DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20170454

A clinicoepidemiological study of cutaneous tuberculosis in a tertiary care teaching hospital in Andhra Pradesh, India

Chintaginjala Aruna, Senthil Kumar A. L., Sridevi K., Swapna K., Ramamurthy D. V. S. B.

Abstract


Background: Cutaneous tuberculosis constitutes 1.5% of extra pulmonary tuberculosis and the disease continues to be a challenging one because of its multifaceted presentation. The present study was done to document the most common type of cutaneous tuberculosis, atypical presentations if any and response to directly observed therapy short course (DOTS).

Methods: All patients with clinically suspected cutaneous tuberculosis attending outpatient department of dermatology in our hospital from October 2012 to April 2016 were included in the study. A detailed history of presenting illness and thorough general, systemic and cutaneous examination was carried out along with documentation of demographic details. Routine blood invetigations, biopsy and mantoux test were done. Diagnosed cases were treated with DOTS.

Results: A total of 25 cases of cutaneous tuberculosis were included in the study. Most common type of cutaneous tuberculosis was lupus vulgaris. Atypical presentations noted during the study were multifocal lupus vulgaris (LV), co-existence of tuberculosis verrucosa cutis (TVC) and LV, TVC of lower lip, erythema induratum of bazin presenting as annular plaque in one case and as erythema nodosum in another case. DOTS were effective in majority of the patients.

Conclusions: Cutaneous tuberculosis is multifaceted. High clinical suspicion is necessary in rare presentations. Coexistence of two or more morphological patterns can occur. Doubtful cases, 5-6weeks of therapeutic trail helps. Adequate dose is essential for good response. Second line drugs are to be considered in case of failure /clinical resistance.

 


Keywords


Cutaneous tuberculosis, Multifocal tuberculosis, Atypical presentations, Erythema induratum of bazin, DOTS

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References


World health organisation, global tuberculosis report 2015. Available from http:// http://www.who.

int/tb/publications/global_report/en/.

Kumar B, Rai R, Kaur I, Sahoo B, Muralidhar S, Radotra BD. Childhood cutaneous tuberculosis: a study over 25 years from northern India. Int J Dermatol. 2001;40:26-32.

Kumar B, Muralidhar S. Cutaneous tuberculosis: A-Twenty-year prospective study. Int J Tuberc Lung Dis. 1999;3:494-500.

Kumar B, Kaur S. Pattern of cutaneous tuberculosis in North India. Indian J Dermatol Venereol Leprol. 1986;52:203-7.

Acharya KM, Ranpara H, Dutta R, Mehta B. A clinicopathological study of 50 cases of cutaneous tuberculosis in Jamnagar district. Indian J Dermatol Venereol Leprol. 1997;63:301-3.

Patra AC, Gharami RC, Banerjee PK. A profile of cutaneous tuberculosis. Indian J Dermatol. 2006;51:105-7.

Thakur BK, Verma S, Hazarika D. A clinicopathological study of cutaneous tuberculosis at Dibrugarh district Assam. Indian J Dermatol. 2012;57:63-5.

Puri N. A clinical and histopathological profile of patients with cutaneous tuberculosis. Indian J Dermatol. 2011;56:550-2.

Sehgal VN, Srivastava G, Khurana VK, Sharma VK, Bhalla P, Beohar PC. An appraisal of epidemiologic, clinical, bacteriologic, histopathologic and immunologic parameters in cutaneous tuberculosis. Int J Dermatol. 1987;26:521-6.

Gopinathan R, Pandit D, Joshi J, Jerajani H, Mathur M. Clinical and morphological variants of cutaneous tuberculosis and its relation to mycobacterium species. Indian J Med Microbiol. 2001;19:193-6.

Pillsbury DM, Shelley WB, Kligman AM. Systemic bacterial infection. In: Dermatology. Philadelphia: WB Saunders; 1956: 499-540.

Murugan S, Vetrichevvel TP, Subramanyam S, Subramanian A. childhood multicentric lupus vulgaris. Indian J Dermatol. 2011;56:343-4.

Vora RV, Diwan NG, Rathod KJ. Tuberculosis verrucosa cutis with multifocal involvement. Indian Dermatol Online J. 2016;7:60-2.

Rao AG. Scrofuloderma associated with tuberculosis verrucosa cutis. Indian J Dermatol Venereol Leprol. 2014;80:76-8.

Sethuraman G, Kaur J, Nag HL, Khaitan BK, Sharma VK, Singh MK. Symmetrical scrofuloderma with tuberculosis verrucosa cutis. Clin Exp Dermatol. 2006;31:452-82.

Sehgal VN, Gupta R, Bose M, Saha K. Immuno histopathological spectrum in cutaneous tuberculosis. Clin Exp Dermatol. 1993;18:309-13.

Narayana GP, Sandhya I. Verrucous carcinoma of the finger: A rare site of occurrence. Indian Dermatol Online J. 2014;5:218-9.

Kala S, Pantola C, Agarwal A. Tuberculosis verrucosa cutis developing over a keloid: A rare presentation. J Surg Tech Case Rep. 2010;2:75–6.

Maharaja K, Khandpur S, Ramam M, Singh MK, Kumar U, Sharma VK. A study of the clinico-histopathological features of erythematous tender nodules predominantly involving the extremities. Indian J Dermatol Venereol Leprol. 2014;80:235-42.

Dwari BC, Ghosh A, Paudel R, Kishore P. A clinicoepidemiological study of 50 cases of cutaneous tuberculosis in a teritiary care teaching hospital in Pokhara, Nepal. Indian J Dermatol. 2010:55:233-7.

Raghu Rama Rao G, Sridevi, Lakshmy Narayan B, Amareswar A, Sandhya S. Directly observed treatment short course and cutaneous tuberculosis: Our experience. Indian J Dermatol Venereol Leprol. 2011;77:330-2.

Ramesh V, Sen MK, Sethuraman G, D'Souza P. Cutaneous tuberculosis due to multidrug-resistant tubercle bacilli and difficulties in clinical diagnosis. Indian J Dermatol Venereol Leprol. 2015;81:380-4.

Ramam M, Tejasvi T, Manchanda Y, Sharma S, Mittal R. What is the appropriate duration of a therapeutic trial in cutaneous tuberculosis? Further observations. Indian J Dermatol Venereol Leprol. 2007;73:243-6.