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Tuberculosis

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Dermatology in Public Health Environments

Abstract

The number of cases of cutaneous tuberculosis (CTB) is increasing concomitantly with the increase of pulmonary tuberculosis. Migration, increasing immunosuppression factors, and treatment resistance are mainly responsible for this growth. The varied clinical presentation and low sensitivity of conventional tests make CTB a disease that is difficult to confirm in many cases. Most histopathologic examination has classic findings, although frequency of bacilli is low and atypical granulomas may occur. New tests with lower error rate and higher accuracy are available and should become known. The list of diseases in the differential diagnosis is extensive and, apart from the shape of the skin lesion, depends on the location and age. The initial treatment is equivalent to that of pulmonary tuberculosis, but has some particularities such as difficulty in confirming possible drug resistance. This knowledge is essential for coping with the disease under current clinical circumstances.

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Authors and Affiliations

  1. Federal University of Pernambuco (UFPE), Recife, PE, Brazil

    Josemir Belo dos Santos, Cláudia Elise Ferraz, Matilde Campos Carrera Thouvenin & Vanessa Lucília Silveira de Medeiros

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  1. Josemir Belo dos Santos
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  2. Cláudia Elise Ferraz
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Correspondence to Josemir Belo dos Santos .

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  1. Dermatology Service of Clinical, Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

    Renan Rangel Bonamigo

  2. Health Secretary of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil

    Sergio Ivan Torres Dornelles

Glossary

Glossary

Acid-fast bacilli (AFB):

testing may be used to detect several different types of acid-fast bacilli, but it is most commonly used to identify an active tuberculosis infection caused by the most medically important AFB, Mycobacterium tuberculosis. Are called acid-fast bacilli because they are rod-shaped bacteria (bacilli) that can be seen under the microscope following a staining procedure whereby the bacteria retain the color of the stain after an acid wash (acid-fast).

Bacille Calmette-Guérin:

Vaccine (strain 1331) is a live mycobacteria vaccine derived from attenuated strains of Mycobacterium bovis to prevent tuberculosis and other mycobacterial infections. BCG has been recommended only for immune-competent children and adults who have high risk of ongoing exposure that cannot be avoided. In addition, it is used as an immunostimulant in the treatment of several diseases.

Erythema induratum of Bazin (EIB):

Is a granulomatous lobular panniculitis associated with tuberculosis, which affects the lower limbs of young and middle-aged women.

Erythema nodosum:

Is characterized by the presence of nodular swelling, hardened, nonulcerative nodules which are seen predominantly in the lower limbs of women.

Lupus vulgaris:

Is a chronic, progressive, and potentially disfiguring form of cutaneous tuberculosis, which occurs in patients with a high degree of immunity against Mycobacterium tuberculosis.

Tuberculin skin test:

(PPD, Mantoux technique, TB skin test) technique consists in one injection of purified protein derivative (PPD) of Mycobacterium tuberculosis in the superficial dermis, in the middle third of the left forearm. The TST is a delayed hypersensitivity type IV reaction induced by T lymphocytes.

Tuberculous gumma:

Also called metastatic tuberculous abscess, is a multibacillary cutaneous tuberculosis. It results from the hematogenous dissemination of the bacillus by an active tuberculosis primary focus, especially in periods of decreased cellular immunity.

Tuberculosis verrucosa cutis:

Is the most common form of exogenous cutaneous tuberculosis. The lesion develops from direct inoculation in the skin of previously sensitized individuals with moderate to high immunity against Mycobacterium tuberculosis.

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dos Santos, J.B., Ferraz, C.E., Thouvenin, M.C.C., de Medeiros, V.L.S. (2018). Tuberculosis. In: Bonamigo, R., Dornelles, S. (eds) Dermatology in Public Health Environments. Springer, Cham. https://doi.org/10.1007/978-3-319-33919-1_6

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