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Infections and infestations of nail unit
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
Vineet Relhan, Vikrant Choubey
Tuberculosis verrucosa cutis or warty tuberculosis is a paucibacillary form of cutaneous tuberculosis that occurs in previously sensitized individuals having a moderate or high degree of immunity. It usually occurs by traumatic exogenous inoculation into the skin through open wounds. People walking barefoot are particularly at risk. It is also known as “prosector’s warts.” Rarely, it can also occur by autoinoculation with sputum in a patient with pulmonary tuberculosis. Common sites of lesions are knees, ankles, buttocks, and hands. Tuberculous paronychia associated with warty tuberculosis has been reported as well.15 The lesion starts as an indurated, warty papule with an inflammatory margin. Gradually, the papule enlarges irregularly forming a firm verrucous plaque with a serpiginous outline. The center may heal with atrophic scarring. At times, exudate and crusting may occur. On histopathological examination, pseudo epitheliomatous hyperplasia with superficial abscess formation is almost always seen. Bacilli are seen only occasionally. Lesions must be distinguished from warts, and from leishmaniasis when crusted lesions are present. The condition is indolent and lesions may remain dormant for months or years. Spontaneous remission may occur, leaving behind atrophic scars. Response to antitubercular treatment is usually good, except when the disease is caused by non-tuberculous mycobacteria, when culture may be required to confirm the etiological agent. PCR may be helpful if positive but is often negative as this is a paucibacillary form.
Bacterial and Atypical Mycobacterial Infections
Published in Clay J. Cockerell, Antoanella Calame, Cutaneous Manifestations of HIV Disease, 2012
Kumar Krishnan, Antoanella Calame, Clay J. Cockerell
Cutaneous infection with M. tuberculosis in a previously sensitized individual results in a skin condition known as tuberculosis verrucosa cutis. This is more common among healthcare workers who come in contact with infected patients, especially when they are exposed to secretions or body fluids. It is also known as pathologist’s warts or prosector’s warts as it is often caused by autoinoculation.33,34 It begins as one or more asymptomatic reddish-brown papules that develop a markedly verrucous surface with abundant crust. When diascopy is performed by pressing a glass slide on the lesion, there is a translucent ‘apple jelly’ appearance. Lesions may undergo necrosis and ulcerate although significant scarring is rare. Occasionally, pus may be expressed; however, in contrast to tuberculous chancre, lymphadenopathy is rare.34 The diagnosis is made by finding acid-fast bacilli in smears or in biopsy specimens and confirmed by cultures.
Principles of Clinical Diagnosis
Published in Susan Bayliss Mallory, Alanna Bree, Peggy Chern, Illustrated Manual of Pediatric Dermatology, 2005
Susan Bayliss Mallory, Alanna Bree, Peggy Chern
Major pointsClassification of cutaneous lesions is based on route of transmission and immunologic responseExogenous sourcePreviously uninfected: primary inoculation tuberculosis or primary tuberculosis complexTypically occurs in a wound: abrasion, insect bite, ear piercing, circumcision siteLesion develops 2–4 weeks after inoculationPresents as a red-brown papule with ‘apple jelly’ translucence on diascopy that may ulcerate or crustAssociated with regional lymphadenopathy or lymphangitisPreviously infected: reinfection tuberculosis or tuberculosis verrucosa cutisVery rare in childrenPresents with large verrucous papule or plaque at the site of re-inoculationDue to strong immunity and hypersensitivity against M. tuberculosis
Extrapulmonary tuberculosis
Published in Expert Review of Respiratory Medicine, 2021
Surendra K Sharma, Alladi Mohan, Mikashmi Kohli
Various clinical types of cutaneous TB, such as lupus vulgaris, scrofuloderma, tuberculosis verrucosa cutis occur. Tuberculids (lichen scrofulosorum; papulonecrotic tuberculid; erythema induratum; and erythema nodosum), TB chancre, miliary TB of the skin have also been described. Following bacille Calmette-Guerin (BCG) vaccination, localized and generalized skin complications have also been described [2].