Lupus vulgaris

Lupus vulgaris, also known as tuberculosis luposa, is a chronic and progressive form of cutaneous tuberculosis that affects the skin. It is the most common form of cutaneous tuberculosis and is caused by the Mycobacterium tuberculosis complex.

Symptoms

The symptoms of lupus vulgaris include reddish-brown nodules that may slowly grow and form a plaque with a 'apple jelly' appearance on diascopy. The nodules may eventually break down to form ulcers and scarring. The lesions are usually painless and are most commonly found on the face, particularly around the nose and ears.

Causes

Lupus vulgaris is caused by the Mycobacterium tuberculosis complex. It is usually the result of an external reinfection and occurs in individuals with a high degree of tuberculin sensitivity and a strong immune response.

Diagnosis

The diagnosis of lupus vulgaris is often delayed due to its insidious onset and slow progression. The diagnosis is usually confirmed by a skin biopsy showing the characteristic tuberculoid granulomas. Other diagnostic tests may include a tuberculin skin test, interferon gamma release assay, and polymerase chain reaction for Mycobacterium tuberculosis.

Treatment

The treatment of lupus vulgaris includes a long course of antituberculous therapy. The most commonly used drugs are isoniazid, rifampicin, pyrazinamide, and ethambutol. Surgery may be required for large ulcers or to correct cosmetic deformities.

Prognosis

The prognosis of lupus vulgaris is generally good with appropriate treatment. However, untreated lupus vulgaris can lead to significant cosmetic deformity and functional impairment.

Epidemiology

Lupus vulgaris is most common in developing countries where tuberculosis is endemic. It is more common in females than in males and usually affects individuals in the second and third decades of life.

See also

• Tuberculosis
• Cutaneous tuberculosis
• Mycobacterium tuberculosis

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