Causes and risk factors
Tuberculosis infection can develop after inhaling droplets sprayed into the air from a cough or sneeze by someone infected with the Mycobacterium tuberculosis bacteria. Disseminated tuberculosis occurs when the primary infection form the lung spread to other parts of the body through blood or lymphatic system. Infants, the elderly, and those infected with HIV are at higher risk for the disease worsening, because of their weaker immune systems.
Clinical presentation
This is most destructive form of tuberculosis of skin. It mainly affects exposed parts of body especially like face and extremities. Lupus vulgaris presents as multiple erythmatous papules or nodules. Papules coalese to form a plaque. Primary lesions form reddish brown plaques. They heal gradually in one portion and progress peripherally in other areas. Rarely, there is crust formation or ulceration. Ulcers heal with scar formation. The nodules have apple-jelly like consistency. Accompanied symptoms of tuberculosis like unintended weight loss, Low grade fever, cough, enlarged lymph nodes may be present.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Mantoux tuberculin test [though not much reliable technique] is done for screening of high risk patients. A chest x ray and multiple sputum cultures for presence of acid fast bacilli are initial evaluation methods confirms the diagnosis. Clinical samples of sputum, pus, skin biopsy are obtained for identification of mycobacterium tuberculosis bacteria. An Xpert MTD/RIF rapid, fully automated nucleic acid amplification test has been introduced recently for rapid diagnosis of TB.
Treatment
The goal of treatment is to cure the infection with anti microbial or antitubercular drugs. Multiple drug therapy is highly effective treatment. DOT [directly observed therapy] reduces the chances of relapse as it is a supervised therapy. Newer drug regimen is advised for MDR TB and XDR TB. Hospitalization may be necessary to prevent spreading the disease to others until the infectious period is over, usually 2-4 weeks after the start of therapy. People can continue their normal activities after the infectious period. Prevention is done with BCG vaccination at birth.
Other Modes of treatment
The other modes of treatment can also be effective in treating lupus vulgaris. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating lupus vulgaris.
