LUPUS VULGARIS Treatment

Lupus vulgaris is due to tuberculous infection of the skin. The diagnosis makes it essential to examine the patient for evidence of other active foci of the disease. Lupus vulgaris was formerly one of the dermatological horrors ; it caused appalling scarring because of the relentless spread of the disease. Now­adays, however, it is justifiable to regard the disease as " benign " because of the brilliant results which are readily obtained from anti-tuberculous drugs. Dermatologists have not been troubled by resistant organisms in the skin, but it is well to remember that this problem does face the chest physician and that, if a pulmonary focus is present, full combined treatment should be given to minimize the chance of resistance developing. A suitable regimen is to give streptomycin by injection, 1 g. twice weekly, and 0.3 g. of isoniazid daily by mouth in divided doses. Ulceration of old lesions of lupus vulgaris always arouses the suspicion of malignancy. The best means of settling this question is to carry out a biopsy and to seek the help of an experienced pathologist.