B11. Tuberculosis of the skin and its treatment

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  • Cutaneous tb is a rare form of extrapulmonary tb
  • Multiple types
    • Tuberculous chancre
      • Occurs at the site where m. tuberculosis enters the skin
      • In people who don’t already have TB
      • Papule -> painless ulcer
    • TB verrucosa cutis
      • Occurs at the site where m. tuberculosis enters the skin
      • In people who already have TB
      • Purplish warty growth
    • Lupus vulgaris
      • Apple-jelly nodules (gelatinous consistency)
      • Sharply defined reddish-brown lesions
      • On head
    • Scrofuloderma
      • Direct extension of underlying TB from lymph nodes, bones or joints to the skin
      • Firm, painless nodules -> ulcerate
    • Miliary TB
      • Haematogenous dissemination of m. tuberculosis
      • Small (millet-sized) erythematous papules -> ulcers, abscesses
    • Tuberculids
      • Papulonecrotic tuberculid
        • Necrotic papules
      • Erythema induratum
        • Hard nodules on back of legs of women
  • Diagnosis
    • Tuberculin skin test (TST) / purified protein derivative (PPD)
    • Interferon gamma release assay (IGRA)
  • Treatment
    • RIPE for 2 months
    • RI for 4 months