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In contrast to the tuberculosis of the lungs and other organs, tubercular infection of the skin is very uncommon. It is slow to develop and most of the cases have had infection in some other part of the body. The manifestations of cutaneous tuberculosis generally belong to three categories: a slowly progressive large area of the skin which is thickened and red and may be ulcerated and/or crusted (lupus vulgaris); tubercular infection in the lymph nodes or bones /joints starting as a cluster of swellings which burst through the skin to produce multiple sinuses which continue to discharge pus (scrofuloderma); and multiple recurrent eruptions which keep on appearing on the skin from time to time (tuberculids). Generally, tuberculosis of the skin does not produce fever or other general signs and symptoms unless the patient has concomitant active tubercular infection in some other organ of the body.

For confirmation of the diagnosis, a piece of the involved skin is usually taken for histopathological examination. Occasionally, it may be possible to demonstrate the organism in the pus discharge.

Treatment

The treatment of tubercular infection of the skin is generally very easy but as a rule it is necessary to give three different drugs over a period of six to nine months for complete healing. Use of multiple drugs in every case is necessary because the organism has a tendency to develop resistance to the anti-tubercular drugs, if used alone. The first indication of improvement is usually visible in one to two months.

In case there is no improvement in two months time, in spite of regular treatment, one should suspect that the organism is resistant to the drugs used and a change of drugs is called for. Even after complete healing of the skin lesion, the treatment should be stopped only under the advice of the doctor who should ensure that the infection has been completely eradicated; otherwise the infection can recur. It is therefore better to take the treatment for a longer period to ensure that the recurrence.will not occur. There is no need for any topical treatment except for routine thorough cleaning of the skin area with a normal soap. Dressing or bandaging the area is also not necessary, unless the pus discharge tends to soil the clothes. Surgical intervention in the form of incision and drainage of the pus should be avoided, unless it is undertaken for the sake of making a diagnosis. There is no need for any special diet or dietary restrictions.

Filed under: Diseases and Conditions