Causative organism Causative organism : : Mycobacterium tuberculosis Mycobacterium tuberculosis Classification :Classification :1.1.Primary tuberculosis of the skin Primary tuberculosis of the skin 2.2.Miliary tuberculosis of the skin Miliary tuberculosis of the skin 3.3.Lupus vulgaris Lupus vulgaris 4.4.Scrofuloderma Scrofuloderma 5.5.Tuberculosis verrucosa cutis Tuberculosis verrucosa cutis 6.6.Tuberculosis cutis orificialis Tuberculosis cutis orificialis 7.7.Tuberculide :Tuberculide :

Tuberculosis of skinTuberculosis of skin

Vary rare conditionVary rare condition It consist of :It consist of :

1. Tuberculous chancre 1. Tuberculous chancre

2. regional lymph node2. regional lymph nodeTuberculous chancre is asymptomatic Tuberculous chancre is asymptomatic

ulcerated nodule covered by crust ulcerated nodule covered by crust The ulcer has the characteristic of The ulcer has the characteristic of

tuberculous ulcer . tuberculous ulcer .

Primary tuberculosis of the skin Primary tuberculosis of the skin

Primary inoculation tuberculosisPrimary inoculation tuberculosis A large, ulcerated nodule at the site of A large, ulcerated nodule at the site of

M.tuberculosisM.tuberculosis inoculation on the right thigh inoculation on the right thigh associated with inguinal lymphadenopathy. associated with inguinal lymphadenopathy.

The erythematous papules on the left The erythematous papules on the left forearm occurred at the site of tuberculin forearm occurred at the site of tuberculin

testing.testing.

It is rare haematogenous dissemnated of It is rare haematogenous dissemnated of tuberculosis .tuberculosis .

The very rare skin eruption consist of The very rare skin eruption consist of generalized erythematous papules and generalized erythematous papules and pustule in an immuno-suppressed person pustule in an immuno-suppressed person

Miliary tuberculosis of the skin Miliary tuberculosis of the skin

Occur as an exogenous inculation of bacilli in Occur as an exogenous inculation of bacilli in a person with high degree of immunity .a person with high degree of immunity .

Age : usually children and also in adult Age : usually children and also in adult Site Site : : Site of trauma Site of trauma Extremities and buttocks Extremities and buttocks Morphology:Morphology: A verrucous indurated plaque with fissure A verrucous indurated plaque with fissure

and active inflammatory border . and active inflammatory border .

Tuberculosis verrucosa cutis Tuberculosis verrucosa cutis

Tuberculosis verrucosa cutisTuberculosis verrucosa cutis Crusted and hyperkeratotic plaque Crusted and hyperkeratotic plaque

arising at the site of inoculation in an arising at the site of inoculation in an individual previously infected with individual previously infected with M. M. tuberculosistuberculosis. There is no associated . There is no associated

lymphadenopathylymphadenopathy

The most common form of skin tuberculosis The most common form of skin tuberculosis Site : head and neck especially around the nose .Site : head and neck especially around the nose . Morphology : Morphology : - patches : - patches : reddish brown reddish brown well demarcated well demarcated contained deep seated nodules contained deep seated nodules positive diascopy positive diascopy Scarring is evident and could be mutilating Scarring is evident and could be mutilating Course : chronic with healing of center by scarring Course : chronic with healing of center by scarring

and extension of the lesion at the periphery . and extension of the lesion at the periphery .

Lupus vulgaris Lupus vulgaris

Lupus vulgarisLupus vulgaris Reddish-brown plaque, which on Reddish-brown plaque, which on diascopy exhibits the diagnostic diascopy exhibits the diagnostic yellow-brown apple-jelly coloryellow-brown apple-jelly color

Types of lupus vulgaris Types of lupus vulgaris ::

1.1. Hypertrophic or verrucus type.Hypertrophic or verrucus type.

2.2. Atrophic type .Atrophic type .

3.3. Ulcerative type .Ulcerative type .

4.4. Tumor like type .Tumor like type . Complication : Complication :

1.1. Development of squamous cell carcinoma Development of squamous cell carcinoma

2.2. Deforming scars Deforming scars

3.3. Destruction of the nose Destruction of the nose

Lupus vulgarisLupus vulgaris

ScrofulodermaScrofuloderma

Scrofuloderma represent a direct extension from Scrofuloderma represent a direct extension from underlying focus (bone or LN) to the skin.underlying focus (bone or LN) to the skin.

Site : Site : _ Neck _ Neck _Chest_Chest

Morphology :Morphology :-An asymptomatic reddish swelling which breaks -An asymptomatic reddish swelling which breaks down to form sinuses, fistulate or tuberculuos down to form sinuses, fistulate or tuberculuos ulcers.ulcers.-Characteristic caseous materil discharges from -Characteristic caseous materil discharges from lesions.lesions.

Tuberculosis Cutis OrificialisTuberculosis Cutis Orificialis

Tuberculoisis cutis orificialis occurs on Tuberculoisis cutis orificialis occurs on or around orifices of patients with low or around orifices of patients with low immunity and internal tuberculosis.immunity and internal tuberculosis.

Site:Site:

-On and around orifices (mouth,anus,…)-On and around orifices (mouth,anus,…)Morphology:Morphology:

-Tuberculous ulcer with a granulating -Tuberculous ulcer with a granulating base.base.

Papulonecrotic TuberculidePapulonecrotic Tuberculide

Site: widely distributed.Site: widely distributed.

Morphology: papules with central Morphology: papules with central necrosis.necrosis.

Response to anti-tuberculous therapy: Response to anti-tuberculous therapy: good.good.

Lichen ScrofulosorumLichen Scrofulosorum

Site: TRUNKSite: TRUNK

Morphology:Morphology:- Lichenoid papules.Lichenoid papules.- Follicular.Follicular.- Skin-colored.Skin-colored.

Response to anti- tuberculosis therapy: Response to anti- tuberculosis therapy: good.good.

Erythema Induratum ofBazinErythema Induratum ofBazin

Age&sex: young adult womanAge&sex: young adult woman

Site: lower leg( posterior aspect).Site: lower leg( posterior aspect).

Morphology:Morphology:

-Deep-seated subcutaneous nodule.-Deep-seated subcutaneous nodule.

-Usually ulcerates.-Usually ulcerates.

-Heals with atrophic scar.-Heals with atrophic scar.

Histopathology of Cutaneous Histopathology of Cutaneous TuberculosisTuberculosis

-Dermal tuberculous tubercles formed of -Dermal tuberculous tubercles formed of central caseation ( may be absent) and central caseation ( may be absent) and surrounded by epithelioid cells , giant surrounded by epithelioid cells , giant cells, monocytes and lymphocytes .cells, monocytes and lymphocytes .

Treatment of TuberculosisTreatment of Tuberculosis

I.I. General:General:- Good nutrition .Good nutrition .- Search for underlying focusSearch for underlying focus

II.II. Medical Treatment:Medical Treatment:- Combination of more than one anti-tuberculous drugCombination of more than one anti-tuberculous druge.g:e.g:1. Rifampicin : 20 mg /kg/day(adult dose:600 mg/day).1. Rifampicin : 20 mg /kg/day(adult dose:600 mg/day).2.2. Isoniazid (INH) : 6 mg /kg/ day (adult dose:300 mg/day).Isoniazid (INH) : 6 mg /kg/ day (adult dose:300 mg/day).3.3. Ethambutol: 15mg/kg/day.Ethambutol: 15mg/kg/day.4.4. Pyrazinamide: 1.5-2.5 gm/day.Pyrazinamide: 1.5-2.5 gm/day.

III. Surgical excision of small lesions.III. Surgical excision of small lesions.