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SUMMAHYThe distinctive clinical and histological features of an extensive case of hyperlceraiosis lenticularis perstans and the rapid and complete response to topical applications of betamethasone-2 7-valerate are recorded. No previous record of effective treatment has been described in the four male cases previously recorded in the literature.A 57 year old female has also been studied with a twenty year old history of an unremitting progressive eruption showing the clinical and histological features of hyperkeratosis lenticularis perstans. In this patient initial response to topical therapy with betamethasone-17-valerate is most gratifying, ai^d is the first treatment to influence the signs and symptoms of the disease state.

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CASES liave been reported of a skin disease resembling diffuse scleroderma, but in whicli subcutaneous nodules have been present. Under the name of " nodular scleroderma " several such cases have been recorded. Dubreuilh (1906) described a ^foman of 44 years with an almost generalized eruption of small nodules wliich were almost confluent on the extremities, shoulders and neck, discrete on the upper part of the trunk and absent on the abdomen and back. The individual lesions were white or yellowish-white, round, smooth nodules from one to two millimetres in diameter, firm to the touch and exhibiting no signs of inflammation. Histologieally there was an increase in the fibrous tissue accompanied by a slight round cell infiltration, which was most marked about hair follieles and gradually faded into the surrounding tissues.Eeitman (1908) reported a Avoman, aged 40 years, in whom there was a dill'use thickening of a ijeculiar alabaster white nature a,bout the nose and neighbouring parts of the cheeks, whicli had been present for several years. There were tiny papules on the nose and ears. The lips w~ere sclerotie, so that opening of the month was difficult. The skin of the neck and hands was infiltrated and studded with tiny follicular papules, Avhile on the lower limbs the skin w-as indnrated but no papules w-ere seen. The mucous membrane covering the right side of the soft palate was sclerotic to palpation, and on the right cheek the impressions of the teeth conld be seen. Histologieally there was a thickening of the cutis with an increased amonnt of fibrous connective tissue. In some of the larger blood vessels there w^as proliferation of the intima and endarteritis. The sweat glands were surrounded by a eellnlar infiltration. Lipschntz (1913) reported a case of selerodaetylia with several tender bean-shaped nodnles. Biopsy of the nodnles showed hypertrophy of the connective tissue, endothelial proliferation and adventitial eellnlar infiltration in the vessels and the deeper parts of the dermis. Lipsehutz considered the case one of selerodaetylia with circmnscribed fibrons nodosities, possibly analogous to those appearing in idiopathic atrophy of the skin.Brnhn's (1921) patient with nodnlar scleroderma was a boy aged 13 years. The skin of the chest and abdomen w^as stippled by browaiish-blne, lentil-sized nodnles, which w^ere raised above the level of the snrronnding skin. The left thigh was involved by a typieal band of scleroderma, roniid >vhieh were lesions, similar to those on the chest. On the left calf, right biittoek and in the right seapular region w^ere nodnlar lesions which were not raised appreciably above

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THE word Hnea m Romau times, after signifying (lie insect wLich "naws cJothes and books (Horace), came later to mean any verminonK or parasitic mfesta;tion of the skiji (Galen). Sabonraud (1904) fonnd that in tbe sixth century the word still retamed this sigrnificance. Steplicn of Antiocli (J525), translating the t,welfth century medical text of Haly-Abbas, used tinea to describe all diseases of the hairy scalp. The tinea favosa of this era is onr modern impetiqo, and tmea lupmosa (Gny de Chanliac, 1641) is om-favus. This mediaeval clasaification remamed m vogue until the be^iinning of the nineteenth centnry and, in France .Gilbert was the last to adhere to the traditional teaching. However, he used favus in the sense whicli is still cnrrent, although the original tinea favosa 'was a bacterial and not a fuagal infection. In England, WiUan expanded Plenk's suggestions and reolassified skin diseases ; thns tinea favosa became porriqo favom and tinea lupinosa became porrigo lupinosa.Ringworm has been a familiar word in onr language since the sixteenth centnry. The Shorter Oxford English Dictionary records its nse in 1647, and Morns (1898) refers to its iiso almost 80 years earlier. At first, ringwmm. was used m England in the same vagne way that tinea was used iu Enrope : ringworm referred to any skin disease in which the lesions were im-anged in l-ings. Tnrner (1736) seems to Inwe been the first to describe the breaking of diseased scalp hairs n\ tinea eapitia. Bateman (1829) flrst nsed the term porrigo scutulata or ringworm of the scalp and separated the condition from pwrigo lupinosa His cbnical description was not good, and Samuel Plnmbe (1837) was the first Englishman to ^YVQ a clear clinieal description of the disease. Alibert's pupil Biett, mtroduced WilJan's classification to France, bnt in doing so he transposed Willan's porrigo favosa {impetigo) and used it to designate favus, pei-petnatin"' tbe error of Alibert. Thns at the beginning of the nineteenth century Biett and Bateman nsed tbe same term to refer to two different diseases. ' Biett also failed to appreciate Bateman's deRcriptiou of pwrigo seutulata {tinea capitis) aud of porrtgo decalvans (alopecia areata) and grouped both these conditions under his heading of porngo favosa. This action of Biett added to the confusion m the first years of the nineteenth cent_my, and in France it was not mitil about 1820 that Mahon tirst clearly distinguished clinically between tinea capitis and favus. His observations were reported by his brother in 1829, but appear to have been overlooked until (^azenave redescribed tinea capitis nnder the name of herpes tonsurans in 1843.

SUMMARY Trichofolliculoma is a rare tumour occurring on the face. The characteristic “wool wisp” protruding from the tumour makes it clinically recognizable in most cases, and the typical histological picture confirms the diagnosis.