|Other names||Tuberculosis luposa|
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 Mycobacterium tuberculosis skin infection. The lesions may ultimately develop into disfiguring skin ulcers if left untreated.
Signs and symptoms
It begins as painless reddish-brown nodules which slowly enlarge to form irregularly shaped red plaque.
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 marks.
Histologically, it shows presence of epithelioid cell granulomas with Langhans giant cells with or without central caseation necrosis in the 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:
- Basal cell carcinoma
- Discoid lupus erythomatosus
- Deep fungal infection
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".
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".
- ^ 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.
- ^ 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.
- ^ a b c d e f g h Dermatology: An Illustrated Colour Text, 3rd ed. Elsevier Health Sciences. 2002. p. 46. ISBN 9780443071409.
- ^ a b c Dermatology - A colour handbook, 2nd ed. Manson Publishing. 2010. p. 216. ISBN 9781840765960.
- ^ 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.
- ^ 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.
- ^ "Lupus", Oxford English Dictionary, online second edition. Accessed 2006
- Image at University of Iowa (graphic)
- Image of lupus vulgaris, 1914 from Our Friend, the Sun: Images of Light Therapeutics from the Osler Library Collection, c. 1901-1944. Digital exhibition by the Osler Library of the History of Medicine, McGill University.