BRITISH DENTAL JOURNAL VOLUME 198 NO. 3 FEBRUARY 12 2005 135 Lupus vulgaris — Report of a case with facial involvement S. Thomas, 1 S. Suhas, 2 K. M. Pai 3 and A. R. Raghu 4 Cutaneous tuberculosis of the orofacial region is a rare condition and when it occurs, can cause confusion regarding the true nature of the lesion. This is compounded by the fact that neither mantoux test nor histopathology is confirmatory. In this report we discuss a case of lupus vulgaris with emphasis on the diagnostic approach to be followed by dental practitioners who come across a similar case. 1* Department of Oral Medicine and Radiology, College of Dental Surgery, Manipal-576104, Karnataka, India; 2-4 Department of Oral Medicine and Radiology, College of Dental Surgery, Manipal-576104, Karnataka, India. *Correspondence to Dr Shibu Thomas E mail: drshibuthomas@rediffmail.com Refereed Paper Received 14.10.03; Accepted 06.02.04 DOI: 10.1038/sj.bdj.4812038 © British Dental Journal 2005; 198: 135–137 Tuberculosis of the skin is a rare disease accounting for approximately 1% of all reported cases of tuberculosis. 1,2 Cutaneous tuberculosis has various clinical manifesta- tions such as plaque, ulcers or mutilating lesions. One progressive form of cutaneous tuberculosis that occurs as a post-primary infection in a person with moderate or high degree of immunity is known as lupus vul- garis. 3 Lupus vulgaris (LV) is characterised by plaque with apple-jelly nodule that extends irregularly with scar formation and tissue destruction. 3 The lesion typically appears on the head and neck, particularly around the nose. 4 Lupus vorax is a variant of LV that affects the nasal cartilage causing ulceration and mutilation. 3 We report a case of lupus vulgaris affecting the nose with emphasis on the diagnostic difficulties and treatment protocol. CASE REPORT A nine-year-old boy presented with a three- year history of multiple nodules appearing on and around the nose. These increased in size and number despite treatment with top- ical and systemic antibiotics. These nodules later coalesced to form a plaque on the nose. The lesion was localised on the nose for two years and in the last six months it had extended to involve the right lower eyelid and upper lip, and had lead to the destruc- tion of the nasal tip. Examination of the patient (Fig. 1) revealed erythrematous scaly plaque with crusting around the nose extending on to the cheeks, inferiorly to the lower lip, angle of the mouth and superiorly to the right lower eye lid. There was destruction of ala nasi, nasal septum and columella. The right lower eyelid showed loss of eyelashes with  Cutaneous tuberculosis is on the rise in immigrant population.  Difficulty in diagnosis is due to rarity of condition in developed nations.  Provides differential diagnosis of mid facial cutaneous lesions.  Provides a diagnostic approach for a dental practitioner in the case of lupus vulgaris. IN BRIEF Fig. 1 Extra oral photograph showing midfacial destructive lesion showing erythrematous scaly plaque with crusting around the nose. PRACTICE