Lupus vulgaris (also known as tuberculosis luposa) are painful cutaneous

tuberculosis Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in ...

skin lesions with nodular appearance, most often on the face around the nose,

eyelid An eyelid is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. The human eyel ...

s, lips, cheeks, ears and neck. It is the most common ''

Mycobacterium tuberculosis ''Mycobacterium tuberculosis'' (M. tb) is a species of pathogenic bacteria in the family Mycobacteriaceae and the causative agent of tuberculosis. First discovered in 1882 by Robert Koch, ''M. tuberculosis'' has an unusual, waxy coating on its c ...

'' skin infection. The lesions may ultimately develop into disfiguring

skin ulcer An ulcer is a sore on the skin or a mucous membrane, accompanied by the disintegration of tissue. Ulcers can result in complete loss of the epidermis and often portions of the dermis and even subcutaneous fat. Ulcers are most common on the skin of ...

s if left untreated.

Signs and symptoms

It begins as painless reddish-brown nodules which slowly enlarge to form irregularly shaped red

plaque Plaque may refer to: Commemorations or awards * Commemorative plaque, a plate or tablet fixed to a wall to mark an event, person, etc. * Memorial Plaque (medallion), issued to next-of-kin of dead British military personnel after World War I * Pla ...

. File:Lupus vulgaris.jpg, Lupus vulgaris, changes in skin in hyperkeratotic forms File:Lupus vulgaris 2.jpg, Lupus vulgaris in a woman in 19th century

Cause

Lupus vulgaris often develops due to inadequately treated pre-existing

. It may also develop at site of BCG vaccination. Rarely, it has been shown to be associated with tattoo marks.

Histopathology

Histologically Histology, also known as microscopic anatomy or microanatomy, is the branch of biology Biology is the scientific study of life. It is a natural science with a broad scope but has several unifying themes that tie it together as a single ...

, it shows presence of epithelioid cell

granuloma A granuloma is an aggregation of macrophages that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such substances include infectious ...

s with

Langhans giant cell Langhans giant cells are large cells found in granulomatous conditions. They are formed by the fusion of epithelioid cells ( macrophages), and contain nuclei arranged in a horseshoe-shaped pattern in the cell periphery. Although traditionally ...

s with or without central

caseation Caseous necrosis or caseous degeneration () is a unique form of cell death in which the tissue maintains a cheese-like appearance.Robbins and Cotran: Pathologic Basis of Disease, 8th Ed. 2010. Pg. 16 It is also a distinctive form of coagulative nec ...

necrosis in the

dermis The dermis or corium is a layer of skin between the epidermis (with which it makes up the cutis) and subcutaneous tissues, that primarily consists of dense irregular connective tissue and cushions the body from stress and strain. It is divided i ...

Diagnosis

diascopy Diascopy is a test for blanchability performed by applying pressure with a finger or glass slide and observing color changes.Marks, James G; Miller, Jeffery (2006). ''Lookingbill and Marks' Principles of Dermatology'' (4th ed.). Elsevier Inc. Page ...

, it shows characteristic "apple-jelly" color. Biopsy will reveal tuberculoid

with few bacilli.

Mantoux test The Mantoux test or Mendel–Mantoux test (also known as the Mantoux screening test, tuberculin sensitivity test, Pirquet test, or PPD test for purified protein derivative) is a tool for screening for tuberculosis (TB) and for tuberculosis diagn ...

is positive.

Differential diagnosis

The condition should be distinguished from: *

Basal cell carcinoma Basal-cell carcinoma (BCC), also known as basal-cell cancer, is the most common type of skin cancer. It often appears as a painless raised area of skin, which may be shiny with small blood vessels running over it. It may also present as a raise ...

Sarcoidosis Sarcoidosis (also known as ''Besnier-Boeck-Schaumann disease'') is a disease involving abnormal collections of inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph nodes. Less commonly af ...

* Discoid lupus erythomatosus *

Leprosy Leprosy, also known as Hansen's disease (HD), is a long-term infection by the bacteria ''Mycobacterium leprae'' or ''Mycobacterium lepromatosis''. Infection can lead to damage of the nerves, respiratory tract, skin, and eyes. This nerve damag ...

* Deep fungal infection

Management

A dermatologist or general physician usually administers combination therapy of drugs used for tuberculosis, such as

Rifampicin Rifampicin, also known as rifampin, is an ansamycin antibiotic used to treat several types of bacterial infections, including tuberculosis (TB), mycobacterium avium complex, ''Mycobacterium avium'' complex, leprosy, and Legionnaires’ disease. ...

Isoniazid Isoniazid, also known as isonicotinic acid hydrazide (INH), is an antibiotic used for the treatment of tuberculosis. For active tuberculosis it is often used together with rifampicin, pyrazinamide, and either streptomycin or ethambutol. For l ...

and

Pyrazinamide Pyrazinamide is a medication used to treat tuberculosis. For active tuberculosis, it is often used with rifampicin, isoniazid, and either streptomycin or ethambutol. It is not generally recommended for the treatment of latent tuberculosis. It i ...

(possibly with either

streptomycin Streptomycin is an antibiotic medication used to treat a number of bacterial infections, including tuberculosis, ''Mycobacterium avium'' complex, endocarditis, brucellosis, ''Burkholderia'' infection, plague, tularemia, and rat bite fever. Fo ...

ethambutol Ethambutol (EMB, E) is a medication primarily used to treat tuberculosis. It is usually given in combination with other tuberculosis medications, such as isoniazid, rifampicin and pyrazinamide. It may also be used to treat ''Mycobacterium avi ...

Prognosis

In longstanding scarred lesions,

squamous cell carcinoma Squamous-cell carcinomas (SCCs), also known as epidermoid carcinomas, comprise a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on the ...

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 Niels Ryberg Finsen (15 December 1860 – 24 September 1904) was a Faroese- Icelandic physician and scientist. In 1903, he was awarded the Nobel Prize in Medicine and Physiology "in recognition of his contribution to the treatment of diseases, ...

using a form of "concentrated light radiation" now known as Photobiomodulation which won him a Nobel Prize.

Queen Alexandra Alexandra of Denmark (Alexandra Caroline Marie Charlotte Louise Julia; 1 December 1844 – 20 November 1925) was Queen of the United Kingdom and the British Dominions, and Empress of India, from 22 January 1901 to 6 May 1910 as the wife of King ...

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".

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 Lupus erythematosus is a collection of autoimmune diseases in which the human immune system becomes hyperactive and attacks healthy tissues. Symptoms of these diseases can affect many different body systems, including joints, skin, kidneys, blo ...

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

References

External links

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University of Iowa The University of Iowa (UI, U of I, UIowa, or simply Iowa) is a public university, public research university in Iowa City, Iowa, United States. Founded in 1847, it is the oldest and largest university in the state. The University of Iowa is org ...

(graphic)
Image of lupus vulgaris, 1914
fro
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 The Osler Library, a branch of the McGill University Library and part of ROAAr since 2016, is Canada's foremost scholarly resource for the history of medicine, and one of the most important libraries of its type in North America. It is located i ...

McGill University McGill University (french: link=no, Université McGill) is an English-language public research university located in Montreal, Quebec, Canada. Founded in 1821 by royal charter granted by King George IV,Frost, Stanley Brice. ''McGill Universit ...

. {{Diseases of the skin and subcutaneous tissue Tuberculosis Mycobacterium-related cutaneous conditions