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PubMed1989

[Apropos of 45 cases of cutaneous tuberculosis in Tlemcen (western Algeria)].

The cutaneous tuberculosis (CTB) is still frequent in Algeria. From March 81 through December 87, forty-five cases were observed in our service of Dermato-Venereology (CHU Tlemcen), something like 6.4 cases per year. The two sexes are equally represented; 66.6% aged under 40; 66.6% are living in cities and have modest social and economical conditions; 20% were inoculated with BCG; previous CTB (personal 8.8% of family 11.1%) were hardly seen. It took some 44% of the patients less than a year to ask for a diagnosis, after receiving several non specific treatments. The rest took longer to come for consultation and in one case, the disease evaluated for 28 years. One explanation is that sometimes the affection causes very little annoyance. The clinical aspects observed were often evocative: Lupus vulgaris, 28.8%, scrofuloderma, 28.8%, specific adenitis, 13.3%, tuberculosis verrucosa cutis, 13.3%, gum, 13.9%, ulcerous CTB, 2.2%. Tuberculin skin test was positive for 86% of the cases and was taken into consideration when it reaches over 15 mm (46%), and with discomfort (4.4%). The treatment was efficient in the large majority of the cases. However, 29.5% of the patients gave up before the end of the cure. We insist upon the priority of the relationship doctor-patient in the case of a chronicle affection, which is less uneasy for some and shameful for a great many.

Adolescent↗
PubMed2006

Comprehensive findings on clinical, bacteriological, histopathological and therapeutic aspects of cutaneous tuberculosis.

OBJECTIVE: To define the bacteriological and histological correlates of the three predominant clinical forms of cutaneous tuberculosis and to evaluate the efficacy of a 9-month daily regimen containing rifampicin and isoniazid. METHODS: In the dermatological clinics of two major teaching hospitals in Chennai, 213 patients with suspected clinical manifestations of cutaneous tuberculosis underwent examination and a skin biopsy for bacteriological and histological tests. They were treated with a daily regimen of rifampicin and isoniazid for 9 months and follow-up for 3 years. RESULTS: Bacteriological and/or histological confirmation of tuberculosis was obtained in 88% of the cases. Lupus vulgaris lesions were seen mainly in the extremities and verrucosa cutis occurred predominantly on the sole and foot, while the cervical and axillary regions were the commonest sites for scrofuloderma. Ninety-two per cent of the patients showed resolution of the lesions within the first 6 months of chemotherapy; 1% failed to respond to this regimen. There was no relapse in any of the cases during the follow-up period of 3 years. CONCLUSIONS: Clinical findings were adequate to identify major forms of cutaneous tuberculosis as evidenced by bacteriological and histopathological examination. A daily regimen of rifampicin and isoniazid for 9 months was effective in treating cutaneous tuberculosis.

Adult↗
PubMed1999

Cutaneous tuberculosis: a twenty-year prospective study.

SETTING: A tertiary care hospital in northern India. OBJECTIVE: To study the patterns of clinical presentation of cutaneous tuberculosis, to correlate them with Mantoux reactivity and BCG vaccination status, and to suggest a clinical classification based on these factors. DESIGN: Analysis of the records of patients with cutaneous tuberculosis who attended the hospital between 1975 and 1995. RESULTS: A total of 0.1% of dermatology patients had cutaneous tuberculosis. Lupus vulgaris was the commonest form, seen in 154 (55%) of these patients, followed by scrofuloderma in 75 (26.8%), tuberculosis verrucosa cutis in 17 (6%), tuberculous gumma(s) in 15 (5.4%) and tuberculids in 19 (6.8%). No correlation was found between Mantoux reactivity and the extent of disease (localised disease 63.6%, disseminated disease 67.9%). The presence of regional lymphadenopathy was an indication of dissemination of the disease (localised disease 34.7%, disseminated disease 71.7%). Dissemination of the disease was observed in the whole of the spectrum of cutaneous tuberculosis (22.1%), but was seen more often in the presence of gumma and scrofuloderma. There were more unvaccinated individuals in the group with disseminated disease (80.3%) than in those with localised disease (65.5%). CONCLUSIONS: Lupus vulgaris was the most common clinical presentation, followed by scrofuloderma, tuberculids, tuberculosis verrucosa cutis and tuberculous gumma. Some patients presented more than one clinical form of the disease. Classification of cutaneous tuberculosis needs to be modified to include smear-positive and smear-negative scrofuloderma apart from the inclusion of disseminated disease. The presence of regional lymphadenopathy serves as a clinical indicator of disseminated disease. Patients with disseminated disease were less likely to have been BCG-vaccinated than those with localised disease.

Adolescent↗
PubMed2005

How soon does cutaneous tuberculosis respond to treatment? Implications for a therapeutic test of diagnosis.

BACKGROUND: It is difficult to demonstrate Mycobacterium tuberculosis in smears or biopsies and to grow it in culture in cutaneous tuberculosis because most cases are paucibacillary. A therapeutic trial of antitubercular drugs is frequently used to confirm the diagnosis in difficult cases. Information is lacking on the response to antitubercular therapy in cutaneous tuberculosis; consequently there are no clear guidelines on when to expect a response and also when to abandon a therapeutic trial. METHODS: We studied the records of 60 patients treated for cutaneous tuberculosis at our hospital to study the time course of the therapeutic response. All patients were treated with a short-course antitubercular regimen consisting of isoniazid 300 mg daily, rifampicin 450 mg daily, ethambutol 800 mg daily and pyrazinamide 1500 mg daily for 2 months followed by isoniazid and rifampicin in the same doses for 4 months. At follow-up visits, each patient was assessed by a dermatologist who recorded the presence or absence of clinical improvement in the skin lesions. RESULTS: Of the 60 patients seen, eight patients did not follow up after the initial consultation, 48 patients improved with treatment and four patients were classified as treatment failures. The timing of the first visit varied from 3 days to 15 months (median 27.5 days, mean 58.96 +/- 94.50) after initiation of treatment. Twenty-one patients were recorded to have improved within the first month of therapy. Twenty-seven patients who first reported more than 30 days after initiation of treatment were found to have improved. Four patients failed to respond during follow up ranging from 3 to 17 months. CONCLUSION: When a therapeutic trial is undertaken in cutaneous tuberculosis, 6 weeks of therapy with four drugs appears adequate to prove (or disprove) the diagnosis.

Adolescent↗
PubMed1982

[Apropos of cutaneous tuberculosis].

A revision of in and out patients' cases of cutaneous tuberculosis is made, joining them in typical forms and tuberculids. From a total of 70 patients, 49 corresponded to typical forms and the rest to tuberculids. They are joining by sex, middle age and nationality remarking if there was any association or no to another envolvement sides and at last, 9 cases with some peculiar characteristics are mentioned.

Adolescent↗
PubMed2003

Incidence of cutaneous tuberculosis in patients with organ tuberculosis.

BACKGROUND: Tuberculosis continues to be a health problem in some countries. The development of resistance to antituberculitic drugs and the increase in diseases and conditions associated with immunodeficiency such as AIDS and chemotherapy have caused tuberculosis to increase recently. As a result, the incidence of cutaneous tuberculosis has been increasing as well. AIM: To detect cutaneous tuberculosis in patients with organ tuberculosis and to establish some characteristics of the relation between organ and cutaneous TB. MATERIAL AND METHODS: A total of 370 patients (145 females and 225 males), aged 2-76 years (mean age 27.5), enrolled for this screening study. These patients were hospitalized patients who already had pulmonary or extrapulmonary tuberculosis diagnosed before admission. All patients underwent a general skin examination, and, if needed, cutaneous biopsies were taken from involved skin areas. RESULTS: Three hundred and forty-seven (93.78%) out of 370 patients had pulmonary tuberculosis only or in association with one of other organ tuberculoses. Twenty-three patients had extrapulmonary TB: nine were TB adenitis, six were TB peritonitis, three were bone tuberculosis, and five were TB meningitides. Of 370 patients, only 13 (3.51%) had cutaneous TB: seven scrofuloderma (SCD; 2.16%), four lupus vulgaris (LV; 1.35%), one LV and SCD, and one Bacille Calmette-Guerin (BCG) adenitis (0.027%). Cutaneous tuberculosis was observed in seven out of 260 patients with parenchymal tuberculosis (2.96%). Four out of nine patients with TB adenitis (44.4%), one out of 12 pulmopleuretic (8.3%), and one out of 67 pleuresic patients (1.40%) had cutaneous TB as well. Mean age of the 13 patients was 32.46 years: mean age of SCD and LV was 24.8 and 48 years, respectively. The one patient with BCG adenitis was 7 months old. Five (62.5%) out of eight patients with SCD, and only one (20%) out of five patients with LV were new cases. Four patients with SCD had a positive family history, while LV patients did not. CONCLUSIONS: Organ tuberculosis is rarely associated with cutaneous tuberculosis. Scrofuloderma and LV are the most frequent forms of skin TB associated with organ TB in this population. Tuberculosis adenitis is the organ TB that causes cutaneous TB most often among other organ tuberculoses. More than one form of cutaneous TB affected only one patient with pulmonary TB; therefore, it is very rare. Tuberculids were not observed in any of the patients.

Adolescent↗