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Erythrose Peribuccale Pigmentrire

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This disease, which was described by Brocq in 1923, is characterized by a combination of erythema and diffuse brownish or brownish-red pigmentation of the perioral region. Although most marked about the mouth, it extends over the chin and along the nasolabial folds as far as the foreihead. A narrow margin of normal skin separates the vermilion of the lips form  the affected area. The disease is bilaterally symmetrical and is definitely outlined at the lateral margins. The intensity of the discoloration varies greatly from day to day and even from hour to hour but the outline of the area involved alters remarkably little over periods of months and years. The disease is closely related to rosacea. Recurrent congestion of the flush area of the face may terminate in a permanent erythema, due to vasodilatation. In addition, there is the pigmentation with its well-defined, unchanging borders, marked symmetry and extreme resistance to therapy that are akin to the manifestations of chloasma. Most of the cases described have occurred in women who have had seborrheic skins and endocrine disturbances. Treatment is the same as for rosacea, prescribing a diet, injections of  strogens and a bleaching cream. Coffee should be completely interdicted.

                                                 ACNE VARIOLIFORMIS

Synonyms. Acne necrotica, acne frontalis, acne atrophica, necrotic granuloma.

Acne varioliformis is characterized by the appearance of superficial indolent brownish-red papulopustules on the forehead, scalp, or other areas. The lesions are follicular, being pierced by lanugo hairs, and tend rapidly to undergo central necrosis, with the formation of a slight central depression and incrustation, Fairly large pitted scars may eventually result, resembling those of variola. The lesions have a tendency to appear more or less in crops and to recur over a period of years. Unusual cases may show involvement of the nose, ears, or trunk, and severe extensive eruptions have been noted. The disease is comparatively rare and the majority of patients are adults. Its etiology is unknown, but it is sometimes classified as a tuberculid.

The disease responds temporarily to many measures, including irradiation. Five per cent ointments of ammoniated mercury or sulfur or antibiotic ointments are usually as efficacious as x-rays or ultraviolet light. In some cases, however, irradiation seems to evoke a more rapid cure, and to deter the liability to recurrences more than any medicinal treatment. Internally. acetarsone or antibiotics are sometimes curative.

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