Lupus Vulgaris

Key Points

Skin condition which is a type of cutaneous tuberculosis
Caused by infection with mycobacterium tuberculosis
Initially consists of shallow, firm lesions, which become red-brown in color and jelly-like

Lupus vulgaris is a type of cutaneous tuberculosis. Initially consisting of tubercular canchres (shallow, firm lesion with a granular base) primarily on the head and/or neck, the lesions will become sharply defined, red-brown in color and have the consistency of jelly. Lesions may coalesce into plaques, and new lesions may form within plaques. Any cartilage in the affected area may become involved, in addition to mucosa (such as the nose). Other symptoms which may accompany the condition include scaling, ulceration, granulated tissue, and necrosis.

Lupus vulgaris is caused by infection with the bacteria mycobacterium tuberculosis. It typically affects those who are sensitive to the bacteria, and is the most common form of cutaneous TB. The condition affects women more than men. This form of cutaneous TB is progressive and chronic, and lesions may appear for years, leading to extreme scarring and disfigurement. Additionally, in long-term cases, squamous cell carcinoma may develop in affected areas.

Differential Diagnosis (Other conditions with similar appearance)
Bowen Disease
Papulonecrotic Tuberculids
Catscratch disease
Pityriasis lichenoides
Dermatitis Herpetiformis
Pseudolymphoma, Cutaneous
Endemic Syphilis
Psoriasis, Pustular
Erythema induratum (Nodular Vasculitis)
Pyoderma gangrenosum
Erythema nodosum
Sarcoidosis
Leishmaniasis
Sporotrichosis
Leprosy
Squamous Cell Carcinoma
Lichen Nitidus
Syphilis
Lichen Planus
Syringoma
Lupus erythematosus, Discoid

Diagnosis
Key Points
Initial diagnosis based on appearance of the affected area
Skin biopsy will confirm diagnosis and rule out other conditions
Tuberculin, blood and imaging tests may be performed to determine the extent of the condition

Lupus vulgaris is initially diagnosed based on the appearance of the affected area. A skin biopsy will be performed to confirm the diagnosis and rule out other, similar appearing conditions. Tuberculin, blood and imaging tests may also be performed to determine the extent of the condition.

Treatment
Treatment generally consists of the administration of antitubercular medications
In some cases, removal of lesions is recommended

Treatment of lupus vulgaris typically consists of the administration of antitubercular medications, usually combinations of particular antibiotics, in a long course, in some cases lasting years. Health care professionals may recommend removal of lesions by surgical excision in cases which are localized.