Cutaneous tuberculosis
From IDWiki
Clinical Manifestations
Primarily cutaneous tuberculosis
- Occurs following direct inoculation into skin
- Most commonly on face, hands, or feet
- Inflammatory papule that ulcerates, with regional lymphadenopathy and eventual scarring
Tuberculous verrucosa cutis
- Occurs following traumatic inoculation into skin of a TB-sensitized person
- Appears as a purple to brownish-red wart
- Most common on the knees, elbows, hands, feet, and backside
- Can spontaneously resolve over years
Lupus vulgaris
- Progressive disease characterized by small, well-defined brownish-red nodules
- Described as "apple-jelly" nodules
Scrofuloderma
- Occurs from direct extension of underlying tuberculous osteomyelitis or lymphadenitis
- Can heal spontaneously over years, with scarring
Tuberculosis cutis orificialis
- Involvement of oral mucosa in patients with visceral TB and immunosuppression
- Presents with red or yellow papules that painfully ulcerate
Miliary tuberculosis
- Miliary tuberculosis can disseminate to skin
- Typically appears as small red spots that progress into ulcers or abscesses
Tuberculoma
- Hematogenous metastasis from an old, healed tubercule
- Most commonly on trunk and extremities
- Presents as a fluctuant subcutaneous abscess that can fistulize or ulcerate
Tuberculid
- A variety of hypersensitivity reactions to current or previous tuberculosis infection
Papulonecrotic tuberculid
- Recurrent crusted papules with central necrosis
- Typically on the extensor surfaces, buttocks, and trunk
- Can heal over 6 to 8 weeks, with scarring
Erythema induratum of Bazin
- Caused by a hypersensitivity vasculitis
- Occurs mostly in women, with subcutaneous nodules on the back of legs that can ulcerate
- Can be persistent or recurring
Lichen scrofulosorum
- Small follicular grouped papules that form superficial plaques and eventually heal without scarring over months
- Most often children or young adults with underlying tuberculous osteomyelitis or adenitis
Lupus miliaris disseminatus faciei
- Rare, related to granulomatous rosacea
Phlyctenular keratoconjunctivitis
- A type 4 hypersensitivity reaction that affects the phlyctens in the conjunctiva
- Most commonly occurs in patients with underlying active tuberculosis
Further Reading
- Cutaneous Manifestation of Tuberculosis. Infect Dis Clin Practice. 2012;20(6):376-383. doi: 10.1097/IPC.0b013e31826412e1
