Specimen of the Week 355: Lupus Vulgaris
By Subhadra Das, on 10 August 2018
Today’s specimen of the week comes from UCL Pathology Collections. The Collections are displayed at the UCL Pathology Museum at the Royal Free Campus of the UCL Medical School in Hampstead. The museum includes a medical teaching collection of nearly 3,000 specimens of human remains illustrating the history of disease. To open up these specialist medical displays to a wider audience, we’ve developed a trail of 10 specimens of well known diseases. As the museum only opens to the public for special events, we’re sharing the trail as part of the Specimen of the Week series.
All of the entries for the UCL Pathology Collections Top 10 Medical Trail have been written by Nazli Pulatmen, who worked with us for her MA Museum Studies placement in the summer of 2018. The first specimen on the trail is of a condition called ‘lupus vulgaris’.
Not much is known about the origin of this hand or how it became a museum object, but the condition that it displays – known as Lupus Vulgaris – has a very interesting history dating back to the 16th century. Lupus vulgaris is an advanced form of cutaneous tuberculosis – that is, tuberculosis of the skin. It occurs when pre-existing tuberculosis isn’t diagnosed or treated properly.
Hungry like the wolf
As seen on this specimen, the condition causes extreme scarring and gives the skin a worm-eaten appearance. It is possible that the condition takes its name from the speed at which it ‘devours’ the skin. In 1590, the English medical writer Philip Barrough described the condition as ‘very hungry like unto a woolfe.’ Lupus, being the Latin word for wolf, was commonly ascribed to various medical problems that caused scarring of the skin.
No two lupuses (or lupi?) are the same
Due to its name, lupus vulgaris has historically been associated with lupus erythematosus, the systemic autoimmune disease. Far more commonly known today than its vulgaris counterpart, systemic lupus rarely, if ever, causes the level of scarring seen on this specimen. Although it does often manifest as skin inflammation and minor scarring, it has nothing to do with tuberculosis. Interestingly, scars caused by lupus vulgaris can also be prone to developing other skin-related health problems, such as squamous cell carcinoma.
Lupus vulgaris today
Lupus vulgaris is extremely uncommon in the UK as tuberculosis is rarely diagnosed – roughly 10 cases per 100,000 people in 2016 according to the World Health Organisation – and treatment is easy to access. Therefore, the few people who are diagnosed with tuberculosis are not left to develop further complications. Worldwide, however, tuberculosis, and its associated health problems such as the skin condition shown on this specimen, remains a sizeable threat to many people who are denied access to healthcare due to systemic poverty, war or other forms of socio-economic marginalisation.
You can find out more about lupus vulgaris from these references.
Lupus vulgaris: Clinical, histopathological, and bacteriologic study of 10 cases. Journal of American Academy of Dermatology, Volume 26, Issue 3. March 1992, p. 404-7. Available at: https://doi.org/10.1016/0190-9622(92)70062-K
World Health Organization (WHO) estimates of tuberculosis incidence by country, 2016. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/677927/WHO_estimates_of_tuberculosis_incidence_by_country__2016.pdf]
Howie, A. (2001). Handbook of Renal Biopsy Pathology. New York City: Springer
The History of the Disease Called Lupus, Journal of the History of Medicine and Allied Sciences, Volume 48, Issue 1, 1 January 1993, Pages 80–90. Available at: https://doi.org/10.1093/jhmas/48.1.80