Papulonecrotic tuberculidA18.4

Author:Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 03.08.2023

Dieser Artikel auf Deutsch

Synonym(s)

papulonecrotic tuberculid; Papulonecrotic tuberculide; tuberculosis cutis papulonecrotica; Tuberkulide ulcerous

Requires free registration (medical professionals only)

Please login to access all articles, images, and functions.

Our content is available exclusively to medical professionals. If you have already registered, please login. If you haven't, you can register for free (medical professionals only).


Requires free registration (medical professionals only)

Please complete your registration to access all articles and images.

To gain access, you must complete your registration. You either haven't confirmed your e-mail address or we still need proof that you are a member of the medical profession.

Finish your registration now

HistoryThis section has been translated automatically.

Darier, 1896

DefinitionThis section has been translated automatically.

Exanthematic, eminently chronic clinical picture occurring in relapses with necrotizing, scarring healing papules in a hyperergic reaction to tubercle antigens. About 1/4 of all tuberculids are papulonecrotic tuberculids.

Occurrence/EpidemiologyThis section has been translated automatically.

Among the (now) overall rare tuberculids, papulonecrotic tuberculid is the most common form.

In countries, such as India, where the prevalence of tuberculosis is high, the presence of papulonecrotic tuberculids is still expected. The focus of infection is not detectable in the majority of cases.

EtiopathogenesisThis section has been translated automatically.

A type III reaction or a type IV reaction is discussed (see below allergy). Pathogenetically, expired tuberculosis of other organs should play a role. The simultaneous occurrence with an active organ tuberculosis is rare! The concurrence with other tuberculids (e.g. erythema induratum - see below Nodular vasculitis) should be given.

ManifestationThis section has been translated automatically.

Occurring primarily in female adolescents and younger adults.

LocalizationThis section has been translated automatically.

Especially the extensor sides of the arms and legs and the buttocks are affected.

Clinical featuresThis section has been translated automatically.

To pea-sized, blue-red, centrally softening and necrotizing nodules. Formation of varioliform scars or shallow ulcerations (ulcerous tubercles) after rejection of the central scab.

LaboratoryThis section has been translated automatically.

High degree of tuberculin sensitivity.

HistologyThis section has been translated automatically.

Necrosis with tuberculoid structures in the vicinity of thrombotic vessels.

Differential diagnosisThis section has been translated automatically.

Vasculitis, hyperergic: no hyperergic tuberculous reaction, no scarring

Pityriasis lichenoides et varioliformis acuta: no hyperergic tuberculous reaction, no scarring

Prurigo simplex subacuta: Absence of pruritus, no hyperergic tuberculous reaction

Anetoderma: Absence of pruritus, no hyperergic tuberculous reaction; no evidence of vasculitis.

TherapyThis section has been translated automatically.

Once diagnosed, patients respond very well to antituberculous therapy.

Progression/forecastThis section has been translated automatically.

Chronic recurrent course over years.

Note(s)This section has been translated automatically.

The synonymous use of the term 'tuberculosis cutis papulonecrotica' should be avoided as this term implies active tuberculosis of the skin.

Case report(s)This section has been translated automatically.

A 30-year-old man presented with a 6-year history of recurrent, multiple asymptomatic, raised lesions on the back and arms. Previously, recurrent abscesses had been treated with oral and topical antibiotics. Some of the lesions had healed spontaneously with scarring.

The patient denied any history of fever, chronic cough, weight loss, and medication use prior to the appearance of the lesions. There was no known contact with tuberculosis patients. General and systemic examination was essentially normal. Dermatologic examination revealed the presence of multiple, well-demarcated, hyperpigmented, crusted papules 0.5-1.0 cm in size, symmetrically distributed over the entire back, the extensor side of both forearms, the arms, and the dorsum of both feet, interspersed with atrophic varioliform scars. Routine laboratory examinations were normal. Tuberculin (Mantoux) was strongly positive (23 × 23 mm) with central necrosis at 72 hours. Sputum test for acid-fast bacilli, chest radiography, ultrasonography of the abdomen and pelvis revealed no abnormalities. A biopsy from an encrusted papule on the forearm showed fibrinoid necrosis surrounded by a mixed inflammatory infiltrate filling the entire dermis, some poorly defined epithelioid granulomas, and lymphocytoclastic vasculitis.

The patient was initially treated with combination therapy of rifampicin, isoniazid, pyrazinamide, and ethambutol for two months, followed by a combination of rifampicin and isoniazid to complete a total of six months of standard antitubercular therapy. Under this therapy, all lesions healed.

LiteratureThis section has been translated automatically.

  1. Connors WJ det al.Program-wide review and follow-up of erythema induratum of Bazin and tuberculosis-associated ocular inflammation management in a TB low-incidence setting: need for improved treatment candidate selection, therapy standardization, and care collaboration.Infect Dis 19:97.
  2. Darier J (1896) Des tuberculides cutanèes. Ann Derm Syph 7: 1431-1436.

  3. Meghana V et al (2017) Papulonecrotic tuberculid. Am J Trop Med Hyg 97:987-988.
  4. Nath AK et al (2008) Penile papulonecrotic tuberculosis: revisited. Indian J Dermatol 53: 220-221.

  5. Palaniappan V et al (2022) Papulonecrotic tuberculid. Clin Exp Dermatol 47:1820-1828.

  6. Pramatarov K et al (1991) Papulonecrotic tuberculid case report. Z Hautkr 67: 62-64
  7. Thappa DM et al (2003) Tuberculid in a child: transformation from papulonecrotic to lichen scrofulosorum. Pediatr Dermatol 20: 91-93

Authors

Last updated on: 03.08.2023