Lupus vulgaris (cutaneous tuberculosis) most commonly affects which anatomical region in India, and what is the characteristic histopathological feature?

• A Ear and nose; caseating granulomas with central necrosis
• B Buttocks; non-caseating granulomas with Langhans giant cells
• C Ear, nose, and cheek; non-caseating or minimally caseating granulomas with epithelioid cells ✓
• D Dorsum of hands; granuloma annulare-like palisading granulomas

Explanation

Lupus vulgaris (LV) most commonly affects the face — particularly the nose and cheeks (also around ears) in Indian patients. It represents post-primary tuberculosis in a host with moderate immunity and high tuberculin sensitivity. Histopathology shows tuberculoid granulomas with epithelioid cells, Langhans giant cells, lymphocytic cuffing, and little or no central caseation (unlike systemic TB lymphadenitis). The characteristic clinical feature is the apple-jelly nodule on diascopy. Caseating granulomas with necrosis are more typical of scrofuloderma overlying cold abscess. Non-caseating granulomas without Langhans cells suggest sarcoidosis.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.