Cutaneous tuberculosis
Cutaneous tuberculosis | |
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Other names: Skin tuberculosis[1] | |
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Specialty | Dermatology, Infectious disease |
Symptoms | Inflammatory papules, ulcers, nodules, pustules, verrucous plaques[3] |
Diagnostic method | Mantoux test, Serum QuantiFERON-TB Gold (QFT-G) levels, PCR, and skin biopsy[3] |
Differential diagnosis | Chronic vegetative pyoderma,Blastomycosis,Chromoblastomycosis, drug reactions and Syphilitic gumma[3] |
Treatment | Isoniazid, rifampicin, pyrazinamide, and ethambutol or streptomycin[3] |
Prognosis | Good(in individuals who are not immunocompromised)[3] |
Frequency | Uncommon(1% to 2% )[3] |
Cutaneous tuberculosis is an infection due to M. Tuberculosis complex, and bacillus Calmette-Guérin. Clinical presentation depends on immunity and also environmental aspects; as well as those individuals using immunobiological drugs who may be susceptible.[4][5] In terms of the treatment for cutaneous tuberculosis we find that isoniazid, rifampicin, and ethambutol are used.[3]
Types
The types of cutaneous tuberculosis is consistent with the following:[6][7]
- TB verrucosa cutis caused via exogenous reinfection and presents as warty lesions on the hands, and knees.
- Miliary TB presents as multiple small skin lesions
- Lupus vulgaris happens due to lymphatic spread from the internal location of tuberculosis and is usually reddish-brown plaques.
- Scrofuloderma happens when tuberculosis spreads from a infected bone to the skin and subcutaneous nodules form .
- Tuberculosis cutis orificialis presents usually around the nose or mouth.
Signs and symptoms
In an affected individual the presentation of skin tuberculosis would be the following:[6][7][8]
-
Skin tuberculosis on hand
-
Skin tuberculosis on face
Complications
Among the possible complications of skin tuberculosis we find:[7]
- Disfiguring scars
- Squamous cell carcinoma
Cause

Mycobacterium tuberculosis, is a species of pathogenic bacteria in the family Mycobacteriaceae and the causative agent of tuberculosis.[9][10]
M. tuberculosis has an unusual, waxy coating on its cell surface primarily due to the presence of mycolic acid. This coating makes the cells impervious to Gram staining, and as a result, M. tuberculosis can appear weakly Gram-positive.[11]
Mechanism
As to the mechanism via which cutaneous tuberculosis can occur, we find that there are two:[3]
- Endogenous invasion is the result of spread of pulmonary tuberculosis by lymphatic dissemination.
- Exogenous invasion is via direct inoculation of the bacteria.
Diagnosis

In terms of the diagnosis of cutaneous tuberculosis we find that the following is done:[3] [12]
- Medical history
- Physical examination
- Tuberculosis skin test
- Skin biopsy
Differential diagnosis
The DDx is based, but not limited, to the following:[3]
- Blastomycosis
- Drug reactions
- Granulomatous rosacea
- Syphilitic gumma
- Papular eczema
- Atypical mycobacterial infection
- Chromoblastomycosis
Treatment

In terms of treatment we find there are two phases:[3]
- Intensive phase which rapidly decreases the burden of M. tuberculosis(8 weeks)
- Continuation phase(9-12 months)
The multidrug treatment involves isoniazid, rifampicin, pyrazinamide, and ethambutol or streptomycin.
Surgical excision of cutaneous TB such as lupus vulgaris or scrofuloderma may be needed.[7]
Epidemiology
As to the epidemiology of cutaneous tuberculosis we find that of the individuals that have extra-pulmonary manifestations of TB, about one to two percent develop cutaneous tuberculosis. It is common in areas of the globe where HIV is also common.[3]
Some types of cutaneous tuberculosis affect young or middle-aged females; though males may be affected as well. Cases in South Africa and Pakistan have been reported, as to rare type(s) of cutaneous tuberculosis.[13] Per WHO the countries with the most cases of cutaneous tuberculosis as a consequence of having a high TB incidence (as well as immunocompromised individuals) are:[14][6]
History

In terms of the history of cutaneous tuberculosis we find that it was first described by Laennec in 1826.[15]
However, the wider discovery of Mycobacterium tuberculosis,which is responsible for tuberculosis, was made by Dr. Robert Koch in 1882.[16]
See also
- Mycobacterium africanum
- Mycobacterium bovis
- Mycobacterium caprae
- Mycobacterium orygis
- Mycobacterium suricattae
References
- ↑ "Cutaneous tuberculosis (Concept Id: C0041309) - MedGen - NCBI". www.ncbi.nlm.nih.gov. Archived from the original on 2024-08-18. Retrieved 2024-08-15.
- ↑ van Staden, Daniélle; Haynes, Richard K.; Viljoen, Joe M. (15 June 2022). "Adapting Clofazimine for Treatment of Cutaneous Tuberculosis by Using Self-Double-Emulsifying Drug Delivery Systems". Antibiotics (Basel, Switzerland). 11 (6): 806. doi:10.3390/antibiotics11060806. ISSN 2079-6382. Archived from the original on 14 July 2022. Retrieved 11 August 2024.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 Charifa, Ahmad; Mangat, Rupinder; Oakley, Amanda M. (2024). "Cutaneous Tuberculosis". StatPearls. StatPearls Publishing. Archived from the original on 2021-08-28. Retrieved 2021-06-17.
- ↑ Dias, Maria Fernanda Reis Gavazzoni; Bernardes Filho, Fred; Quaresma, Maria Victória; Nascimento, Leninha Valério do; Nery, José Augusto da Costa; Azulay, David Rubem (December 2014). "Update on cutaneous tuberculosis". Anais Brasileiros de Dermatologia. 89 (6): 925–938. doi:10.1590/abd1806-4841.20142998. Archived from the original on 28 August 2021. Retrieved 17 June 2021.
- ↑ Hill, Michael K.; Sanders, Charles V. (January 2017). "Cutaneous Tuberculosis". Microbiology Spectrum. 5 (1). doi:10.1128/microbiolspec.TNMI7-0010-2016. ISSN 2165-0497. Archived from the original on 28 August 2021. Retrieved 17 June 2021.
- ↑ 6.0 6.1 6.2 Tirado-Sánchez, Andrés; Bonifaz, Alexandro (1 June 2018). "Cutaneous Tuberculosis: a Review of the Current Literature". Current Tropical Medicine Reports. 5 (2): 67–76. doi:10.1007/s40475-018-0140-z. ISSN 2196-3045. Archived from the original on 14 August 2024. Retrieved 20 August 2024.
- ↑ 7.0 7.1 7.2 7.3 "Cutaneous tuberculosis (TB)". DermNet®. 26 October 2023. Archived from the original on 21 May 2024. Retrieved 12 August 2024.
- ↑ Maloney, McKenzie E.; Cohen, Bernard (17 May 2023). "Cutaneous tuberculosis in the pediatric population: A review". JAAD International. 12: 105–111. doi:10.1016/j.jdin.2023.05.001. ISSN 2666-3287. Archived from the original on 20 August 2024. Retrieved 20 August 2024.
- ↑ Gordon SV, Parish T (April 2018). "Microbe Profile: Mycobacterium tuberculosis: Humanity's deadly microbial foe". Microbiology. 164 (4): 437–439. doi:10.1099/mic.0.000601. PMID 29465344.
- ↑ Ryan KJ, Ray CG (2004). "Mycobacteria". Sherris Medical Microbiology : an Introduction to Infectious Diseases (4th ed.). New York: McGraw-Hill. p. 439. ISBN 978-0-83-858529-0.
- ↑ Fu LM, Fu-Liu CS (2002-01-01). "Is Mycobacterium tuberculosis a closer relative to Gram-positive or Gram-negative bacterial pathogens?". Tuberculosis. 82 (2–3): 85–90. doi:10.1054/tube.2002.0328. PMID 12356459.
- ↑ Kaul, Subuhi; Jakhar, Deepak; Mehta, Shilpa; Singal, Archana (December 2023). "Cutaneous tuberculosis. Part II: Complications, diagnostic workup, histopathologic features, and treatment". Journal of the American Academy of Dermatology. 89 (6): 1107–1119. doi:10.1016/j.jaad.2021.12.064. Archived from the original on 2024-08-18. Retrieved 2024-08-15.
- ↑ dos Santos, Josemir Belo; Figueiredo, Ana Roberta; Ferraz, Cláudia Elise; de Oliveira, Márcia Helena; da Silva, Perla Gomes; de Medeiros, Vanessa Lucília Silveira (2014). "Cutaneous tuberculosis: epidemiologic, etiopathogenic and clinicalaspects - Part I". Anais Brasileiros de Dermatologia. 89 (2): 219–229. doi:10.1590/abd1806-4841.20142334. ISSN 0365-0596. Archived from the original on 3 December 2023. Retrieved 20 August 2024.
- ↑ "Tuberculosis 2021" (PDF). WHO. Archived (PDF) from the original on 14 October 2021. Retrieved 20 August 2024.
- ↑ Sharma, Neeraj; Kumar, Kunal; Chaudhary, Robin; Yadav, Aseem; Singh, Nalin; Vasan, Amit Singh (14 November 2023). "Papulonecrotic Tuberculid—a Rare Cutaneous Expression of a Common Disease: a Case Report". SN Comprehensive Clinical Medicine. 5 (1): 268. doi:10.1007/s42399-023-01612-y. ISSN 2523-8973. Archived from the original on 18 August 2024. Retrieved 17 August 2024.
- ↑ "World TB Day History". Centers for Disease Control and Prevention. 18 October 2023. Archived from the original on 7 December 2018. Retrieved 17 August 2024.
Further reading
- Brito, Arival Cardoso de; Oliveira, Clivia Maria Moraes de; Unger, Deborah Aben-Athar; Bittencourt, Maraya de Jesus Semblano (2022). "Cutaneous tuberculosis: epidemiological, clinical, diagnostic and therapeutic update". Anais Brasileiros de Dermatologia. 97 (2): 129–144. doi:10.1016/j.abd.2021.07.004. ISSN 0365-0596.