DISEASES   OF   THE   NOSE.  353

Diagnosis. — The  disease  resembles  syphilis  and  may  even  be
taken  for  rhino-scleroma.  In  the  non-ulcerative  form  of  lupus,
small  brownish-red  tubercular  nodules  are  observed  in  the  skin  or
mucous  membrane,  which  may  disappear  by  a  process  of  absorp-
tion and  desquamation  of  the  epidermis  with  formation  of  deep
channels  of  cicatricial  tissue.  Upon  detachment  of  the  brown
crusts  in  the  ulcerated  form  of  the  disease,  there  remains  a  soft,


FlG.    115. — LUPUS   OF   THE   NOSE   AND   MOUTH.
Case,  age  thirty-five.
granular  ulcer  covered  with  mucus.     Grasping  the  tissue  with  a
fixation  forceps,  the  tissue  forming  the  periphery  and  base  of  the
ulcer  is  found  to  be  soft  and  is  detached  as  a  granular  mass.    The
soft  tissue  can  be  removed  with  but  little  hemorrhage  with  a  curette.
The  pain  from  curettement  is  very  severe.     A  history  of  prolonged
nasal  discharge  should  suggest  the  possibility  of  lupus.
The   disease  is  differentiated  from  syphilis  by  its  failure  to  re-
23


354  DISEASES   OF   EAR,    NOSE   AND   THROAT.
spond  to  antisyphilitic  treatment,  from  epithelioma  by  microscopical
examination.
Treatment. — The  treatment  is  usually  curettement  in  the  ulcerative
stages  and  the  daily  application  of  the  X-ray  together  with  the
correction  of  any  constitutional  dyscrasia.  Plastic  operation  may
be  resorted  to  for  the  correction  of  the  nasal  deformity.
