| Lupus vulgaris | |
|---|---|
| Other names | Tuberculosis luposa |
 | |
| Lupus vulgaris | |
| Specialty | 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.
It begins as painless reddish-brown nodules which slowly enlarge to form irregularly shaped red plaque. [3]
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]
Histologically, it shows presence of epithelioid cell granulomas with Langhans giant cells with or without central caseation necrosis in the dermis. [6]
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:
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]
In longstanding scarred lesions, squamous-cell carcinoma can develop. [3]
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".
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]
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 the lower extremities and in the gastrointestinal tract. An ulcer that appears on the skin is often visible as an inflamed tissue with an area of reddened skin. A skin ulcer is often visible in the event of exposure to heat or cold, irritation, or a problem with blood circulation.
A mouth ulcer (aphtha) is an ulcer that occurs on the mucous membrane of the oral cavity. Mouth ulcers are very common, occurring in association with many diseases and by many different mechanisms, but usually there is no serious underlying cause. Rarely, a mouth ulcer that does not heal may be a sign of oral cancer. These ulcers may form individually or multiple ulcers may appear at once. Once formed, an ulcer may be maintained by inflammation and/or secondary infection.
Cutaneous squamous-cell carcinoma (cSCC), also known as squamous-cell carcinoma of the skin or squamous-cell skin cancer, is one of the three principal types of skin cancer, alongside basal-cell carcinoma and melanoma. cSCC typically presents as a hard lump with a scaly surface, though it may also present as an ulcer. Onset and development often occurs over several months. Compared to basal cell carcinoma, cSCC is more likely to spread to distant areas. When confined to the epidermis, the outermost layer of the skin, the pre-invasive or in situ form of cSCC is termed Bowen's disease.
Granuloma inguinale is a bacterial disease caused by Klebsiella granulomatis characterized by genital ulcers. It is endemic in many less-developed regions. It is also known as donovanosis, granuloma genitoinguinale, granuloma inguinale tropicum, granuloma venereum, granuloma venereum genitoinguinale, lupoid form of groin ulceration, serpiginous ulceration of the groin, ulcerating granuloma of the pudendum, and ulcerating sclerosing granuloma. Oral manifestations are also notably seen. The lesions of oral cavity are usually secondary to active genital lesions.
Panniculitis is a group of diseases whose hallmark is inflammation of subcutaneous adipose tissue. Symptoms include tender skin nodules, and systemic signs such as weight loss and fatigue.
Miliary tuberculosis is a form of tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions (1–5 mm). Its name comes from a distinctive pattern seen on a chest radiograph of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds—thus the term "miliary" tuberculosis. Miliary TB may infect any number of organs, including the lungs, liver, and spleen. Miliary tuberculosis is present in about 2% of all reported cases of tuberculosis and accounts for up to 20% of all extra-pulmonary tuberculosis cases.
Tuberculosis verrucosa cutis is a rash of small, red papules and nodules in the skin that may appear two to four weeks after inoculation by Mycobacterium tuberculosis in a previously infected and immunocompetent individual.
The oral mucosa is the mucous membrane lining the inside of the mouth. It comprises stratified squamous epithelium, termed "oral epithelium", and an underlying connective tissue termed lamina propria. The oral cavity has sometimes been described as a mirror that reflects the health of the individual. Changes indicative of disease are seen as alterations in the oral mucosa lining the mouth, which can reveal systemic conditions, such as diabetes or vitamin deficiency, or the local effects of chronic tobacco or alcohol use. The oral mucosa tends to heal faster and with less scar formation compared to the skin. The underlying mechanism remains unknown, but research suggests that extracellular vesicles might be involved.
Necrobiosis lipoidica is a rare, chronic skin condition predominantly associated with diabetes mellitus. It can also occur in individuals with rheumatoid arthritis or without any underlying conditions (idiopathic). It is characterized by hardened, raised areas of the skin, often appearing on the shins, with a yellowish center and a surrounding dark pink area. The lesions are generally asymptomatic but can become tender and ulcerate when injured.
A pyogenic granuloma or lobular capillary hemangioma is a vascular tumor that occurs on both mucosa and skin, and appears as an overgrowth of tissue due to irritation, physical trauma, or hormonal factors. It is often found to involve the gums, skin, or nasal septum, and has also been found far from the head, such as in the thigh.
Granuloma annulare (GA) is a rare, sometimes chronic skin condition which presents as reddish bumps on the skin arranged in a circle or ring. It can initially occur at any age, though two-thirds of patients are under 30 years old, and it is seen most often in children and young adults. Females are two times as likely to have it as males.
Cheilitis is a medical condition characterized by inflammation of the lips. The inflammation may include the perioral skin, the vermilion border, or the labial mucosa. The skin and the vermilion border are more commonly involved, as the mucosa is less affected by inflammatory and allergic reactions.
Desquamative gingivitis is an erythematous (red), desquamatous (shedding) and ulcerated appearance of the gums. It is a descriptive term and can be caused by several different disorders.
Discoid lupus erythematosus is the most common type of chronic cutaneous lupus (CCLE), an autoimmune skin condition on the lupus erythematosus spectrum of illnesses. It presents with red, painful, inflamed and coin-shaped patches of skin with a scaly and crusty appearance, most often on the scalp, cheeks, and ears. Hair loss may occur if the lesions are on the scalp. The lesions can then develop severe scarring, and the centre areas may appear lighter in color with a rim darker than the normal skin. These lesions can last for years without treatment.
Tropical ulcer, more commonly known as jungle rot, is a chronic ulcerative skin lesion thought to be caused by polymicrobial infection with a variety of microorganisms, including mycobacteria. It is common in tropical climates.
Tuberculosis cutis orificialis, also known as acute tuberculous ulcer or orificial tuberculosis,) is a form of cutaneous tuberculosis that occurs at the mucocutaneous borders of the nose, mouth, anus, urinary meatus, and vagina, and on the mucous membrane of the mouth or tongue.
Tuberculous cellulitis is a skin condition resulting from infection with mycobacterium, and presenting as cellulitis.
Eosinophilic ulcer of the oral mucosa is a condition characterized by an ulcer with an indurated and elevated border. The lesion might be tender, fast-growing and the patient often not be aware of any trauma in the area.
The history of radiation therapy or radiotherapy can be traced back to experiments made soon after the discovery of X-rays (1895), when it was shown that exposure to radiation produced cutaneous burns. Influenced by electrotherapy and escharotics—the medical application of caustic substances—doctors began using radiation to treat growths and lesions produced by diseases such as lupus, basal cell carcinoma, and epithelioma. Radiation was generally believed to have bactericidal properties, so when radium was discovered, in addition to treatments similar to those used with x-rays, it was also used as an additive to medical treatments for diseases such as tuberculosis where there were resistant bacilli.
