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 .

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

neutrophilic reaction puntuated by areas of necrosis and with numerous tubercle bacilli ‡ 3-6 wks later.Primary tuberculous chancre ‡ Ac. ‡ Caseation becomes evident and tubercle bacilli sparse . giant cells and lymphocytes appear. the infiltrate becomes granulomatous and epithelioid cells.

containing numerous tubercle bacilli . surrounded by macrophages.Acute miliary tuberculosis ‡ Focal areas of necrosis and abscess formation.

Lupus vulgaris ‡ Epithelioid cells. occasional Langhans giant cell & mononuclear cells are present. usually in the upper dermis. ulceration acanthosis or occasional psedoepitheliomatous hyperplasia may be present . ‡ Occasional foreign body giant cell may be present ‡ Caseation usually minimal ant Tubercle bacilli difficult to demontrate ‡ Atrophy.

hypergrnulosis.Tuberculosis verrucosa cutis ‡ Hyperkeratosis. ‡ Tuberculoid granulomas with moderate amount of caseous necrosis and few tubercle bacilli in mid-dermis ‡ Marked fibrosis . acanthosis and papillomatosis overlying an acute inflammatory infiltrate in the epidermis and microabscesses in the upper dermis.

‡ Tuberculoid structures with marked caseous necrosis ‡ Epithelioid cells. large no. of giant cells ‡ Tubercle bacilli easily identified .Scrofuloderma ‡ HPE of center of lesion reveals ulceration and abscess formation.

ulceration and lymphoedema ‡ Easy demonstration of Tubercle bacilli .Tuberculosis cutis orificialis ‡ Nonspecific.

Treatment of Cutaneous Tuberculosis .

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