PYELO - NEPHRITriS IN CHILDREN

chiefly on the trunk and is diffuse, but deepest on areas normally pigmented. A characteristic feature is that the brown area is dappled over with lighter spots, as though it had been rained upon, the so-called " raindrop pigmentation." Arsenical pigmentation is usually accompanied by keratoses on the palms and soles and possibly by other signs of arsenical poisoning. There are two types of depigmentation which should not cause difficulty in diagnosis,viz.,vitiligo and syphilitic leucoderma. Vitiligo occurs anywhere, often on the hands, face and neck. The areas are irregular, often large, thl-e margins of the patches are sharp, and there is often hyperpigmentation around the patches. When the areas involved are large, sometimes it is difficullt to decide which is the normal skin, the white or the dark. The convex edges of the white patches enable one to recognize that it is the white which is abnormal, while the dark is normal. Syphilitic leucoderma is almost confined to the sides of the neck; the areas are small, oval, and of uniform size. They fade gradually into the darker areas, giving a very characteristic dappled effect. Dermatitis artefacta is generally easy but sometimes difficult to diagnose. It always occurs on places which can be reached by the patient. The appearances are usually odd and not like any known skin disease. They may be produced in various ways, e.g., by applying lysol or carbolic acid to the skin, or merely by rubbing with a wet finger. The patients are usually women and often show evidence of h'steria, e.g., anaestllesia of the bulbar conjunctiva and soft palate, and suggestion anaesthcsia to pin pricks. They often seem really to be unaware that they produce the lesions themselves, and it is generally impossible to persuade the sympathetic relatives, and sometimes even the family doctor, that the lesions are artificial ! I will close with a word about drug etruptions. Remember that acneiform lesions with comedones can be produced bychlorine or tar, usually on the peiiis, scrotum, and arms, while bromides and iodides can produce pustular lesions resembling acne, but without comedones, on the face and back. Iodides may produce also fleshy masses resembling gummata or sarcomata on the face, forearms, and hands, and if these are mistaken for gummata the iodide mnay be pushed and the condition aggravated. Bromides may produce papillomatous masses covered with numerous points exuding pus, especially on the legs. These may persist for some time after the ingestion of the drug has been stopped, and so lead to difficulty in diagnosis.