Cutaneous tuberculosis: Difference between revisions

Revision as of 16:59, 6 December 2019

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

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 granuloatmous rosacea

Phlyctenular keratoconjunctivitis

A type 4 hypersensitivity reaction that affects the phlyctens in the conjunctiva
Most commonly occurs in patients with underlying active tuberculosis

@@ Line 33: / Line 33: @@
 === 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 granuloatmous 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 ==