Lupus vulgaris
| Lupus vulgaris | |
|---|---|
_Lupus_vulgaris_2.jpg) |
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| Lupus vulgaris | |
| Classification and external resources | |
| ICD-10 | A18.4 (ILDS A18.420) |
| ICD-9-CM | 017.0 |
| eMedicine | derm/434 |
| MeSH | D008177 |
Lupus vulgaris (also known as Tuberculosis luposa) are painful cutaneous tuberculosis skin lesions with nodular appearance, most often on the face around the nose, eyelids, lips, cheeks, ears and neck. It is the most common M. tuberculosis skin infection. The lesions may ultimately develop into disfiguring skin ulcers if left untreated.
It begins as painless reddish-brown nodules which slowly enlarge to form irregularly shaped red plaque.
Lupus vulgaris, changes in skin in hyperkeratotic forms
Lupus vulgaris in a woman in 19th century
Lupus vulgaris often develops due to inadequately treated pre-existing tuberculosis. It may also develop at site of BCG vaccination. Rarely, it has been shown to be associated with tattoo mark and also with long term bindi use, the so-called "bindi tuberculosis".
Histologically, it shows well-formed granulomas with necrotic centers in dermis.
On diascopy, it shows characteristic "apple-jelly" color. Biopsy will reveal tuberculoid granuloma with few bacilli. Mantoux test is positive.
The condition should be distinguished from:
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).
In longstanding scarred lesions, squamous cell carcinoma can develop.
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" now known as Photobiomodulation which won him a Nobel Prize. Queen Alexandra of Great Britain, (1844–1925), consort to Edward the 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".
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