Lupus vulgaris
Lupus vulgaris | |
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Other names | Tuberculosis luposa |
Infectious disease |
Lupus vulgaris (also known as tuberculosis luposa[1]) are painful cutaneous tuberculosis skin lesions with nodular appearance, most often on the face around the nose, eyelids, lips, cheeks, ears[2] and neck. It is the most common Mycobacterium tuberculosis skin infection.[3] 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
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Lupus vulgaris, changes in skin in hyperkeratotic forms
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Lupus vulgaris in a woman, late 19th century
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Lupus vulgaris in a man, c. 1900
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Advanced lupus vulgaris over the entire face and neck
Cause
Lupus vulgaris often develops due to inadequately treated pre-existing tuberculosis.[3] It may also develop at site of BCG vaccination.[4] Rarely, it has been shown to be associated with tattoo marks.[5]
Histopathology
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[3]
- Sarcoidosis[3]
- Discoid lupus erythomatosus[3]
- Leprosy[4]
- Deep fungal infection[4]
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).[3]
Prognosis
In longstanding scarred lesions, squamous-cell carcinoma can develop.[3]
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
Queen Alexandra of Great Britain, (1844–1925), consort to Edward 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".[7]
See also
- Miliary tuberculosis
- Tuberculous gumma (metastatic tuberculous abscess or ulceration)
- List of skin conditions
References
- ISBN 978-1-4160-2999-1.
- ISBN 978-0-7216-2921-6.
- ^ ISBN 9780443071409.
- ^ ISBN 9781840765960.
- S2CID 45399120.
- PMID 25396129.
- ^ "Lupus", Oxford English Dictionary, online second edition. Accessed 2006
External links
- 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.