Abstract
Introduction: Previous studies from India concluded that the incidence of cutaneous tuberculosis has fallen from 2% to 0.15%, whereas more recent reports suggest that cutaneous tuberculosis is again becoming more prevalent. Aims: To study the patterns of clinical presentation of cutaneous tuberculosis, to correlate them with histopathology, Mantoux reactivity and BCG vaccination status in the north-west region of Punjab. Methods: Analysis of the records of patients with cutaneous tuberculosis who attended the hospital between Jan 2009 to Dec 2012. Results: A total of 36 (0.02%) of dermatology patients had cutaneous tuberculosis. The type of cutaneous tuberculosis in decreasing order of incidence was lupus vulgaris 16 (44.44%) followed by tuberculosis verrucosa cutis 10 (27.77%), scrofuloderma 7 (19.44%) and tuberculids 3 (8.33%). There were no cases of erythema nodosum or miliary tuberculosis. Multiple sites were involved in 17 (47.22%) patients. Face and neck were the most common sites affectedMost of the patients (52.77%) presented with single lesion. Active tuberculosis in other organs were observed in 8 (22.22%) patients. Mantoux test was positive in 23 (63.88%). BCG scar was present in 23 (63.8%) patients. 29 cases (80.55%) showed characteristic histopathological changes of cutaneous tuberculosis. Conclusions: The incidence of cutaneous tuberculosis in the present study was found to be 0.02% which is far lower as compared to previous reports. Reason for this observation could be the effective implementation of the National Program for tuberculosis at primary and secondary level leading to early diagnosis and treatment, hence lesser number of cases reaching to a tertiary center. This study also depicts the histopathological correlation evident in 80.55% of the histopathological specimens which is highly significant.
Highlights
Studies from India concluded that the incidence of cutaneous tuberculosis has fallen from 2% to 0.15% [4], whereas more recent reports suggest that cutaneous tuberculosis is again becoming more prevalent [5]
During the 48 months of our study 36 patients were found to be suffering from cutaneous tuberculosis out of approx 1,80,000 patients with skin diseases attended the skin OPD, giving an incidence of 0.02%
M. tuberculosis can cause skin infection by direct inoculation into the skin, by haematogenous spread from an internal lesion or by direct contact with tuberculosis in an underlying deeper structure
Summary
Previous studies from India concluded that the incidence of cutaneous tuberculosis has fallen from 2% to 0.15%, whereas more recent reports suggest that cutaneous tuberculosis is again becoming more prevalent. Aims: To study the patterns of clinical presentation of cutaneous tuberculosis, to correlate them with histopathology, Mantoux reactivity and BCG vaccination status in the north-west region of Punjab. Conclusions: The incidence of cutaneous tuberculosis in the present study was found to be 0.02% which is far lower as compared to previous reports. Reason for this observation could be the effective implementation of the National Program for tuberculosis at primary and secondary level leading to early diagnosis and treatment, lesser number of cases reaching to a tertiary center. Family history of pulmonary/extrapulmonary TB, a positive Mantoux test and histopathological features aid the diagnosis
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