Symptoms

"It is sometimes preceded by malaise, anorexia and a slight febrile attack, but these prodromic symptoms are often wanting, or are so little marked that the attention of the patient is first attracted by the development of the vesicles.

Whatever be the seat of the eruption, it presents the following characters:

There is seen at first spots of a deep red color, small, rounded, a little raised, and with their edges clearly defined. These spots vary in size from that of a lentil to that of a twenty-five cent piece; they are sometimes surrounded by a rose-coloured areola; they show soon in their centre a small vesicle filled with transparent yellowish liquid. This vesicle appears the day following that of the red spot. It dries rapidly from the centre, which is occupied by a small blackish scab, whilst the liquid is absorbed from the cir­cumference. The phenomena takes place towards the second or third day of the eruption.


The subsequent phenomena are as follows : - The liquid in the circumference of the vesicle is reabsorbed, whilst that which occupies the centre becomes a blackish scab. At last it may happen, especially during cold weather, that the fluid exuded in the vesicle is absorbed rapidly. It will then have only a small whitish or yellowish macula, placed in the centre of a red disc, and formed by loosened epidermis. In this case it is that the affection has been confounded with erythema papulatum. On the mucous surfaces the vesicles are whitish and surrounded by a violet coloured areola - the scabs are detached sooner. The red discs and vesicles are more or less numerous. They are generally separated by intervals of sound skin; sometimes they are disposed in groups of two or three, touching at their circumference. They do not all appear at once, but by successive crops during many days. The affected parts have scarcely any itching. The febrile symptoms which exist rarely at the commencement cease when the eruption is developed.


The duration of hydroa vesiculeux is from two to four weeks; each element in the eruption taken by itself runs through its course in four or five days. The affection is prolonged for many weeks only by the eruption of fresh crops of vesicles. A relapse may take place.

The disease is seen in both sexes, but more frequently in the male. It appears among adults from twenty to thirty years of age. It is more frequent in spring and autumn; cold and variation of temperature have a marked influence on its appearance - and course. Finally it is always seen amongst people who have had still symptoms of gout."

"Hydroa vesiculeux," says Bazin, in continuing his description, which we have given above almost at length, "is essentially arthritic - at least we have always found it among arthritic subjects, and it has steadily presented clear relations to gouty manifestations."