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[Cutaneous tuberculosis yesterday and today]
Anales De La Real Academia Nacional De Medicina
|February 24, 2001
Summary
Cutaneous tuberculosis incidence declined due to treatments and M. bovis control. Recent advances like PCR confirm tuberculous etiology for atypical forms, suggesting a potential resurgence.
Area of Science:
- Dermatology
- Infectious Diseases
- Microbiology
Background:
- Historically, cutaneous tuberculosis was common in Europe but declined with specific treatments and M. bovis infection control.
- Classically divided into typical tuberculosis and atypical tuberculids, the etiology of the latter was debated until PCR techniques identified M. tuberculosis DNA in lesions.
Discussion:
- The concept of tuberculides faced skepticism regarding their tuberculous origin throughout the latter half of the 20th century.
- Polymerase chain reaction (PCR) advancements since the 1990s have enabled direct detection of Mycobacterium tuberculosis DNA in skin lesions, supporting tuberculous etiology for atypical forms.
Key Insights:
- PCR detection of bacillary DNA in lesions has confirmed the tuberculous origin of atypical cutaneous tuberculosis (tuberculids).
- Anergic forms of cutaneous tuberculosis, like tuberculosis cutis miliaris disseminata and tuberculous gumma, are becoming less rare due to rising immunodeficiency.
Outlook:
- The incidence of cutaneous tuberculosis may increase due to the general resurgence of tuberculosis, driven by immunodeficiency (AIDS), drug-resistant strains, and immigration.
- While an increase is predicted, it is unlikely to reach the historical incidence levels observed in previous centuries.