Lupus vulgaris
{{Short description|Painful facial skin nodules due to infection by M. tuberculosis}}
{{Infobox medical condition
| name = Lupus vulgaris
| image = An introduction to dermatology (1905) Lupus vulgaris 2.jpg
| caption = Lupus vulgaris
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| field = Infectious disease
| synonyms = Tuberculosis luposa
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Lupus vulgaris (also known as tuberculosis luposa{{cite book |author1=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages=Chapter 74 |isbn=978-1-4160-2999-1}}) are painful cutaneous tuberculosis skin lesions with nodular appearance, most often on the face around the nose, eyelids, lips, cheeks, ears{{cite book |author1=James, William D. |author2=Berger, Timothy G. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |year=2006 |isbn=978-0-7216-2921-6 |pages=335 |display-authors=etal}} and neck. It is the most common Mycobacterium tuberculosis skin infection.{{cite book |title=Dermatology: An Illustrated Colour Text, 3rd ed |year=2002 |publisher=Elsevier Health Sciences |isbn=9780443071409 |pages=46}} 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.
File:Lupus vulgaris.jpg|Lupus vulgaris, changes in skin in hyperkeratotic forms
File:Lupus vulgaris 2.jpg|Lupus vulgaris in a woman, late 19th century
File:Fox Plate XLVIII.jpg|Lupus vulgaris in a man, c. 1900
File:The British journal of dermatology (1888) (14762351321).jpg|Advanced lupus vulgaris over the entire face and neck
Cause
Lupus vulgaris often develops due to inadequately treated pre-existing tuberculosis. It may also develop at site of BCG vaccination.{{cite book |title=Dermatology - A colour handbook, 2nd ed |year=2010 |publisher=Manson Publishing |isbn=9781840765960 |pages=216}} Rarely, it has been shown to be associated with tattoo marks.{{cite journal |last1=Ghorpade |first1=A |title=Lupus vulgaris over a tattoo mark--inoculation tuberculosis. |journal=Journal of the European Academy of Dermatology and Venereology |date=27 August 2003 |volume=17 |issue=5 |pages=569–71 |pmid=12941097 |doi=10.1046/j.1468-3083.2003.00787.x |s2cid=45399120}}
Histopathology
File:An introduction to dermatology (1905) Lupus vulgaris simplex.jpg
Histologically, it shows presence of epithelioid cell granulomas with Langhans giant cells with or without central caseation necrosis in the dermis.{{cite journal |last=Varadraj |first=Vasant Pai |year=2014 |title=A clinico-histopathological study of lupus vulgaris: A 3 year experience at a tertiary care centre |journal=Indian Dermatol Online J |volume=5 |issue=4 |pages=461–465 |doi=10.4103/2229-5178.142497 |pmid=25396129 |pmc=4228641 |doi-access=free}}
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).
Prognosis
File:Riehl Zumbusch Tafel XIV (2).jpg
In longstanding scarred lesions, squamous-cell carcinoma can develop.
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.
The inscription on a bronze statue of Queen Alexandra of Great Britain, (1844–1925), consort to Edward VII, at the Royal London Hospital, notes that she "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"."Lupus", Oxford English Dictionary, online second edition. Accessed 2006
See also
- Miliary tuberculosis
- Tuberculous gumma (metastatic tuberculous abscess or ulceration)
- List of skin conditions
References
{{Reflist}}
External links
{{Commons category}}
- [https://web.archive.org/web/20070807071651/http://tray.dermatology.uiowa.edu/~Clara/LupVulg001.htm Image] at University of Iowa (graphic)
- [https://digital.library.mcgill.ca/sun/fullrecord.php?ID=6837 Image of lupus vulgaris, 1914] from [https://digital.library.mcgill.ca/sun/index.php 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.
{{Gram-positive Actinomycetota diseases}}
{{Dermatitis and eczema}}
{{Medical resources
| DiseasesDB =
| ICD10 = {{ICD10|A|18|4|a|15}} (ILDS A18.420)
| ICD9 = {{ICD9|017.0}}
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| MedlinePlus =
| eMedicineSubj = derm
| eMedicineTopic = 434
| MeshID = D008177
}}
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