ERYTHEMA ELEVATUM DIUTINUM

Under this title Crocker and Williams¹ have called attention to a
rare malady, of unknown nature, characterized by persistent, raised,
pinkish to purplish, flattened nodules or patches, with sharply defined
edges, and usually free from any subjective symptoms.. These writers
also refer to somewhat analogous or allied cases by Bury,² Hutchin-

¹ Crocker and Williams, Brit. Jour. Derm., 1894, pp. 1 and 33 (with colored plate
and references to similar or allied cases).

² Bury, Illust. Med. News, May 18, 1889, p. 145 (with colored plate).

ER YTHEMA ELEVATUM DIUTINUM                     169

son,¹ and Boeck, and present abstracts of the same. The features of
the several cases, while in many respects similar, differed in some minor
particulars.² The common features were the purplish hue, marked
elevation with abrupt edges, the rather solid or firm character of the
efflorescence, their persistence for months, years, or indefinitely, and
their occurrence in subjects of gouty or rheumatic nature or history.
In some cases, in one or more patches, there was dilatation of a few sur­
face capillaries. The eruption was scanty in a few cases, consisting of
one to several areas, and in others, while scarcely abundant, patches
were to be seen over a number of places, sometimes widely scattered.
I have met with 4 cases with some of the features here described—3
women and 1 man—all past the age of forty, one past fifty. The erup­
tion in 2 of these cases consisted of but a single patch on the nose, and in
the third a patch on each cheek. In the fourth case (a recent one) there
were several small areas scattered over the face.³

Microscopic study of the Crocker and Williams’ case showed the
seat of the morbid changes to be between the epidermis and deep por­
tion of the corium, immediately adjacent to the coil glands, and to
be fibrocellular in character, the process being of a chronic inflammatory
nature.

The reported cases were apparently not materially influenced by the
treatment variously employed. In my cases the cheek case recovered
spontaneously or, possibly, from a mild astringent protective applica­
tion employed; the nose case (male) was treated with applications of
Vleminckx‘s solution, and eventually recovered; and in the third patient
(female nose case) it finally yielded to the continuous application of
mercurial plaster.

¹Hutchinson, Illust. Clin. Surg., 1878, vol. i, p. 39 (with colored plate); Brit.
Jour. Derm., 1888-90, vol. i, p. 10; Arch. Surg., 1889-90, vol. i, p. 372; ibid., vol.
ii, 1890-91, plate lxi (this last is Bury's case). Gilchrist, Trans. Amer. Derm. Assoc.
for 1900, p. 221, also recorded a case presenting some resemblance to the disease under
consideration, occurring on the extremities, in a child, but exhibiting a ringed nodular
appearance. F. J. Smith also reports a case, Brit. Jour. Derm., 1894, p. 144. Accord­
ing to Crocker, Brit. Jour. Derm., 1894, p. 148, model 1599 (Quinquaud's case, child‘s
hand), in the Museum of the Hôpital St. Louis, Paris, labeled “fibrômes multiples nodu-
laires des extrémités, histologiquement fibrômes fasculés,” is a case of this disease.

² In the Bury and Crocker and Williams cases the lesions were situated over the
articulations and on the palmar surfaces; began as nodules, becoming confluent, result­
ing in a flattened patch, disclosing, however, its nodular origin; the lesions were at first
erythematous and later purplish; all were persistent, some indefinitely so, others finally
undergoing involution; no tendency to spread over large areas; the subjects (3 cases)
were young females. In the Hutchinson type there was no special localization shown,
but usually over flat bony surfaces; the lesions began as flattish nodules, if close together
coalesced, and lost their nodular character, forming elevated, flattened patches; they
were purplish from the beginning, and were persistent, with no involution tendency,
and disposed to spread widely; the subjects (4 cases) were males and somewhat ad­
vanced in years. The lesions were somewhat less firm than the Bury type; the ele­
vation could be almost removed by long-continued pressure, being apparently chiefly
due to edematous infiltration.

³ Darier's Sarcoid; Boeck‘s Sarcoid—Urban, Brit. Jour. Derm., 1910, p. 331.

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