rly and typical
appearance is that of brownish-yellow or pink nodules in the skin, about
the size of hemp seed. Healing frequently occurs in the centre of the
affected area while the disease continues to extend at the margin.

When there is actual destruction of tissue and ulceration--the so-called
"_lupus excedens_" or "_ulcerans_"--healing is attended with
cicatricial contraction, which may cause unsightly deformity. When the
cheek is affected, the lower eyelid may be drawn down and everted; when
the lips are affected, the mouth may be distorted or seriously
diminished in size. When the nose is attacked, both the skin and mucous
surfaces are usually involved, and the nasal orifices may be narrowed or
even obliterated; sometimes the soft parts, including the cartilages,
are destroyed, leaving only the bones covered by tightly stretched scar
tissue.

The disease progresses slowly, healing in some places and spreading at
others. The patient complains of a burning sensation, but little of
pain, and is chiefly concerned about the disfigurement. Nothing is more
characteristic of lupus than the appearance of fresh nodules in parts
which have already healed. In the course of years large tracts of the
face and neck may become affected. From the lips it may spread to the
gum and palate, giving to the mucous membrane the appearance of a
raised, bright-red, papillary or villous surface. When the disease
affects the gums, the teeth may become loose and fall out.

[Illustration: FIG. 96.--Tuberculous Elephantiasis in a woman aet. 35.]

On parts of the body other than the face, the disease is even more
chronic, and is often attended with a considerable production of dense
fibrous tissue--the so-called _fibroid lupus_. Sometimes there is a
warty thickening of the epidermis--_lupus verrucosus_. In the fingers
and toes it may lead to a progressive destruction of tissue like that
observed in leprosy, and from the resulting loss of portions of the
digits it has been called _lupus mutilans_. In the lower extremity a
remarkable form of the disease is sometimes met with, to which the term
_lupus elephantiasis_ (Fig. 96) has been applied. It commences as an
ordinary lupus of the toes or dorsum of the foot, from which the
tuberculous infection spreads to the lymph vessels, and the limb as a
whole becomes enormously swollen and unshapely.

Finally, a long-standing lupus, especially on the cheek, may become the
seat of epithelioma--_lupus