SPECIFIC AFFECTIONS OF THE FOLLICULAR APPARATUS OF THE SKIN IN LEPROSYl

In the examination of leprosy patients my attention has been arrested by a peculiar affection of the follicular structure of the skin that, so far as known to me, has not been described heretofore. In K lingmiiller's exhaustive review of leprosy (4), which comprises the world's literature up to 1930, there are no indications that this condition has been recorded. Among the reports on leprosy that have appeared since 1930 I have not found one that refers to it. In examinations of patients with skin lesions of leprosy the presence of the generally known specific manifestations is noted, manifestations which are responsible for the extreme heterogenity and diversity of the clinical picture. Among tliem are different kinds of macules-erythematous, pigmented, depigmented. On the background of these macules striking follicular changes are frequently observed. Thus Henderson described . five kinds of such lesions. Besides them there are observed different kinds of infiltrations-marginated and diffuse-as well as leprous nodules, often found together; these can be differentiated from one another by their appearance, which is related to their duration. More detailed examination of the skin of some patients has disclosed, besides the presence of other elements, small follicular spots, varying in size from that of the head of a pin up to that of a millet seed, that are usually of yellow or yellowish-brownish color though sometimes they are more reddish. Only a smaller part of them, those that are located at the periphery of the affected areas, retain hairs in the centers ; as a rule they do not have hairs and, indeed, even the follicular opening may be absent (Plate 16, fig. 1). A characteristic of these follicular spots is superficial atrophy. The epithelium is thin and forms fine wrinkles on lateral pressure, and because of atrophy the spots appear sunken in comparison with the surrounding surf~ce. They are not perceptible on palpation.