Which of the following is/are tuberculides:
Correct Answer: Lichen scrofulosorum
Description: Ans: A (Lichen scrofulosorum) Miliary tuberculosis and Lupus vulgaris are not classified as Tuberculids Characteristic Features of Lichen Scrofulosorum (Tuberculid) Discrete cutaneous lesions occurring in the superficial dermis in patients with tuberculosis elsewhere in the body Perifollicular and eccrine localization about hair follicles and sweat ducts in the dermis Epithelioid Granulomas without Caseous necrosis -Non caseating granulomas (Caseation is rare} Acid fast organisms are usually not seen Cell mediated immunity to tubercular antigen is usually strongly positive (Hypersensitivity reaction to tubercular antigen) Good Response to Antitubercular therapy. Tuberculides Tuberculides include a group of skin reactions that exhibit tuberculoid features histologically. There origin is still debated and different theories of pathogenesis exist They are believed to occur due to Hypersensitivity reaction to Mycobacterial Antigens and hence the name 'Tuberculides' * Some believe tuberculides occur due toLocal Hypersensitivity reaction to mycobacteria. Some believe tuberculides occur due to a Hypersensitivity reaction to mycobacterial antigens that have reached the skin by Haematogenous spread from foci of active infection. Others believe that these lesions are unrelated to Tuberculosis because: * AFB have not been isolated, cultured or produced in animal inoculation * These conditions often do not respond to Antituberculous drugs but may respond to steroids. * (According to 'Behl' Erythema Nodosum is also a Tuberculide while some texts do not include it as a Tuberculide- We therefor do not consider this as an answer). Tuberculides | | | Definition Classification | | - incontrast to true tuberculosis, tuberculids are explained as a hypersensitivity reaction to mycobacterium tubreculosis or its products in a patient with significant immunity - The main features are a positive tuberculin test, evidence of manifest or past tuberculosis and a positive response to antituberculous therapy - There is virtually always absence of bacilli in skin biopsy speciments & culture, although PC'R has detected mycobacterial DNA in some forms -Several conditions once thought to represent tuberculides are now classified as variants of rosacea True tuberculides (M tuberculosis-bo vis appear to play a significant role) * Mieropapular-Lichen scrofulosorum * Papular-Papulonecrotic tuberculide * Nodular-erythema induratum of Bazin/Nodular tuberculide Facultative tuberculides (M. tubercutosis/bovis may be one of the several etiopathogenic factors) * Erythema induratum (Nodular vasculities) Nontubereulides (formerly designated tuberculides; there is no relationship to tuberculosis) * Lichenoid tuberculid * Rosacea like tuberculid * Lupus miliaris disseminatus faciei Conditions included in Tuberculides Lichen Scrofulosorum Erythema Induratum Papulonecrotic Tuberculides (Acne Scrofulorosum) Lupus Miliaris disseminatus Faciei Rosaceous Tuberculide Cutaneous Tuberculosis (Non Tuberculides) Lupus Vulgaris Sacrofuioderma Tubercularis Cutis Verrucosus Tuberculosis Cutis Orificialis Miliary tuberculosis and Metastatic Tuberculosis Abscess may also present as Cutaneous tuberculosis
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