Skin-nontumor / Clinical dermatology
Infectious disorders

Author: Mowafak Hamodat, M.D., MB.CH.B, MSc., FRCPC (see Authors page)

Revised: 1 June 2016, last major update July 2011

Copyright: (c) 2002-2016,, Inc.

PubMed Search: Tuberculosis [title] skin

Cite this page: Tuberculosis. website. Accessed October 25th, 2016.
Definition / General
  • Cutaneous disease is uncommon in U.S
  • Primary (inoculation) tuberculosis of the skin is the cutaneous analogue of the pulmonary ghon focus
  • Primary cutaneous tuberculosis may be associated with tattooing, ritual circumcision, nose piercing, inoculation of homeopathic solutions or injury by contaminated objects to laboratory workers, surgeons or prosectors; there may be no obvious source of infection

  • Erythema induratum of Bazin: also called nodular vasculitis if no coexisting tuberculosis; rare, more common in past; presents as recurrent tender subcutaneous nodules on calves of women with tuberculin hypersensitivity
  • Lichen scrofulosorum: lichenoid eruption of minute papules in children and adolescents with tuberculosis (Indian J Dermatol Venereol Leprol 2010;76:494)
  • Lupus vulgaris: most common form of re-infection tuberculosis, occurring predominantly in young adults; refers to painful cutaneous TB skin lesions with a nodular appearance, usually near the nose, eyelids, lips, cheeks and ears; untreated lesions may develop into disfiguring skin ulcers ("lupus" historically meant an ulcerative skin disorder), and are associated with squamous cell carcinoma
  • Tuberculids: heterogeneous group of cutaneous lesions due to TB infection elsewhere in the body
Clinical Features
  • Red indurated papule appears 1 - 3 weeks after penetrating injury; papule ulcerates and forms a so-called "tuberculoid chancer"
Case Reports
Clinical Images

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Lesions on children

Adult woman with erythrocyanotic circulation and ulcerated lesions

Micro Description
  • Early lesions have a mixed dermal infiltrate of neutrophils, lymphocytes and plasma cells; followed by superficial necrosis and ulceration
  • Weeks later, tuberculoid granulomas form, with variable caseation necrosis
  • Acid-fast bacilli are usually easy to find in the early lesions, but are rare once granulomas develop
  • Erythema induratum of Bazin: granulomatous vasculitis affecting subcutaneous large vessels (may need multiple serial sections to identify); also granulomatous inflammation of lobules of subcutis; lesions may contain acid-fast bacilli by PCR
Micro Images

Images hosted on PathOut servers:

Contributed by Angel Fernandez-Flores, M.D., Ph.D.

Positive Stains