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ORIGINAL CONTRIBUTIONS
Year : 1997  |  Volume : 63  |  Issue : 5  |  Page : 301-303

A clinicopathological study of 50 cases of cutaneous tuberculosis in Jamnagar District




Correspondence Address:
K M Acharya


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Source of Support: None, Conflict of Interest: None


PMID: 20944360

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  Abstract 

A clinicopathological study of 50 cases of cutaneous tuberculosis was carried out. Majority of patients (30%) belonged to the age group 11-20 years. Male to female ratio was 3 : 2. In our study commonest type of cutaneous tuberculosis was lupus vulgaris (36%) followed by tuberculosis verrucosa cutis (32%) and scrofuloderma (28%). Face and neck were the commonest sites (36%) affected. All the patients showed significant response to antituberculosis treatment within a period of 9 months.


Keywords: Cutaneous tuberculosis, HIV, Antituberculosis therapy


How to cite this article:
Acharya K M, 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

How to cite this URL:
Acharya K M, Ranpara H, Dutta R, Mehta B. A clinicopathological study of 50 cases of cutaneous tuberculosis in Jamnagar District. Indian J Dermatol Venereol Leprol [serial online] 1997 [cited 2019 Jun 16];63:301-3. Available from: http://www.ijdvl.com/text.asp?1997/63/5/301/4599


Tuberculosis is still a major problem in India. The incidence of pulmonary and extrapulmonary tuberculosis is on the rise particularly in this HIV era. Though cutaneous tuberculosis is on the decline there are possibilities that with increased incidence of pulmonary and extrapulmonary tuberculosis, the incidence of cutaneous tuberculosis may go parallel. With a view to find out incidence of cutaneous tuberculosis, in and around Jamnagar, this study was undertaken. Lannec's earliest description of his own "prosectors warts" in 1826 was the first to link mycobacterial infection and cutaneous disease.[1] Cutaneous lesions may be composed of papules, nodules, plaques, ulcers, verrucous lesions, papillomatous tumours, vegetative reactions or cicatricial infiltration. [1,2]


  Materials and Methods Top


The detailed history regarding age, sex, occupation, education, marital status and socioeconomic class was taken. History of trauma was taken into consideration. Special enquiry was made to ascertain any family history of cutaneous or systemic tuberculosis. Complete general and systemic examinations were carried out in addition to dermatological examination for evidence of tuberculosis elsewhere in the body. Smear from the affected area and sputum for acid-fast bacilli were carried out in each case. Routine haemogram with ESR, Mantoux test, and histopathological examination were performed. X-ray chest in all cases, and barium meal, barium swallow and ultrasonography in indicated cases were also done. All the patients were investigated for HIV infection (serum ELISA).


  Results Top


Fifty patients were found to be suffering from cutaneous tuberculosis during our study period of 44 months. During the same period 23600 patients with skin diseases were seen, giving an incidence of 0. 21% of cutaneous tuberculosis. The age varied from 3 to 60 years, majority of patients belonged to younger age group (11 - 20 years) comprising 30% of total patients. In 8 cases (16%) disease was noted to appear before the age of 10 years. There were 30 (60%) male patients and 20 (40%) female patients giving male to female ratio of 3:2. Forty-one patients (82%) were from poor socioeconomic class. The duration of disease varied from 3 months to 5 years. Maximum cases were of lupus vulgaris i.e. 18 (36%) followed by tuberculosis verrucosa cutis and scrofuloderma in 16 (32%) and 14 (28%) respectively. Two (4%) cases with orificial tuberculosis, one involving perianal region and the other involving glans penis were observed.

During our study we did not come across papulonecrotic tuberculides, erythema nodosum, or miliary tuberculosis. Face and neck were the sites affected in 18 (36%) patients; buttocks in 10, trunk 9, legs in 7, foot in 2, hand in 1 (2%) each.

Majority of the patients (90%) presented with single lesion. The rest had multiple lesions (10%). Active tuberculosis in other organs viz. lung, bone and lymph nodes were observed in 16 (32%) patients. Thirty-four patients (68%) showed inflammatory papule formation followed by scarring at the site of BCG vaccination within a period of 3-6 weeks but 16 patients (32%) did not show any such response. Mantoux test was positive in 34 (68%) with an induration > 10mm, and negative in the remaining. Biopsy reports of 48 cases (96%) showed characteristic histopathological changes of tuberculosis. In 2 cases (4%) the histopathological features were non-specific.

All the patients were negative for HIV.

After establishing the diagnosis all patients were given anti-tuberculosis treatment. Patients showed significant response within the period of 9 months.


  Discussion Top


Cutaneous tuberculosis is now rarely seen in Western countries but it is encountered commonly in developing countries.[2] In our study, we observed that exposed areas were more often affected. Face was commonly involved. Practically no site was found to be spared. Lupus vulgaris was the commonest type of cutaneous tuberculosis in our study as observed in various other studies from India.[3]-[5] None of our patients had developed cutaneous tuberculosis at vaccination site. Carcinomatous change as reported in lupus vulgaris,[6] was not recorded in the present study. Tuberculosis verrucosa cutis was found next common to lupus vulgaris whereas in one study scrofuloderma was next to lupus vulgaris.[4]



 
  References Top

1.Tomecki K J, Hall G S. Tuberculosis of the skin, In : Clinical Dermatology Vol 3, editor Demis D J, J B Lippincott Company, Philadelphia, 1989; unit 16-28:1-26.  Back to cited text no. 1    
2.Savin J A. Mycobacterial infection, In: Textbook of Dermatology, 5th edn, Editors, Champion R H, Burton J L, Ebling FJG, Oxford University Press, Bombay; Blackwell Scientific Publication 1992;1033-1066.  Back to cited text no. 2    
3.Singh G. Lupus vulgaris in India. Ind J Dermatol Venereol Leprol 1974;40:257-260.  Back to cited text no. 3    
4.Satyanarayan B V. Tuberculoderma: A brief review together with Statistical analysis and observation. Ind J Dermatol Venereol Leprol 1963;24:25-42.  Back to cited text no. 4    
5.Pandhi R K, Bedi T R, Kanwar A J, et al. Cutaneous tuberculosis: a clinical and investigative study. Ind J Dermatol Venereol Leprol 1977;22:99-106.  Back to cited text no. 5    
6.Kumar B, Kaur S. Pattern of cutaneous tuberculosis in North India. Ind J Dermatol Venereol Leprol 1986;52:203-207.  Back to cited text no. 6    




 

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