Abstract:
Background Lupus vulgaris as the main picture of the old cutaneous tuberculosis is no more existing at the time being but replaced by different and diverse cutaneous clinical features that can mimic other skin diseases. Objective To record all patients with skin tuberculosis and to do full clinical and histopathological evaluation. Methods This is case series descriptive study where all patients with cutaneous tuberculosis were recorded during the period from 2015-2021 years. Full demographic features were recorded and full clinical assessment was carried out. Classifications of clinical presentations were done. Skin biopsies for histopathological examination were performed. Tuberculin testing was done as confirmatory diagnostic aid especially when it is needed. Results Seventy-two patients with cutaneous tuberculosis were seen and evaluated, their ages ranged from 6months-60 years with a median 28 years, with 42(58.33%) males and 30 (41.66%) females. The course of disease was chronic and the duration of rash ranged from 0.5-10 years. All parts of the body were affected, with limbs predominance 38(52.77%).The lower limbs were affected in 22 (30.55%) cases followed by upper limbs 16 (22.22%) cases , trunk 15 (20.83%), face 13(18%) and neck in 6 (8.33%) cases. In many patients, the initial lesions were inflammatory red cutaneous lumps and plaques that overtime change into different clinical lesions. The following clinical types were identified: cold abscesses and discharging sinuses were the most commonly diagnosed clinical variants as seen in 38 (52.77%) patients, followed by tuberculous chancre in 17 (23.61%), tuberculosis verrucosa cutis (warty TB) in 11 (15.27%) and orificial tuberculosis in 6 (8.23%) patients. No systemic involvement was documented in all patient apart from one patient with lung TB. No cases with classical lupus vulgaris were observed. The pathology of lesions were characteristically inflammatory lymphocytic granulomatous reactions. Conclusion The old picture of cutaneous tuberculosis in form of lupus vulgaris is now no more existing and rarely observed but replaced by different cutaneous chronic pyogenic lesions like pictures of cold abscesses, cutaneous lumps, ulcers, sinuses and scarring, lupus pernio like and warty lesions. Chronic leishmaniasis should be regarded as the most common and an important differential diagnosis. Sarcoidosis although a rare disease but remains an important challenging differential diagnosis.
Page(s):
9-17
DOI:
DOI not available
Published:
Journal: Journal of Pakistan Association of Dermatologists, Volume: 33, Issue: 1, Year: 2023
Keywords:
lupus vulgaris
,
cutaneous
,
Mycobacterium tuberculosis
,
Tuberculin Skin Test
,
Scrofuloderma
,
cold abscesses
,
chronic leishmaniasis