CUTANEOUS TUBERCULOSIS: DIAGNOSIS AND

TREATMENT

DERMATOLOGY PG RESIDENT: DR A. ALLOCK

GUIDE : DR R.V RANADE

CUTANEOUS TUBERCULOSIS: DIAGNOSIS AND TREATMENT

DIAGNOSIS IS SUGGESTED BY :

•Clinical history and physical signs

•A positive reaction to tuberculin test

•Histopathological demonstration of tuberculoid granuloma

• Intralesional demonstration of AFB

•Proof of extralesional systemic active tuberculosis by suitable

culture methods

•Effect of specific therapy

 Histopathology of the lesions
• Histopathologic reactions to M.Tuberculosis
can be organized along an immunopathologic
spectrum.

• A sequence from non-necrotic epithelioid

cell granulomas with no AFB through necrotic
epithelioid grnulomas with some AFB to the
position of necrosis with abundant AFB can
be arranged.
 Primary tuberculous chancre
• Ac.neutrophilic reaction puntuated by areas of
necrosis and with numerous tubercle bacilli
• 3-6 wks later, the infiltrate becomes
granulomatous and epithelioid cells, giant
cells and lymphocytes appear.
• Caseation becomes evident and tubercle
bacilli sparse
 Acute miliary tuberculosis
• Focal areas of necrosis and abscess formation,
surrounded by macrophages, containing
numerous tubercle bacilli
 Lupus vulgaris
• Epithelioid cells, occasional Langhans giant cell &
mononuclear cells are present, usually in the
upper dermis.
• Occasional foreign body giant cell may be present
• Caseation usually minimal ant Tubercle bacilli
difficult to demontrate
• Atrophy, ulceration acanthosis or occasional
psedoepitheliomatous hyperplasia may be
present
 Tuberculosis verrucosa cutis
• Hyperkeratosis, hypergrnulosis, acanthosis
and papillomatosis overlying an acute
inflammatory infiltrate in the epidermis and
microabscesses in the upper dermis.
• Tuberculoid granulomas with moderate
amount of caseous necrosis and few tubercle
bacilli in mid-dermis
• Marked fibrosis
 Scrofuloderma
• HPE of center of lesion reveals ulceration and
abscess formation.
• Tuberculoid structures with marked caseous
necrosis
• Epithelioid cells, large no. of giant cells
• Tubercle bacilli easily identified
 Tuberculosis cutis orificialis
• Nonspecific, ulceration and lymphoedema
• Easy demonstration of Tubercle bacilli
Treatment of Cutaneous Tuberculosis