What Is Lupus Vulgaris?

It is a more common type of skin tuberculosis. The characteristic damage is many applesauce-colored nodules and plaques, which irregularly expand, form scars, and damage tissue. The course of disease lasts for many years. The basic damage is lupus nodules from millet to pea, reddish-brown to tan, translucent, soft to the touch, slightly raised on the skin.

Basic Information

English name

lupus vulgaris

Visiting department

dermatology

Multiple groups

Children and teenagers

Common symptoms

The characteristic lesions are many applesauce-colored nodules and plaques, which expand irregularly, form scars, damage tissue, and last for many years.

Causes of Lupus Vulgaris

The disease is lupus vulgaris in a person who has previously been infected with tuberculosis and has been sensitized. Secondary skin tuberculosis is highly sensitive to pure protein derivatives of tuberculin. Mycobacterium tuberculosis can penetrate the skin through the skin damage. Lupus vulgaris can also spread to the skin directly or through lymph vessels from ulcerated lymph nodes and osteoarticular tuberculosis lesions, or it can spread to the skin through blood flow from visceral tuberculosis lesions. Very few cases can occur at the BCG vaccination site, so it is believed that after the BCG vaccination, if granulation tissue occurs in the inoculation site and does not subside for a long time, it should be followed up and observed. In addition, the nutrition, living conditions, health status, and personal resistance of patients have a great relationship with the occurrence and development of lupus vulgaris.

Clinical manifestations of lupus vulgaris

The basic damage is lupus nodules from millet to pea, reddish-brown to tan, translucent, soft to the touch, slightly raised on the skin, and the nodules are thin and tender. When you probe with a probe, you can use a little force. Penetration, easy penetration and bleeding (probe penetration). If pressure diagnosis is performed with slides, nodules are more pronounced when the local congestion is reduced, and they are pale yellow or yellow-brown, such as applesauce color, so they are also called "applesauce nodules". Sometimes many nodules merge with each other to form a large red-brown infiltration. Sexual damage, diameter can reach 10-20cm, the surface is uneven, soft to touch, covered with large leaf-like scales. In the long-term course, some lesions heal on their own, and some nodules often ulcerate to form ulcers. At the beginning of the ulcer, only a part of the damage is seen, which can cause the entire damage to ulcer later. The ulcers are mostly superficial, round or irregular, the surface of the ulcers is red-brown granulation tissue, there is a small amount of thin pus, and the pus is dried and stained with thick brown palate. The edge of the ulcer is irregular, soft, dark red, and the edge is sneaky. During the development process, the scar on the center or one side of the ulcer is cured, but the edge or the other side continuously expands outwards, which can form large lesions, and can also form special shapes such as ring, arc or serpentine. The tissue is highly destructive, and it will form uneven stripe scars after healing. In severe cases, the scars shrink, and deformities or dysfunctions occur. Another feature of lupus vulgaris is that new lupus nodules can be regenerated on the scar tissue that has been healed, and then ulcerated to form ulcers, so the disease often persists for decades.

In addition to the above typical damages, due to the different body reactivity of patients, there are the following clinical types:

Flat lupus vulgaris

The damaged surface is smooth, there may be a few scales, flaky infiltrating patches, composed of lupus nodules, and flattened atrophic scars after healing.

2. Proliferative Lupus Vulgaris

Including nodular lupus, tumor-like lupus, wart-like lupus, and papillary lupus. This type of lupus is a dense fusion of lupus nodules, which is high in the skin with obvious infiltrating masses or papillary proliferation of varying sizes.

3. Ulcerative lupus

A large area of ulcer often forms, which can occur from ulceration of lupus nodules, or secondary to tuberculosis infection of lymph nodes, bones or other tissues under the skin.

4. Disseminated lupus

It is caused by tuberculosis in the body's internal tuberculosis. The disease can be seen in children suffering from acute infectious diseases such as measles or scarlet fever, and small patches of lupus nodules appear scattered on the skin. The number of lesions is large and they are not fused with each other.

The most common sites of lupus vulgaris are the face, followed by the limbs, hips, and neck. Lupus vulgaris on the face often causes tissue damage and damages the face. Limbs and neck damage can be caused by contracture deformity due to scar contraction. Lupus vulgaris also often invades the mucosa. There are no obvious subjective symptoms, and there may be pain when there is a secondary infection.

Lupus vulgaris usually develops in childhood or adolescence. More than half of the patients develop the disease within the age of 10, and about 80% of the patients develop the disease before the age of 20.

Diagnosis of Lupus Vulgaris

According to the characteristics of lupus vulgaris, the disease usually starts from an early age, and the basic damage is apple sauce-like lupus nodules. After the ulceration, a scar is formed, and a new nodule can be regenerated on the scar. It has the characteristics of destruction and healing at the same time. Histopathological examination showed tuberculosis or tuberculous infiltration, and the general diagnosis is not difficult.

Lupus vulgaris complications

Secondary infections, elephantiasis limbs, other tuberculosis, skin cancer, etc.

Lupus vulgaris treatment

Standard antituberculosis treatment is generally applied, and adverse drug reactions are monitored.

For local treatment of small lupus vulgaris, curettage can be performed under local anesthesia, postoperative compression to stop bleeding, and topical application of bismuth gallate 10%. For small-scale skin damage, 1% procaine solution 1ml and 2.5% isoniazid solution 2ml can be used to make a circular subcutaneous injection around the damage, or 5% isoniazid ointment can be applied to the damage. After anaesthesia, the skin lesions were coated with lactic acid, chromic acid, or pure phenolic acid to corrode.