Lupus vulgaris is one of about ten known types of so-called skin tuberculosis, which, like pulmonary tuberculosis, is usually caused by Mycobacterium tuberculosis. As a rule, the infectious disease, which only rarely occurs in Central Europe, is a reinfection, because the skin normally represents an impenetrable barrier for the pathogen. Lupus vulgaris usually manifests itself as persistent and chronic foci of inflammation in the nose, cheeks and neck.
What is lupus vulgaris?
Lupus vulgaris is a special form of skin tuberculosis. As with other forms of tuberculosis, the causative agent is usually Mycobacterium tuberculosis. While the disease only rarely occurs in Central Europe, it is still relatively common in some developing countries due to the unfavorable hygienic conditions and the less comprehensive medical care. See AbbreviationFinder for abbreviations related to Lupus Vulgaris.
Symptoms of lupus vulgaris are skin changes in the nose, cheeks and neck. Typically, small brownish papules form on the skin, which are soft to the touch and eventually develop into ulcers. In contrast to other forms of tuberculosis, lupus vulgaris is not notifiable because it is only slightly infectious.
As a rule, the disease is not caused by a primary infection with Mycobacterium tuberculosis, but usually corresponds to a re- or secondary infection. The original infection with Mycobacterium tuberculosis may have been a long time ago – up to several years – and have triggered tuberculosis or have taken a symptom-free and therefore unnoticed course.
Lupus vulgaris cutaneous tuberculosis is an infectious disease that is usually caused by the pathogen Mycobacterium tuberculosis. However, the disease is rarely triggered by a primary infection because the pathogenic bacteria cannot penetrate healthy skin and usually first reach the bronchi and lungs or the digestive tract by droplet infection.
The tubercle bacillus, as Mycobacterium tuberculosis is also called, can only trigger lupus vulgaris if it can enter the connective tissue of the subcutaneous tissue, for example via the lymphatic or bloodstream. Only in exceptional cases can the bacterium penetrate the skin directly via a weeping wound or similar entry points and trigger a primary infection there. The prerequisite is that the potential skin entry points come into direct contact with tubercle bacilli (smear infection ).
Symptoms, Ailments & Signs
In the early stages, lupus vulgaris is symptomatic of small, about the size of a pea, brown blisters or nodules (papules), which initially feel soft and do not cause any pain or discomfort. The areas of the nose, cheeks and neck are usually affected. In some cases, the extremities, i.e. hands and feet, are also affected.
Small scaly patches on the skin that develop like warts are often symptomatic of the early stages of the disease. Strangely enough, the general condition of the sick people is hardly affected during the initial phase of lupus vulgaris, which can last for several years.
Diagnosis & course of disease
In addition to the externally visible symptoms of the skin, the creation of bacterial cultures plays an important role. The bacteria for the cultivation are isolated from biopsy material of the diseased tissue. In addition, differential diagnoses are recommended in order to clearly differentiate suspected lupus vulgaris from other diseases with similar symptoms, especially from tuberculosis cutis verrucosa and lupus erythematosus chronicus discoides.
The attempt to detect the tubercle bacilli by light microscopy using common staining methods usually delivers unusable results. The occurrence of Langhans giant cells in the skin nodules is histologically striking. They arise from the fusion of macrophages during the feeding process ( phagocytosis ).
As the disease progresses, new nodules form at the edge of the foci of inflammation, while the inner ones heal. Gradually, deep ulcers can develop, and in some cases in which the nasal mucosa is affected, even the nasal cartilage is attacked, so that facial disfigurement must also be counted among the symptoms of advanced lupus vulgaris. Deep-reaching tissue destruction on the hands and feet is also observed.
Lupus vulgaris usually causes small blisters to form on the skin. The blisters themselves do not represent a complication or discomfort and in most cases are not associated with pain. However, they can have a negative effect on the patient’s aesthetics and lead to reduced self-esteem or inferiority complexes.
Furthermore, the patient’s extremities are particularly affected by this complaint. The spots can also show warts, which can also affect the aesthetics. In many cases, no treatment is initiated by the patient if the symptoms do not lead to any particular discomfort or are not painful.
If there is no treatment, however, this can promote destruction of the tissue on the feet and hands. It can also cause pain. As a rule, the treatment of this disease takes place with the help of medication and can limit the symptoms relatively well. However, the therapy can last for several months. Complications do not arise in most cases. Likewise, the life expectancy of the patient is not reduced by this complaint.
When should you go to the doctor?
Skin changes and abnormalities of the complexion are signs of the organism for existing irregularities. A doctor’s visit should take place if the changes persist for several weeks or are increasing. In particular, the formation of poplars in the facial area should be examined and treated. If blisters or nodules develop, a doctor should be consulted. If the affected areas of skin hurt or open wounds develop, the affected person needs help. Sterile wound care is necessary so that no further pathogens can enter the body through the skin.
If adequate wound care cannot be guaranteed, a doctor should be asked for help and support to prevent sepsis from developing. If you have dry skin, dandruff on your skin or itching, you should see a doctor. If the skin is tight or warts appear, these are further indications of the body that should be clarified. Medical treatment is necessary to initiate a regression of the symptoms.
If, in addition to the facial area, the extremities also show peculiarities of the complexion, a doctor should be consulted in good time. If emotional or mental problems arise as a result of the optical changes, medical support is required. In the event of behavioral problems, social withdrawal or mood swings, a doctor’s visit is therefore necessary.
Treatment & Therapy
Since lupus vulgaris is usually a post-primary type of tuberculosis, it can be assumed that the causative agent, Mycobacterium tuberculosis, is already in other parts of the body and can potentially become pathogenic again, even if the corresponding symptoms are absent.
In addition, the chronic and very stubborn course of lupus vulgaris indicates that local control of the tubercle bacilli is not sufficient for sustained therapy. Treatment with systemic tuberculostatics is recommended, which in the most favorable case leads to the complete destruction of the pathogenic germs. A number of tuberculostatics are available which intervene in the metabolism of the tubercle bacilli at various points.
As a rule, drug therapy begins as a combination therapy with the simultaneous intake of several drugs with different active ingredients in order to achieve the broadest possible effect. After the initial therapy, which usually lasts about two months, another therapy lasting several months follows with a changed composition of the medication.
Outlook & Forecast
Skin tuberculosis is rare in western industrialized countries. It is mostly related to poor hygienic conditions. The condition is by far the most common in the cheek region. The prognosis for complete healing is good. Strikingly, the disease lupus vulgaris affects more women than men.
The treatment period can extend over months. Starting therapy early usually has a positive effect on the long term. Doctors usually change the medication after two months. The symptoms only disappear if the tuberculostatic drugs are taken consistently and systematically. If the treatment is stopped prematurely, a relapse is very likely. Because the sources of infection are still present in the body. It has been proven that many patients do not consult a doctor because they do not perceive any restrictions. However, this often results in destruction of the tissue. Permanent pain is possible.
After healing, continuous monitoring is necessary. This is because sometimes tumors form in the affected areas. Skin tuberculosis itself is not fatal. However, it should not go unmentioned that psychological well-being suffers as a result of prolonged skin changes.
There are no direct preventive measures that could prevent infection with tubercle bacilli. The best indirectly effective preventive measures are to observe certain standards of hygiene and stay away from potential sources of infection and to strengthen the immune system.
Until the 1990s there was the possibility of vaccination with live attenuated vaccine (BCG vaccination) to prevent tuberculosis infection. However, vaccination is no longer recommended by the Standing Committee on Vaccination (STIKO) due to its lack of effectiveness and significant side effects.
Careful follow-up is essential for patients suffering from lupus vulgaris. Even after successful therapy, those affected still have a high risk of recurrence. Since the majority of recurrences occur within the first five years, follow-up examinations take place particularly regularly during this period.
The intervals and the scope of these examinations are individually dependent on the type and severity of the disease. For this reason, a close medical check-up (every three to six months) is recommended in the first five years. Follow-up care should be maintained for life. Some forms have a relatively high tendency to recur.
Those affected should have their entire skin checked regularly by a dermatologist after surgery or alternative therapy. Conscientious aftercare can detect pathological changes in the skin or secondarily affected organs in good time. Regular self-examination is also an important part of aftercare. Those affected should avoid strong sunlight in the future and ensure adequate UV protection.
You can do that yourself
A lupus vulgaris must be medically clarified and treated in any case. Medical treatment can be supported by some self-help measures and home remedies.
Bed rest and rest apply first. Patients should ensure that the affected skin areas are not exposed to irritating substances such as lint, dust or sweat. It is best to clean the blisters and nodules regularly with lukewarm water and then disinfect them. In consultation with the doctor, natural remedies can also be used under certain circumstances – ointments made from lady’s mantle or tormentil are recommended, for example. Arnica can also be applied in the form of an infusion provided the skin is not inflamed. General measures such as a healthy and balanced lifestyle are also recommended. Exercise and an appropriate diet reduce stressand contribute to a speedy recovery.
In the case of longer-lasting illnesses, a therapeutic consultation is useful. In a conversation with a specialist, the aesthetic and thus also psychological problems that lupus vulgaris brings with it can be worked through. If the symptoms have not subsided after a few days, you must speak to the responsible doctor again.