Criteria for the Diagnosis of Certain Tuberculoderms

Abstract

All dermatologists are aware of the great progress that has been made in recent years in our knowledge of cutaneous tuberculosis. We have kept abreast of the advances with the knowledge of tuberculosis elsewhere and have followed the research in related fields. We have attempted to apply the new facts as each was established to what was known about cutaneous tuberculosis, but despite our considerable present knowledge, despite all the advances in the fields of allergy and immunology, we have been unable to find an explanation for the great variance in the morphologic aspects of the various tuberculoderms as we know them today.The finding of the tubercle bacillus in lupus vulgaris lesions, both by culture and inoculation, disclosed that this cutaneous disease is in general tuberculous. This was a great advance, but it did not explain why in certain tuberculous patients there should develop such a slow, almost benign, form of cutaneous tuberculosis, even though its manifestation in the skin was a destructive and serious malady in itself. Other cutaneous dis¬ eases less destructive than lupus vulgaris had been suspected of being closely related to lupus, but proof of their tuberculous causation was slow in coming. Gradually evidence was accumulated that some of these, for example acnitis, were also caused by the tubercle bacillus, and one by one a number of diverse cutaneous conditions were proved to be of tuberculous causation or, because of certain constant observations, were strongly suspected of being tuberculous. When this relationship, real or suspected, of tuberculosis was applied to a large series of poorly described cutaneous lesions, a nosologie terminology evolved which to this day makes the subject incredibly involved and complex.In 1896 Darier propounded his theory of the tuberculids, and a new nomenclature was evolved. Lesions which were suspected of being tuberculous, but in which the tubercle bacillus could rarely if ever be found, were called "tuberculids," and the enthusiasm of some allowed a large number of cutaneous conditions to be included in this ill defined nosologie group.As certain cutaneous lesions which either had been proved to be tuberculous or were still strongly suspected of being so became better known and were reported with greater regularity, an effort was made to classify them. Some students of the subject decided that certain types arose from inoculation in virgin soil, and they classified these types as external cutaneous tuberculosis, while other forms developed from endogenous infections and these they called internal types. Other classifica¬ tions were based on the mode of spread and on the suspected manner of sowing of the bacilli in the skin.The way the patient who harbored various tuberculous lesions reacted to tuberculin provided explanation for the pathogenesis of certain types and hence another means of classification. The course and prognosis of the disease revealed the close relationship of some of these diverse conditions.Regardless of which classification one accept...

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

“…There was no difference in the yield of culture positivity in the three types of cutaneous tuberculosis. Although it is widely believed that it is difficult to demonstrate viable bacilli in a paucibacillary condition like cutaneous tuberculosis (Michelson 1948; Sehgal et al. 1987) culture positivity rate was 55% in the present study.…”

“…Similarly, unlike skin tuberculosis, in other forms of extra pulmonary tuberculosis, there is evidence of disseminated disease (Balasubramaniam & Ramachandran 2000) There was no difference in the yield of culture positivity in the three types of cutaneous tuberculosis. Although it is widely believed that it is difficult to demonstrate viable bacilli in a paucibacillary condition like cutaneous tuberculosis (Michelson 1948;Sehgal et al 1987) culture positivity rate was 55% in the present study. This could be due to the use of multiple media for culture and the use of Kirchner's liquid medium for preserving the biopsy material till they were processed as has been performed in non-cutaneous tuberculosis (Mitchison et al 1983;Vanajakumar et al 1997).…”

Cutaneous tuberculosis in children and adolescents: a clinicohistological study

“…This site preponderance in developing countries is probably due to the prevailing local habit of children playing without clothing. This contrasts with LV in western countries, where the face is the most common site affected, with frequent involvement of the nose and cheeks 20,21 …”

“…This contrasts with LV in western countries, where the face is the most common site affected, with frequent involvement of the nose and cheeks. 20,21 In daily practice, it can be difficult to clinically differentiate skin tuberculosis from cutaneous leishmaniasis, leprosy, chromomycosis, sporotrichosis and verrucous lesions. 22 Several authors have highlighted the difficulty of histological confirmation because of the fact that many of these diseases produce tuberculoid granulomas.…”

Tuberculosis verrucosa cutis which Remained Undiagnosed for Forty-Three Years

“…Tuberculosis verrucosa cutis (table l) is a form of cuta neous tuberculosis due to an exogenous inoculation of M. tuberculosis complex into the skin through minimal wounds or abrasions in previously infected and sensitized persons [1][2][3]. Usually, it appears as an asymptomatic in durated verrucous nodule or plaque with an inflammatory border which shows gradual peripheral extension.…”