HYDROCYSTOMA

IO87

Granulosis Rubra Nasi.¹—While the first case of this malady was
recorded by Luithlen (1900, 1 case), it is especially by Jadassohn (1901,
7 cases), Hermann (1902, 10 cases), and, later, by Macleod ( 903),
that attention has been particularly called to this peculiar affection.
The present accepted name we owe to Jadassohn. The malady is
usually limited to the nose, to the front and sides; exceptionally, in addi­
tion to involving this part, it has been observed to affect also the upper
lip (Macleod), cheek (Jadassohn, Herrmann), and eyebrow (Pringle).
Examined casually and not too closely, it bears resemblance in its gen­
eral aspects to an ill-defined lupus erythematosus or lupus vulgaris.
The part is of a bright red color, diminishing in intensity toward the
sides of the nose, and fading gradually, without any demarcation, into
the adjacent normal skin. Over the area, irregularly distributed, are
to be seen pin­point­ to pin-head-sized, deep-red or brownish-red specks
and papules, the color wholly disappearing upon pressure. There is no
disposition to coalescence. The papules gradually develop into pustules
and some undergo desiccation. There is in all cases an associated hy-
peridrosis of the affected area, and sometimes of other parts; the sweat
often being seen on the involved region in scattered droplets, giving it a
damp, glistening appearance. The course of the malady is exceedingly
chronic, but inasmuch as it has never been seen in adults, it apparently
disappears as the age of youth is passed, and without leaving scar or
trace. Its subjects are all delicate children, and more commonly males
(in Jadassohn’s 7 cases, between seven and sixteen; 6 of his patients were
boys). Pinkus has, however, recently reported what seems to be a case
of this malady in a man aged fifty-nine, existing since childhood, asso­
ciated with both hyperidrosis and hydrocystoma. Lebet also cites a
combination of hydrocystoma with the disease; and in one of Jadassohn’s
cases there were a few hydrocystoma lesions, which he considered purely
accidental. Both Lebet and Pinkus believe there is a relationship.
Season usually has no influence, but aggravation was noted in Mac-
leod’s case in hot weather. Hyperidrosis seems to be a predisposing
factor. There is no reaction after tuberculin injections (Jadassohn).

¹ Literature: Luithlen, Kaposi's Festschrift, 1900, p. 709; Jadassohn, Archiv, 1902,
vol. lviii, p. 145; Hermann, ibid., 1902, vol. lx, p. 77; W. Pick, ibid., 1902, vol. lxii,
p. 105; Macleod, Brit. Jour. Derm., 1903, p. 131 (case demonstration), and ibid., p.
197 (full report of same case, with review of the literature and references—I am
indebted to this paper). Pringle (case records given by Macleod) demonstrated 2
cases before Derm. Soc’y of London, 1894, under provisional diagnosis of “hydrocys-
toma.” Case reported by Meachen, Brit. Med. Jour., 1903, xv, p. 104 (also cited by
Macleod), is also suggestive of this disease. Saalfeld (Soc’y Trans.), Monatshefte, 1903,
vol. xxxvi, p. 28 (case demonstration—nose and upper lip); Malherbe, Jour. mal.
cutan., Feb., 1905; Audry, Jour. mal. cutan., Nov., 1903; Ormsby (Soc’y Trans.),
Jour. Cutan. Dis., 1905, p. 183 (case demonstration); Bäumer, Dermatolog. Zeitschr.,
1904, vol. xi, H. 9; Pinkus, “Ueber die Beziehungen des Hidrocystoms zur Granulosis
rubra nasi,” ibid.; Lebet, “Constitution a l’étude de l’hidrocystome (avec une note sur
la granulosis rubra nasi),” Annales, 1903, p. 273; Marcel Sée, Annales, 1904, p. 1037
(case demonstration); Baumer, Dermatolog. Zeitschr., 1904, vol. xi, p. 646 (histology);
Colcott Fox, Brit. Jour. Derm., 1906, p. 320 (case report); Macleod, ibid., p. 342
(second case, further history of first case, and résumé, with references of other published
cases, with a general consideration of clinical characters, etiology, anatomy, pathogene-
sis, and treatment); Hallopeau, Jour. mal. cutan., April, 1906 (4 cases, in 1 instance
showing heredity, and in other circulatory disturbance (asphyxia) of the fingers and
ears); Adamson, Brit. Jour. Derm., 1907, p. 71 (case demonstration).

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DISEASES OF THE APPENDAGES

The principal pathologic changes are to be found in the corium, and
especially about the sweat apparatus; according to Jadassohn and
others the histologic findings give the impression that it is a chronic
inflammation originating in the vessels around the sweat apparatus.
The epidermis, with the exception of a slight parakeratosis in the neigh­
borhood of the sweat pores, is not involved. Herrmann was not able to
confirm Jadassohn’s histologic conclusions, as to a particular predomi­
nance of the process in and about the sweat apparatus, but regarded the
condition as purely a perivascular disturbance of an inflammatory type.
Treatment seems without positive influence, the malady being resistant
to all therapeutic measures so far tried. Malherbe commends linear
scarification.

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