congestiva by Hebra in
1845, A ll three w riters referred to. the discoid and chronic
type of the disease. Twenty one years la te r, Kaposi (1872]
described the acute or subacute disseminated type.
Of these two main v arieties of the disease, the
chronic and discoid form is by far the most common, c o n stit­
uting a ll the cases in th is thesis and according to Sequeira
(1947) about eighty percent of a ll cases in this coantry.
The remaining twenty percent are of the disseminated type.
The incidence of the disease according to P o llitze r
(1924) is 0.035$ or roughly 1 in 300 oases seen in Dermatology.
On examining the records of The Royal Infirm ary, Glasgow,
over a period of twenty years from 1928 to 1947, 512 cases of
Lupus Erythematosus Discoides were found in a to ta l of 92,212
new dermatological cases seen in the Outpatient Dispensary.
This gives a somewhat higher ra tio of 1 in every 180 new cases
seen and is in agreement w ith Weiss (1936) whose ratio was
1 in every 155 new dermatological cases. In this survey,
the age of the patients varied from seven years to seventy
six years with an average age of th irty six years. Of the
512 cases of the disease„ no less than 271 were in the age
group th irty to forty years. The sex ratio was 332 females
to 180 males or roughly 2 to 1.
The present series of 56 cases is in agreement with
th is , as the average age of the patient is th irty four years
and the sex ra tio of 40 females to 16 males, although slig h tly
higher than the above ra tio , is typical for the disease.
The i n itia l lesion of Lupus Erythematosus Discoides
consists of a small erythematous macule or papule which is
usually covered with a greyish-yellow adherent scale. The
primary lesion enlarges peripherally and eventually forms a
discoid plaque which d iffers in size and shape, and is rose
pink to deep purple in colour.
The border is usually elevated and in filtra te d while
the centre is depressed, paler in colour and shows either a
scaly or unbroken epidermis in which dilated or plugged
fo llic u la r openings may be seen. The scales, varying in
colour, may be scanty or abundant and they are usually
anchored firm ly to the underlying epidermis by means of
horny projections from th eir surface. This is a well noted
ch aracteristic of the disease.
4
In some cases erythematous redness predominates,
while in others, seborrhoea-like scaling is more pronounced.
When the disease undergoes involution, the patches
may resolve without trace but almost invariably typical
scars are le f t. These are su p erficial, f la t, smooth and
d u ll white in colour, although occasionally they show
te la n g ie c ta sis.
The erythematous and seborrhoea-like varieties of
the disease are the common su p erficial type and are most
frequently seen on the face, especially on the malar
prominences, the bridge of the nose and the ears. Another
type of the disease less commonly seen on the face is the
telan g iectatic v ariety . In th is, rosy red or deep purple
plaques develop. The surface is often slig h tly oedematous
and there is an absence of scaling and dilated fo llic le s .
Typical scarring however not infrequently follows involution
of this type.
The scalp also is frequently attacked and in this
area involution usually takes place with more pronounced
scar formation. Less common sites for the disease, are the
dorsum of the hands and fin g ers, the conjunctivae and mucous
membranes of the mouth and lip s. Lesions in the la tte r
situ atio n may be present alone, but more often they coexist
with cutaneous lesions. Culver (1915) describes them as