Cutaneous tuberculosis: Difference between revisions

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== Clinical Presentation ==
== Clinical Manifestations ==
=== Primarily cutaneous tuberculosis ===
=== Primarily cutaneous tuberculosis ===
* Occurs following direct inoculation into skin
* Occurs following direct inoculation into skin
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* Occurs from direct extension of underlying [[tuberculous osteomyelitis]] or [[tuberculous lymphadenitis|lymphadenitis]]
* Occurs from direct extension of underlying [[tuberculous osteomyelitis]] or [[tuberculous lymphadenitis|lymphadenitis]]
* Can heal spontaneously over years, with scarring
* 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 ===
* [[Miliary tuberculosis]] can disseminate to skin
* [[Miliary tuberculosis]] can disseminate to skin
* Typically appears as small red spots that progress into ulcers or abscesses
* 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 ===
=== Tuberculid ===
* Likely a hypersensitivity reaction from previous tuberculosis infection
* A variety of hypersensitivity reactions to current or previous tuberculosis infection

* Presents as a generalized exanthem in healthy patients with no active disease but previous infection
==== Papulonecrotic tuberculid ====
* Subtypes include
* Recurrent crusted papules with central necrosis
⚫
** Erythema induratum occurs mostly in women, with nodules on the back of legs that can ulcerate
** Papulonecrotic tuberculid has recurrent crusted papules on the extensor surfaces, buttocks, and trunk that scar over in about 6 weeks
* Typically on the extensor surfaces, buttocks, and trunk
* Can heal over 6 to 8 weeks, with scarring
** Lichen scrofulosorum has small follicular papules with underlying active disease

==== 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 [[tuberculous adenitis|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 ==
== Further Reading ==

Latest revision as of 01:21, 21 July 2020

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

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

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