This used to be a very common and disfiguring disease in western countries. It still occurs in some underdeveloped countries and atypical forms still appear in western communities. The declining incidence may be largely attributed to better hygiene, less malnutrition, improving living standards, elimination of infected milk herds, and BCG vaccinations.

The disease is caused by the bacillus Mycobacterium tuberculosis. It affects other animals as well as man, and may occur in most organs of the body, particularly the lungs. The type of skin infection depends on the person’s resistance to the germ. When a person with good immunity is infected, the host resistance may be sufficient to confine the infection to fairly localized nodules. If immunity is less effective in localizing the infection, multiple chronic nodules will appear.

There are various forms of tuberculosis. One of these, warty tuberculosis, may begin as a lump, nodule or pustule, which becomes warty. There are no associated enlarged lymph glands, and spontaneous healing of the disease usually occurs.

Another form, primary inoculation tuberculosis, typically takes the form of a raised red lump or ulcer, with associated enlargement of the nearby lymph glands. This may spontaneously heal or may proceed to Lupus vulgaris, the chronic progressive form of tuberculosis.

Lupus vulgaris is the commonest tuberculosis of the skin, and is the chronic progressive form. It usually begins as a brown mark on the face, which becomes lumpy and translucent. It progresses slowly, with resultant scarring and ulceration, leading to severe mutilation. The name lupus’ (Latin for ‘wolf’) is a reference to the wolf-like ugly appearance of the advanced, and fortunately rare, case.

Other rarer forms of skin tuberculosis also exist. The treatment of all forms is as for tuberculosis elsewhere, together with plastic surgery where necessary. The drugs most frequently used are Isoniazid, Paraminosalicylic acid and Streptomycin, either singly or in combination. In certain cases Rifampidn may be used. Treatment is for two to three months. Plastic surgery may be necessary for the rehabilitation of those with disfiguring scarring.

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