Skin Tuberculosis

Lupus Vulgaris Definition: It’s a painful, skin tuberculosis with nodules mostly over the face like eye lids, nose, cheeks, ears even extending to neck. It is the most common Mycobacterium tuberculosis skin infection. Its also known as Tuberculosis luposa.. Description:  Its also known as “tuberculosis luposa” & “tuberculosis luposa cutis”.  Its more common in males in compare to female.  Basically this disease begins before puberty.  Its duration varies from 3 months 30 yrs.  It is more common in lower socioeconomic group.  It is the most common cutaneous TB occurring in 75% cases.  Systemic TB associated with Lupus Vulgaris in 30% cases. Types: There are 4 variant types of Lupus Vulgaris. 1) Psoriasiform 2) Nodular 3) Papular 4) Erythematous 1) Psoriasiform:  Single or multiple flat plaques are present varying in shape & size.  Mostly oval having irregular margins with erythematous base.  Generally covered with scales silvery in colour looking like psoriasis.  Commonly found on legs, back, knees. 2) Nodular:  Multiple nodules are present with “apple jelly” like appearance.  Commonly found on thighs & hips 3) Papular:  Small reddish brown papules.  Commonly found on cheeks and rarely on nose and abdomen. 4) Erythematous:  Plaques are 2-5 cm in size.  Irregular margins with minimum scales.  Located on face, arms & hips. History: It was first time described by Erasmus Wilson in the year 1865 Its chronic and progressive nature was very marked in 19th century. It remains active for 10 yrs, 20 yrs even longer. Then it is seen that It is resistant to any treatment. Then Neils Ryberg Finsen finally broke its consistency through “concentrated light radiation” and now its called as “Photobiomodulation. Because of this discovery he was awarded with Nobel Prize. Word-meaning: The word “lupus” comes from Latin work which means wolf. Clinical Features: Clinically we have see following signs & symptoms.  Initially it starts as a reddish-brown nodules which is painless then.  Over a period of time a well-defined skin coloured erythematous plaque is formed and called “apple jelly plaque” .  Its lesion is generally found on buttocks, thighs and face. But lesion over genitalia, nasal mucosa and auricular cartilage are rare.  Indurates lesion on earlobes named as “turkey ears” is also an important sign. And this one is recently observed. Aetiology:  The most common causative organism is M.tuberculosis and some cases of M. bovis also recorded.  Often there is a history of tuberculosis which was not treated properly at that time.  It may also develops at the site of BCG Vaccination(Bacillus Calmette-Guerin Vaccine commonly administered at upper left arm)  It also found to be associated with tatto or Bindi place but its rare and its called Bindi tuberculosis. Mode of Infection: Either exogenous or endogenous. Diagnosis: For the diagnosis of Lupus Vulgaris a thorough case history and full physical examination should be done. 1) Tuberculin/Mantoux Test:- This test becomes positive after 2-10 weeks following the infection. 2) Fine Needle Aspiration Cytology:- This test is not commonly used for diagnosis of Lupus Vulgaris. However, it does show epithelioid granullomas with or without chronic inflammatory infiltrate in 89% cases. Acid fast bacilli present in 22% cases 3) Interferon Gamma release Assay:- It is done on whole blood due to high specificity and speed even sensitivity of Lupus Vulgaris is average 4) Biopsy:- This test is a confirmatory diagnosis. Differential Diagnosis: >Basal cell carcinoma >Sarcoidosis >Discoid lupus erythomatosus >Leprosy >Deep fungal Infection Health Is Wealth

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