Definition.- A rare, chronic, mildly inflammatory disease, presenting millet- seed-sized, flat, reddish or yellowish, scaly papules, usually arranged in circles or groups and occurring in scrofulous subjects.
Symptoms. – So little discomfort arises from this condition that it is often discovered only accident. At first the lesions are pin-point is size, gradually becoming pin-head. At first red, they later become livid or brownish and then yellowish, sometimes fading to the normal color of the skin, but they do not change their conical form until they resolve, leaving a moderate stain behind. Minute scales may form at the apex of the papules. They are usually located on the front of the chest, abdomen or on the lateral aspect of the trunk but in children they may be found on the extremities. No matter what the location, they appear to have their origin in or about the hair follicles. The course is chronic and the individual lesions arise close together in groups or circles changing little for months, while new lesions appear in the free interspaces bearing some resemblance, when fully developed, to goose-flesh. Pustules occasionally form after a sebaceous plug has accumulated and on the face a pustular acne may coexist. Local sensations are slight or absent and no excoriations are seen unless a genital eczema or a seborrhea of the scalp is present at the same time.
Etiology and Pathology – This rare disease is somewhat more common in males and develops in childhood and adolescence. It is almost invariably associated with swollen glands, scrofulous joints, caries or other bone diseases, and tubercular family history, indicating that it is a tuberculous condition. Failure to find the tubercle bacillus has led to the belief that it is due to the toxins of this germ. Microscopically the pathological cause, according to Kaposi, is a cell infiltration and exudation in and around the hair-follicles and their sebaceous glands as well as the papillae immediately adjoining the follicular openings.
Diagnosis – Papular eczema is differently located, appears more red, often becomes vesicular and is attended with marked itching. The lesions of punctate psoriasis and lichen ruber undergo marked changes and become scaly. The miliary syphilid is rarely limited to the trunk and will show other evidence of syphilis. Keratosis pilaris is not associated with signs of scrofula and its lesions are usually located on the extensor and outer surface of the extremities.
Prognosis and Treatment. – This disease will run an indefinite course, if not treated, but it always respond to the judicious management. Physiological methods are chiefly indicated. Hebra’s treatment, consisting of cod-liver oil externally and internally, will always cure these cases, but it would seem that plain oily inunctions, such as vaseline with fifteen drops of subacetate of lead solution or five grains of thymol to the ounce, were much cleaner and quite as effective as the cod-liver oil externally. Internal medication is most important and the following may be studied: Aren. iod., Baryta carb., B. iod., B. mur., Calcarea carb., Kali carb., K. iod., Mez., Staphysagria