Signs and symptoms
It begins as painless reddish-brown nodules which slowly enlarge to form irregularly shaped red Cutaneous conditions#Primary lesions, plaque.Cause
Lupus vulgaris often develops due to inadequately treated pre-existing tuberculosis. It may also develop at site of BCG vaccine, BCG vaccination. Rarely, it has been shown to be associated with tattoo marks.Histopathology
Histologically, it shows presence of epithelioid cell granulomas with Langhans giant cells with or without central caseation necrosis in the dermis.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: * Basal cell carcinoma * Sarcoidosis * Discoid lupus erythematosus, Discoid lupus erythomatosus * Leprosy * Mycosis, Deep fungal infectionManagement
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
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" now known as Light therapy, Photobiomodulation which won him a Nobel Prize. Alexandra of Denmark, Queen Alexandra of Great Britain, (1844–1925), consort to Edward VII, 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 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 2006See also
* Miliary tuberculosis * Metastatic tuberculous abscess or ulceration * List of cutaneous conditionsReferences
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