Lewandowsky’s Tuberculid

Lewandowsky’s tuberculid, also known as lupus vulgaris-like tuberculid or Rosacea-like tuberculid of Lewandowsky is a type of skin condition that resembles rosacea but is caused by a reaction to tuberculosis (TB) antigens. It is also known as tuberculosis-associated erythema nodosum-like lesions or cutaneous tuberculosis-associated nodules. The condition is characterized by the development of painful, red, raised nodules (bumps) on the skin, typically on the face and neck. Other symptoms may include itching, swelling, and tenderness. The nodules may also be accompanied by pustules (pimple-like lesions filled with pus).

Rosacea-like tuberculid of Lewandowsky is a rare type of skin condition that mimics the symptoms of rosacea. It is characterized by redness, pimple-like bumps, and swelling of the skin on the face and neck. The condition is believed to be caused by a hypersensitivity reaction to the bacteria that causes tuberculosis (TB) and can occur in individuals with a history of exposure to TB or who have a weakened immune system. The condition is named after Dr. Max Lewandowsky, who first described it in the early 1900s.

The exact cause of the rosacea-like tuberculid of Lewandowsky is not known, but it is thought to be a result of a hypersensitivity reaction to TB antigens. The condition is rare and typically occurs in individuals who have been previously exposed to TB or who have an underlying immune system disorder.

Causes

The main causes of this condition are thought to be related to Mycobacterium tuberculosis, a bacterium that can infect the skin and cause a range of symptoms.

There are several risk factors that can increase the likelihood of developing rosacea-like tuberculid of Lewandowsky, including:

1. Previous exposure to tuberculosis: Individuals who have been previously infected with tuberculosis have a higher risk of developing the condition.
2. Age: Rosacea-like tuberculid of Lewandowsky is more common in middle-aged to elderly individuals.
3. Immune system status: Individuals with a weakened immune system, such as those with HIV/AIDS, are more susceptible to the condition.
4. Other medical conditions: People with underlying medical conditions, such as diabetes or heart disease, may have a higher risk of developing rosacea-like tuberculid of Lewandowsky.
5. Genetics: There may be a genetic component to the condition, as it tends to run in families.

In conclusion, rosacea-like tuberculid of Lewandowsky is a rare form of cutaneous tuberculosis that is caused by the bacterium Mycobacterium tuberculosis. Individuals with a history of tuberculosis exposure, those who are middle-aged to elderly, those with weakened immune systems, and those with underlying medical conditions may have an increased risk of developing the condition.

Symptoms

Main symptoms include:

1. Papules and pustules: Small red bumps and pimple-like lesions are the hallmark of this condition, which are most commonly found on the face, neck, and chest.
2. Redness and inflammation: The affected skin is often red, swollen, and tender to the touch.
3. Pain and itching: The lesions can be painful or itchy, and scratching or rubbing the skin can cause further irritation and breakage of the skin.
4. Hyperpigmentation: Dark spots or patches can develop on the affected skin after the lesions have healed.
5. Scarring: In severe cases, scarring can occur on the affected skin, which can be permanent.

Diagnosis is typically based on the clinical presentation and a skin biopsy to confirm the presence of TB bacteria. Treatment usually involves a combination of antibiotics and topical or systemic corticosteroids to control the inflammation.

Diagnosis

The main diagnosis for rosacea-like tuberculid of Lewandowsky is a type of cutaneous tuberculosis. The diagnosis is usually made based on the patient’s history, physical examination, and laboratory tests.

The following tests may be used to confirm the diagnosis:

1. Skin biopsy: A small sample of skin tissue is taken and analyzed under a microscope to look for signs of tuberculosis bacteria.
2. Tuberculin skin test (TST): A small amount of purified protein derivative (PPD) is injected into the skin and the reaction is observed after 48-72 hours. A positive reaction indicates exposure to tuberculosis.
3. Interferon-gamma release assay (IGRA): This test measures the release of interferon-gamma in response to a specific tuberculosis antigen.
4. Acid-fast bacilli (AFB) stain – a laboratory test that identifies the tuberculosis bacteria in a sample of skin or other tissue.
5. Blood tests – to check for antibodies to tuberculosis, as well as other markers of inflammation.
6. X-rays and CT scans – to check for any signs of tuberculosis in the lungs or other internal organs.
7. Mycobacterial culture – a laboratory test to grow and identify the type of tuberculosis bacteria present in a sample of skin or other tissue.
8. Chest X-ray: This test is used to check for signs of lung tuberculosis.

It is important to note that the diagnosis of rosacea-like tuberculid of Lewandowsky is a clinical diagnosis and may be supported by laboratory tests. A combination of tests may be needed to confirm the diagnosis.

Treatment

The main treatment for the rosacea-like tuberculid of Lewandowsky is a combination of antibiotics and anti-inflammatory medications. This may include tetracycline, minocycline, doxycycline, metronidazole, and azithromycin. Additionally, topical creams and ointments containing metronidazole, azelaic acid, or calcineurin inhibitors may be used to reduce redness and inflammation.

In severe cases, corticosteroids may be prescribed to reduce inflammation. It is important to avoid triggers such as hot drinks, spicy foods, sun exposure, and alcohol, which can worsen symptoms.

In addition to antibiotics, topical creams such as metronidazole or azelaic acid can be used to reduce redness and swelling. These creams help to improve the appearance of the skin and reduce the severity of the symptoms.

Topical treatments include:

• Azelaic acid: helps to reduce redness, swelling, and inflammation.
• Metronidazole: an anti-inflammatory cream that helps to calm skin.
• Ivermectin: helps to reduce redness and itching.

Oral medications include:

• Isoniazid: an antibiotic that helps to treat the underlying tuberculosis infection.
• Tetracyclines: antibiotics that help to reduce redness, swelling, and inflammation.

In severe cases, additional treatment may include:

• Steroid creams or ointments: helps to reduce inflammation.
• UV light therapy: helps to reduce redness and swelling.

It is important to consult a dermatologist for proper diagnosis and treatment plan, as the severity and symptoms can vary from person to person.

References