Cutaneous tuberculosis

Clinical Presentation

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

• Likely a hypersensitivity reaction from previous tuberculosis infection
• Presents as a generalized exanthem in healthy patients with no active disease but previous infection
• Subtypes include
  • 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
  • Lichen scrofulosorum has small follicular papules with underlying active disease

Further Reading

• Cutaneous Manifestation of Tuberculosis. Infect Dis Clin Practice. 2012;20(6):376-383. doi: 10.1097/IPC.0b013e31826412e1