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August 22, 1953


Author Affiliations

San Francisco

From the Department of Medicine (Subdepartment of Dermatology), University of California School of Medicine.

JAMA. 1953;152(17):1606-1610. doi:10.1001/jama.1953.03690170020007

Hellerström, of Stockholm, first mentioned the possibility of cutaneous tuberculosis developing in abrasions from public swimming pools. He described six facial lesions, five of which followed abrasions sustained in the same pool.1 Water and sediment from the pool involved in the sixth case produced tuberculosis in a guinea pig. With material from the infected animal, tubercle bacilli were grown on a special medium. Hellerström's patients were males, aged 14 to 29 years, with no history of tuberculosis. In five pulmonary findings were normal, and in the sixth there were small hilar calcifications. In five the tuberculin reaction was negative before and positive after the injury. The clinical picture was strikingly uniform, with soft reddish-brown papules, pinhead to split pea in size and crusted and coalescent. The initial swimming pool abrasions became covered with epithelium but gave rise to granulomas without a period of perfect healing. Diascopy showed lupus vulgaris