Lupus vulgaris


Painful cutaneous tuberculosis skin lesions with nodular appearance, most often on the face around the nose, eyelids, lips, cheeks, ears and neck.

  • M/C M. tuberculosis skin infection

Aetiology

  • Inadequately treated pre-existing tuberculosis
  • BCG vaccination site
  • Tattoo mark
  • Long-term bindi use “bindi tuberculosis”

Clinical features

  • Painless reddish-brown nodules which slowly enlarge to form irregularly shaped red plaque
fig-16-well-defined-erythematous-crusted-plaque-of-lupus-vulgaris-on-face-of-a-child
Well defined erythematous crusted plaque of lupus vulgaris on face of a child, note the lesion in the submental region too | Cutaneous Tuberculosis – Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/296847810_fig8_Fig-16-Well-defined-erythematous-crusted-plaque-of-lupus-vulgaris-on-face-of-a-child [accessed 5 Nov, 2017]

Complications:

  • Disfiguring skin ulcers
  • Squamous cell carcinoma (SCC)

Diagnosis

Investigations:

  • Monteaux test positive
  • Diascopy: “Apple-jelly” color
    • Test for blanchability performed by applying pressure with a finger or glass slide and observing colour changes

Tissue biopsy:

  • Well-formed tuberculoid granulomas with few bacilli & necrotic centres
640px-an_introduction_to_dermatology_28190529_lupus_vulgaris_simplex
Lupus vulgaris simplex. The corium is studded with little collections of tuberculous follicles which make up the apple-jelly nodules. The vessles are dilated and the tissues between the nodules contain many leuocytes. Teh epithelium is slightly cedematous and the horny layer is irrefular. 75x | By Norman Purvis Walker – Walker, Norman Purvis (1905) An introduction to dermatology (3rd ed.), William Wood and company Retrieved on 26 September 2010., Public Domain, https://commons.wikimedia.org/w/index.php?curid=11603461

Differential diagnosis:

  • Basal cell carcinoma
  • Sarcoidosis
  • Discoid lupus erythematosus
  • Leprosy
  • Deep fungal infection

Management

  • Antitubercular drugs
  • Incomplete healing:
    • Excision & skin grafting
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