Lupus vulgaris

Lupus vulgaris (also known as tuberculosis luposa[1]) are painful cutaneous tuberculosis skin lesions with nodular appearance, most often on the face around the nose, eyelids, lips, cheeks, ears[2] and neck. It is the most common Mycobacterium tuberculosis skin infection.[3] The lesions may ultimately develop into disfiguring skin ulcers if left untreated.

Lupus vulgaris
Other namesTuberculosis luposa
Lupus vulgaris
SpecialtyInfectious disease

Signs and symptoms

It begins as painless reddish-brown nodules which slowly enlarge to form irregularly shaped red plaque.[3]

  • Lupus vulgaris, changes in skin in hyperkeratotic forms
    Lupus vulgaris, changes in skin in hyperkeratotic forms
  • Lupus vulgaris in a woman, late 19th century
    Lupus vulgaris in a woman, late 19th century
  • Lupus vulgaris in a man, c. 1900
    Lupus vulgaris in a man, c. 1900

Cause

Lupus vulgaris often develops due to inadequately treated pre-existing tuberculosis.[3] It may also develop at site of BCG vaccination.[4] Rarely, it has been shown to be associated with tattoo marks.[5]

Histopathology
Dermis showing well-formed granulomas with necrotic centers

Histologically, it shows presence of epithelioid cell granulomas with Langhans giant cells with or without central caseation necrosis in the dermis.[6]

Diagnosis

On diascopy, it shows characteristic "apple-jelly" color. Biopsy will reveal tuberculoid granuloma with few bacilli. Mantoux test is positive.

Differential diagnosis

The condition should be distinguished from:

Management

A dermatologist or general physician usually administers combination therapy of drugs used for tuberculosis, such as rifampicin, isoniazid, and pyrazinamide (possibly with either streptomycin or ethambutol).[3]

Prognosis

In longstanding scarred lesions, squamous-cell carcinoma can develop.[3]

History

In the 19th century, the chronic and progressive nature of this disease was particularly marked: it remained active for ten years, twenty years, or even longer and, proved resistant to all treatment until the breakthrough by Niels Ryberg Finsen using a form of "concentrated light radiation" or light therapy (now known as photobiomodulation) which won him a Nobel Prize.

Queen Alexandra of Great Britain, (1844–1925), consort to Edward VII, as the inscription on the bronze statue of her at the London Hospital, notes, "Introduced to England the Finsen light cure for Lupus, and presented the first lamp to this hospital".

Etymology

The term "lupus" (meaning "wolf" in Latin) to describe an ulcerative skin disease dates to the late thirteenth century, though it was not until the mid-nineteenth that two specific skin diseases were classified as lupus erythematosus and lupus vulgaris. The term may derive from the rapacity and virulence of the disease; a 1590 work described it as "a malignant ulcer quickly consuming the neather parts; ... very hungry like unto a woolfe".[7]

See also

References
  1. Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. pp. Chapter 74. ISBN 978-1-4160-2999-1.
  2. James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. p. 335. ISBN 978-0-7216-2921-6.
  3. Dermatology: An Illustrated Colour Text, 3rd ed. Elsevier Health Sciences. 2002. p. 46. ISBN 9780443071409.
  4. Dermatology - A colour handbook, 2nd ed. Manson Publishing. 2010. p. 216. ISBN 9781840765960.
  5. Ghorpade, A (27 August 2003). "Lupus vulgaris over a tattoo mark--inoculation tuberculosis". Journal of the European Academy of Dermatology and Venereology. 17 (5): 569–71. doi:10.1046/j.1468-3083.2003.00787.x. PMID 12941097. S2CID 45399120.
  6. Varadraj, Vasant Pai (2014). "A clinico-histopathological study of lupus vulgaris: A 3 year experience at a tertiary care centre". Indian Dermatol Online J. 5 (4): 461–465. doi:10.4103/2229-5178.142497. PMC 4228641. PMID 25396129.
  7. "Lupus", Oxford English Dictionary, online second edition. Accessed 2006
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