A 12-year-old boy presented with progressively increasing skin lesions for 4 years. On examination plaque like lesions with scaling and hyperkeratotic margins were present on face, earlobules, buttocks, left forearm and back of left lower leg. (Figs. I & II). There was history of measles and tuberculosis contact prior to illness. A positive montoux test (25 × 15 mm) supported the possibility of Lupus Vulgaris (LV). Skin biopsy confirmed the diagnosis. The lesions have shown improvement on anti-tubercular treatment.

Fig.1. Multiple lesions of Lupus vulgaris.

Fig. 2. Plaque type lesions with scaling and hyperkeratotic margins.

Lupus vulgaris (LV) is a chronic, progressive form of cutaneous tuberculosis that develops as a result of direct extension from underlying joints or lymph nodes through lymphatic or hematogenous spread, or rarely by cutaneous inoculation with BCG vaccine often after a temporary impairment in immunity. In India face is affected less often and the buttocks and trunk more frequently. A typical solitary lesion consists of a brownish red, soft papule that has an apple jelly colour when examined by diascopy. One or several lesions may develop, including nodular plaques that are flat and serpiginous, hyper-trophic and verrucous, or edematous in appearance. Spontaneous healing occurs centrally, and lesions characteristically reappear within the area of atrophy. Tubercular lymphadenitis is present in 40% and 10-20% have tuberculosis of the lungs, bones or joints.

The differential diagnosis includes sar-coidosis, leprosy, atypical mycobacterial infection, blastomycosis, chromoblastomycosis, actinomycosis, leishmaniasis, hypertrophic lichen planus, Psoriasis, lupus erythematous, lymphocytoma and Bowen’s diasese. Anti- tuberculous drug therapy usually halts further spread and induces involution.

Parveen Bhardwaj,
Vikram Mahajan,
Departments of Pediatrics and Skin and VD,
Indira Gandhi memorial College,
Shimla (H.P.) 171001,
India.