Lupus miliaris disseminatus faciei: when a rare skin disease involves the eyelid / Lupus miliaris disseminatus faciei: quando uma rara dermatose acomete a pálpebra

ABSTRACT The authors present a case of lupus miliaris disseminatus faciei , a rare skin disease of unknown etiology, which may cause unaesthetic scarring due to its difficult treatment. The histopathological examination of epithelioid granulomas with caseating necrosis, together with the clinical features, are important for diagnosis and early treatment with better results. Despite difficult and unsatisfactory treatment, there are ongoing studies on therapy to improve aesthetic and social impairment. This case report describes an initial misdiagnosis delaying appropriate treatment, and highlights the value of physical examination and clinical judgment for another pathological examination, whenever necessary, aiming at better treatment outcomes in daily practice.

RESUMO Os autores apresentam um caso de lupus miliaris disseminatus faciei , uma dermatose rara, de etiologia desconhecida, que pode deixar cicatrizes não estéticas, pela dificuldade de tratamento. O exame histopatológico de granulomas compostos por células epitelioides, com necrose caseosa, e as características clínicas, são importantes para o diagnóstico e tratamento precoce, com melhores resultados. Apesar do tratamento difícil e insatisfatório, há estudos em andamento sobre terapias para melhorar o comprometimento estético e social. Este relato de caso descreve um diagnóstico inicial errôneo, que atrasou o tratamento adequado, e destaca o valor do exame físico e raciocínio clínico para solicitar outro exame anatomopatológico, quando necessário, de forma a obter melhores desfechos com o tratamento, na prática diária.

Lupus vulgaris of centrofacial area - a peculiar presentation

Lupus vulgaris is a cutaneous manifestation of Mycobacterium tuberculosis infection. It assumes various clinical forms including plaque, ulcerative, hypertrophic, vegetative, papular and nodular type. We here present an unusual case of a ten-year-old girl diagnosed as hypertrophic lupus vulgaris of centrofacial area including nose. Histopathological examination and bacteriological studies were carried out to establish the diagnosis. Unlike plaque type, hypertrophic variety is quite uncommon and only few cases have been reported. Its peculiar appearance on the face which is hardly described in previous literatures and well response to antitubercular therapy prompted us to report it

Mast Cells in Non-neoplastic Skin Lesions.

Background: Mast cells are found in tissues throughout body, particularly in proximity to surfaces that interface with the external environment. They are found at all levels of dermis, where they are grouped around blood vessels, nerves and appendages. Increase in mast cell number have been reported in various cutaneous diseases. Aims: We aim to identify and analyse the morphological aspects of distribution of mast cells and their value in non-neoplastic skin lesions. Material and Methods: Ninety seven biopsies of various skin lesions were studied for mast cells by Toluidine Blue at pH 3.9. Result: All the skin lesions showed significant increase in mast cell number. Psoriasis showed maximum number of mast cells (127/mm2) followed by Lichen planus (108/mm2). Among the cases of cutaneous bacterial infections, mast cells were maximum in leprosy cases (99/mm2) and lowest in cutaneous tuberculosis. A comparative decrease in number of mast cells was seen from lepromatous leprosy to tuberculoid leprosy. A wide range of morphological alterations of mast cells were observed in these skin lesions. Psoriasis and bullous pemphigoid cases showed maximum spindle cell morphology. Conclusion: Tissue mast cell number, distribution and morphology vary in different skin lesions depending on the degree of mast cell activation. This may have a bearing on diagnosis and management.

Cutaneous tuberculosis and squamous-cell carcinoma / Tuberculose cutânea e carcinoma de células escamosas

The incidence of all forms of cutaneous tuberculosis, including lupus vulgaris (the most common form) decreased progressively in developed countries during the twentieth century, this change being attributed to improved living standards and specific therapy. Despite the decrease in cutaneous tuberculosis, some cases are still found and correct diagnosis and management are fundamental, both for the patients and for public health. Long lasting, misdiagnosed or untreated cutaneous tuberculosis may lead to different forms of cancer. This case report involves a 74-year old male farmer with lupus vulgaris on his face. During anti-tuberculosis treatment he developed a tumor on his forehead, which was histologically confirmed as a squamous cell carcinoma.

A incidência de todas as formas de tuberculose cutânea, incluindo o lúpus vulgar (a forma mais comum) diminuiu progressivamente nos países desenvolvidos durante o século XX e esta mudança foi atribuída a melhores condições de vida e uso de terapia específica. Apesar da diminuição da TBC cutânea, alguns casos ainda são detectados hoje em dia e o diagnóstico acurado e o tratamento apropriado são fundamentais para os doentes e a saúde pública. A TBC cutânea quando prolongada, diagnosticada erroneamente ou não tratada pode levar a diferentes neoplasias. Este é o relato de um caso de lúpus vulgar na pele do rosto de uma paciente do sexo masculino, agricultor, de 74 anos de idade. Durante a terapia antituberculosa ele desenvolveu um tumor na pele da testa, histologicamente confirmado como carcinoma de células escamosas.

Lupus vulgaris on the buttock mimicking tinea corporis

Lupus vulgaris is the most common form of cutaneous tuberculosis which usually occurs in patients previously sensitized to mycobacterium tuberculosis. It is often clinically and histopathologically confused with various cutaneous disorders. Here, we present a 28-year-old man attended in our medical college with slowly progressive, asymptomatic, annular erythematous skin lesions on the buttocks for 8 years. He consulted with many physicians and was improperly treated with an oral antifungal agent for several months under the diagnosis of tinea corporis, but no cure was observed. A diagnosis of lupus vulgaris was made based on the histopathological examination and the polymerase chain reaction. Anti-tuberculosis therapy was administered and the lesions started to regress

Lupus vulgaris in a pediatric patient: a clinicohistopathological diagnosis

Lupus vulgaris is the most common form of cutaneous tuberculosis which usually occurs in patients previously sensitized to Mycobacterium tuberculosis. We present a case of a 10-year-old boy who was diagnosed as lupus vulgaris clinically and histopathologically. He had well demarcated, irregularly bordered, pink, infiltrated plaques on his left cheek showing apple-jelly appearance on diascopy. The histopathological examination showed tuberculoid granulomas with Langhans type giant cells. The Mantoux reactivity was in normal limits, and no acid-fast bacilli was found in the lesion, either by direct stained smears or by culture. The lesions showed marked improvement on anti-tuberculosis treatment. We want to emphasize that histopathological examination has diagnostic value in lupus vulgaris in correlation with clinical appearance, when direct analysis or culture is negative.

A study of mast cells in granulomatous lesions of skin, with special emphasis on leprosy.

76 skin biopsies that included material from 7 controls, 65 granulomatous skin lesions and 2 each of granulation tissue and chronic non-specific inflammation, were subjected to histopathological evaluation on haematoxylin and eosin and pertinent special stains. Mast cell study was done on slides stained by toluidine blue method, with special reference to their location, and morphology and cell count were done with the help of occculomicrometre. In normal skin, mast cell density was 11.43/mm2 with a range of 6-22/mm2 and an S.D. of 5.94. Highest value in the whole series was seen in TVC (66/mm2), followed by lupus vulgaris (50/mm2). Mast cell counts were normal in indeterminate and TT leprosy and showed a rise over the immunological spectrum BT to LL, with values in LL being 32.86/mm2 (28-40/mm2).

Study of mast cells in non-neoplastic skin lesions.

Sixty non-neoplastic skin lesions were studied for mast cells by toluidine blue stain. The highest numbers of mast cells were seen in the viral infections of the skin (50/mm2) and lowest number of mast cells in congenital diseases (17/mm2). Out of the cutaneous bacterial infections, highest numbers of mast cells were seen in leprosy (44/mm2) while in lupus vulgaris they were much less (37/mm2). In leprosy cases it was observed that as the lesions moved from indeterminate to both polar tuberculoid and lepromatous, the mast cell count increased. It could therefore be summarised that periodic follow-up of indeterminate and borderline lesions for mast cell count might help in predicting stability of lesions. In non-infectious squamous and papular lesions the mean mast cell count was 39/mm2. The highest numbers of mast cells in the non-infectious vesicular and bullous lesions were in bullous pemhigoid (57/mm2) and lowest in dermatitis (38/mm2).

Lupus vulgar: a propósito de un caso clínico de 40 años de evolución / Lupus vulgaris: apropos of a clinical case of 40 years evolution

Se presenta un caso de tuberculosis cutánea de tipo lupus vulgar de forma vegetante, de 40 años de evolución, en un paciente de 50 años de edad, de sexo masculino, sin diagnóstico de certeza hasa el momenteo de la consulta, en el que se pudo aislar bacilos de Koch de tipo humano. Se hacen consideraciones clínicas, etiológicas y patogénicas y se destaca que en nuestro paciente no se logró demostrar lesiones viscerales activas ni cicatrizales, planteándose interrogantes acerca del mecanismo patogénico invoculucrado