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            The British Journal of Dermatology, April, 1905




                  THE BRITISH JOURNAL OF DERMATOLOGY.

                              APRIL, 1905.




                     XANTHO-ERYTHRODERMIA PERSTANS.
                        By H. RADCLIFFE-CROCKER.


The above provisional clinical title was suggested to me by my coadjutor
at University College Hospital, Mr. George Pernet, for a well-defined
affection of the skin, of which I have met with ten instances during the
last three years, all but one of them in private practice. I am not
aware that the disease in question has been described before, unless it
can be brought under Brocq’s “erythrodermies pityriasiques en plaques
disseminées,” with which it will be closely compared when the cases
themselves have been considered.

A case which I showed at the Dermatological Society of London in
October, 1904, when Drs. Hallopeau, Gastou, Jacquet and Pautrier were
present, was not regarded by them as a case of Brocq’s disease, with
which they were presumably familiar, but as an entirely new affection in
their experience.

The following description is drawn up from nine of the cases, all males,
which, in the main features, closely resemble each other. The remaining
case, a lady, had some important differences which will be discussed
later.

So far, all the cases have been adults, though some of them were young.
The lesions are evolved in patches of a pale pink or yellowish hue on
the limbs and trunk, the uncovered parts, such as the face and hands,
being free or very slightly affected. Generally, the patches come out
very gradually and in small numbers and, in the main, symmetrically, but
as the older patches never go away spontaneously, while fresh ones are
continually evoluting at short or long intervals, large areas are
involved, and in the course of years (in one case, months) the whole
trunk and limbs are crowded with lesions, though there are always spaces
of normal skin intervening, or sometimes completely enclosed by the
diseased process, where the original patches have coalesced. For the
most part the original patches are discrete and enlarge but little after
their formation, unless they merge into adjoining patches, when
hand-sized or larger areas may be formed.

With regard to individual patches, they are usually of oval or elongated
form, arranged symmetrically in oblique lines on the back in the
direction of the ribs, probably in the lines of fission, more or less
horizontal in direction in front, and often, but not always, in vertical
lines on the limbs. On the latter, especially the thighs, they not
infrequently present the appearance of streaks formed by the finger, the
upper part of the stroke being abrupt, and the lower shading off. This
may sometimes also be seen on the trunk. The majority of the single
patches range from one to three inches in their longest diameter; the
borders are not very well-defined nor raised above the rest, but there
is no difficulty in discerning the morbid from the healthy skin. They
are not raised above the surface, but may be rather deep in the cutis.
Infiltration can often be distinctly felt when the patch is pinched up
in comparison with the adjoining healthy tissues, but in the more recent
and smaller patches it is imperceptible, and occasionally they look like
mere stains. Their colour is either pale pink or yellowish; in some
cases the yellowish hue is pronounced, in others absent or nearly so; on
the lower limbs the pink hue predominates. The surface is smooth on the
trunk, but is often slightly rough on the arms and thighs, and below the
knees maybe distinctly rough or even in branny scales. The patches are
never so marked on the upper as on the lower limbs, the palms are always
free, and the backs of the hands are generally unaffected, but sometimes
there are a few small patches below the wrist. The face is nearly always
free, though I have seen faint patches in one case. There is very little
to suggest that the disease is inflammatory, and itching is quite absent
in most of the cases; a few patients said they had some itching when
hot, but only in one case was it really complained of, and that only in
the early evoluting stage of the patches. The initial site for the
lesions varies; the thighs are the most frequently first affected, the
legs next in frequency, and then the trunk. The lower limbs, too, are
generally more crowded with lesions than other parts.

The duration of the disease may be very long. My first case had been
developing for over ten years, others had been only for a few months;
but in the case of a medical man, over 50 when I saw him, he said that
patches first appeared on his legs when he was a house-surgeon, and had
been slowly evolving ever since, so that after thirty years he was
pretty thickly covered, as none as far as he knew had gone entirely
away, though they had temporarily disappeared when he had rubbed in
chrysarobin ointment, but had gradually returned to their old site.

The disease is compatible with perfect health; and even when there was
any departure from the normal there was no reason to suppose that the
abnormality was in any way connected with the skin lesions, while the
majority of the patients