obsolete lupus vulgaris

Obsolete Treatment Options for Lupus Vulgaris

Lupus vulgaris, a form of cutaneous tuberculosis, was once treated with various methods that are now considered outdated.

• Isoniazid Monotherapy: The use of isoniazid as a monotherapy to treat lupus vulgaris has been deemed obsolete since 2020 [4]. Initially, a quadruple therapy regimen was used for two months, followed by a single-drug treatment phase.
• X-Rays and Light Therapy: In the early 20th century, x-rays were used to treat small rodent ulcers and lupus vulgaris. However, studies have shown that their effectiveness is comparable to or even inferior to other treatments [8].
• Topical Treatments: During the 19th century, various topical treatments such as salicylic acid were employed to manage lupus vulgaris symptoms. These methods are no longer considered effective and have been largely replaced by more modern therapies.

These outdated treatment options highlight the significant progress made in understanding and managing lupus vulgaris over the years. Modern approaches focus on a combination of medications, lifestyle changes, physical therapy, and other evidence-based treatments to effectively manage this condition [2].

References: [2] - Some common treatment options may include medications, surgical procedures, lifestyle changes, and physical therapy. [4] - Oct 29, 2020 — Notice! The monotherapy of cutaneous tuberculosis with isoniazid is obsolete! [8] - by M Morris · 1905 · Cited by 2 — ulcer and lupus vulgaris. In small rodent ulcers we have not found that its effect is any better than that of the x rays, while in the case of ...

Lupus vulgaris, also known as cutaneous tuberculosis, is an infectious disease that affects the skin. While it is considered rare in modern times, there are still some cases reported worldwide.

Common signs and symptoms:

• Skin lesions: Lupus vulgaris typically presents with one or more skin lesions, which can be single or multiple, and may appear as nodules, plaques, or ulcers.
• Painful lesions: The lesions associated with lupus vulgaris are often painful to the touch.
• Fever: Some people with lupus vulgaris may experience fever, especially in the early stages of the disease.
• Swollen lymph nodes: Enlarged and tender lymph nodes can be a sign of lupus vulgaris.

Less common signs and symptoms:

• Joint pain: Joint pain or swelling is not typically associated with lupus vulgaris, unlike other forms of lupus.
• Skin discoloration: The skin lesions may become discolored over time, turning red, purple, or brown.
• Scarring: Lupus vulgaris can lead to scarring and tissue damage if left untreated.

Important note:

Lupus vulgaris is a form of tuberculosis that primarily affects the skin. It is not related to systemic lupus erythematosus (SLE), which is an autoimmune disease that can affect multiple organs, including the skin, joints, kidneys, and brain.

References:

• [1] by C Dalle Vedove · 2012 · Cited by 107 — It is rare and it is characterized by typical general lupus-like symptoms with arthralgia, myalgia, fever, pleurisy and pericarditis. ... vulgaris and lupus ...
• [3] by C Dalle Vedove · 2012 · Cited by 107 — It is rare and it is characterized by typical general lupus-like symptoms with arthralgia, myalgia, fever, pleurisy and pericarditis. ... vulgaris and lupus ...
• [9] by L Dequidt · 2019 · Cited by 5 — Cutaneous mycobacterial infections are difficult to diagnose in paucibacillary forms such as lupus vulgaris. The main causal agent is Mycobacterium ...
• [10] Early signs and symptoms of lupus vary for each person and may affect different parts of the body. While new symptoms can appear, others often disappear. While new symptoms can appear, others ...

Treatment of Lupus Vulgaris

Lupus vulgaris, also known as cutaneous tuberculosis, was a type of skin tuberculosis that was once prevalent but is now considered an obsolete disease due to the availability of effective treatments. The primary treatment for lupus vulgaris involved the use of antitubercular drugs.

Combination Therapy

According to medical literature [4], combination therapy with multiple drugs was the preferred treatment approach for lupus vulgaris. This typically included a combination of rifampicin, isoniazid, and pyrazinamide, which were commonly used to treat tuberculosis [9].

• Rifampicin (R-450 mg) was often used in conjunction with other antitubercular agents.
• Isoniazid (H-600 mg) was also a key component of the treatment regimen for lupus vulgaris.
• Pyrazinamide was sometimes used alongside rifampicin and isoniazid to enhance the effectiveness of the treatment.

Single Drug Therapy

While combination therapy was the preferred approach, single drug therapy was occasionally used in specific cases [5]. However, this method was generally discouraged due to concerns about resistance and reduced efficacy.

Surgical Excision

In some instances, surgical excision of localized cutaneous TB lesions, such as lupus vulgaris or scrofuloderma, might be recommended [5].

Evolution of Treatment

The treatment landscape for lupus vulgaris has evolved significantly over the years. Prior to the introduction of isoniazid, various other treatments were employed, including intralesional injections of calciferol [3]. However, with the advent of modern antitubercular agents, combination therapy has become the standard approach.

References

• [4] Combination therapy was often used for lupus vulgaris treatment.
• [9] Recommended treatment involves an intensive phase consisting of Rifampicin (R-450 mg), Isoniazid (H-600 mg) Ethambutol (E-1200mg).
• [5] Single drug therapy is discouraged, and surgical excision might be recommended in specific cases.

Differential Diagnosis of Lupus Vulgaris

Lupus vulgaris, a form of cutaneous tuberculosis, can be challenging to diagnose due to its similarity with other skin conditions. The differential diagnosis for lupus vulgaris includes:

• Sarcoidosis: A systemic granulomatous disease that can present with skin lesions similar to those seen in lupus vulgaris [3][4].
• Leprosy: A chronic bacterial infection caused by Mycobacterium leprae, which can manifest as skin lesions and nerve damage [2][7].
• Deep fungal infections: Such as histoplasmosis or coccidioidomycosis, which can cause skin lesions that resemble those seen in lupus vulgaris [6][12].
• Squamous cell carcinoma: A type of skin cancer that can arise from long-standing cases of lupus vulgaris [8].
• Discoid lupus erythematosus: An autoimmune disease that causes chronic inflammation and scarring on the skin, which can be mistaken for lupus vulgaris [9].

Key Features to Distinguish Lupus Vulgaris

To accurately diagnose lupus vulgaris, it is essential to consider the following features:

• Histopathological findings: A biopsy of the affected skin can reveal granulomatous inflammation and caseating necrosis, which are characteristic of lupus vulgaris [5].
• Clinical presentation: Lupus vulgaris typically presents as firm, translucent, yellow-brown 'apple jelly' nodules on the face and neck, with a serpiginous edge and regression edge with atrophy and scarring [4][11].

Investigations to Confirm Diagnosis

To confirm the diagnosis of lupus vulgaris, the following investigations can be performed:

• Skin biopsy: To examine histopathological features.
• Culture: To isolate Mycobacterium tuberculosis from the affected skin.
• Mantoux test: To assess the patient's immune response to M. tuberculosis.

By considering these differential diagnoses and key features, healthcare professionals can accurately diagnose lupus vulgaris and provide appropriate treatment.