At the margin of these squamous patches numerous isolated, white-tipped papular lesions may frequently be seen. The scalp is generally affected when the disease has existed for some time, and the face often presents an appearance suggestive of ichthyosis.
In the rugous form or stage of the disease the affected portions of skin present a dull-red, leathery appearance, with slight scaling and deep parallel furrows (see plate and Fig. 48). Upon the hands the skin sometimes becomes shrivelled and drawn to an extent which seriously interferes with the motion of the fingers (Fig. 49), while the nails show marked evidence of malnutrition. In some cases nodular ridges are found at the bend
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Fig. 49.—Chronic form of disease.
of the elbow, upon the pubes, and elsewhere, and present a moniliform or bead-like appearance (Fig. 50).
Itching is commonly present, and often very severe and annoying in advanced cases, and an exacerbation of the eruption is frequently preceded by an intense burning sensation.
The prognosis in lichen ruber is an unfavorable one. Although the disease may yield to judicious treatment, and even improve spontaneously, a long series of relapses may be looked for, and a fatal termination be predicted in many cases. The reported cure of cases by French and German writers may be readily explained by their belief in the identity of lichen ruber and lichen planus.
