Cutaneous tuberculosis in Indian children: the importance of screening for involvement of internal organs
Article first published online: 18 MAY 2004
Journal of the European Academy of Dermatology and Venereology
Volume 18, Issue 5, pages 546–551, September 2004
How to Cite
Pandhi, D., Reddy, B., Chowdhary, S. and Khurana, N. (2004), Cutaneous tuberculosis in Indian children: the importance of screening for involvement of internal organs. Journal of the European Academy of Dermatology and Venereology, 18: 546–551. doi: 10.1111/j.1468-3083.2004.00970.x
- Issue published online: 2 JUL 2004
- Article first published online: 18 MAY 2004
- Received: 15 May 2003, accepted 19 May 2004
- antitubercular therapy;
- cutaneous tuberculosis;
- lichen scrofulosorum;
- verrucosa cutis
Aims and objectives Resurgence of skin tuberculosis especially with drug-resistant strains has been well documented in recent years, but this problem has not received much attention in the paediatric age group. Hence, we carried out the present study to analyse the clinical and therapeutic aspects of cutaneous tuberculosis in children.
Materials and methods A detailed clinical examination, investigations, such as haemogram, serology for HIV, Mantoux test, chest X-ray, cytology, culture and histopathology were carried out in all children. They were treated with antitubercular therapy (WHO regimen), and the clinical response was followed up.
Results Of 142 patients with cutaneous tuberculosis, 68 were children (40 females, 28 males). These children were aged from 9 months to 14 years. The duration of the disease varied from 1 month to 6 years. Family history of tuberculosis was present in 28 (41.2%) of the patients. Scrofuloderma was the most common presentation encountered in 30 (44.1%) patients with preferential involvement of the cervical (56.2%) and inguinal (20%) regions. Fifteen (22.1%) patients had lupus vulgaris, of which the keratotic type was the most common (46.7%), 16 had lichen scrofulosorum, three had tuberculosis verrucosa cutis, and four had more than one type of tuberculosis. Involvement of the lung in 14 (20.6%), bone in seven (10.2%), and both in four (5.9%) was found. Histopathology corroborated the clinical diagnosis in 54 (80.6%), culture was positive in six (8.8%). Fifty (73.5%) patients completed the treatment with an excellent response, no multidrug resistant cases were seen.
Conclusions Cutaneous tuberculosis in children continues to be an important cause of morbidity, there is a high likelihood of internal involvement, especially in patients with scrofuloderma. A search is required for more sensitive, economic diagnostic tools. Response to treatment at 4 weeks often helps in substantiating the diagnosis of tuberculosis in doubtful cases.