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Childhood cutaneous tuberculosis: a study over 25 years from northern India
1Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. kumarbhushan@hotmail.com
Insights
Childhood cutaneous tuberculosis in northern India shows distinct patterns, with scrofuloderma being common. Disseminated disease in children highlights the need for revised therapeutic strategies.
Area of Science:
- Dermatology
- Pediatrics
- Infectious Diseases
Background:
- Cutaneous tuberculosis (TB) presents varied clinical patterns.
- Understanding childhood TB epidemiology is crucial for targeted interventions.
Purpose of the Study:
- To analyze childhood cutaneous TB patterns in northern India over 25 years.
- To compare childhood TB with adult TB presentations.
Main Methods:
- Retrospective analysis of 75 pediatric cutaneous TB cases (1975-1999).
- Data collection included clinical presentation, vaccination status, and Mantoux reactivity.
Main Results:
- Scrofuloderma (SFD) and lupus vulgaris (LV) were the most common forms.
- Girls outnumbered boys, particularly in SFD.
- Disseminated disease occurred in 21.3% of children, often linked to lower vaccination rates.
Conclusions:
- Childhood cutaneous TB exhibits unique epidemiological and clinical features compared to adults.
- Disseminated cases require adjusted treatment protocols beyond standard cutaneous TB regimens.
Aims:
We undertook this study to analyse the pattern of childhood cutaneous tuberculosis prevailing in northern India over the past 25 years and to highlight differences from and similarities to adult tuberculosis.
Materials And Methods:
Clinical records of children with cutaneous tuberculosis who attended the Nehru Hospital attached to the Postgraduate Institute of Medical Education and Research, Chandigarh, India, between January 1975 to December 1999 were analysed.
Results:
Four hundred and two patients with cutaneous tuberculosis were examined during the 25-year period of observation. These patients formed 0.1% of the total dermatology outpatients. Seventy-five (18.7%) of these 402 cases were children ( 10 mm). Histopathologic reports were available for evaluation in all 75 children. Out of 30 cases of LV, 24 (80%) showed classical tuberculous histology. In contrast, out of 40 cases with SFD, only 19 (47.5%) showed classical histology. Classical tuberculous histology was noted in all 3 (100%) cases of TVC and 1 (100%) case each with tuberculids and gumma. Tubercle bacilli could be demonstrated in 4/30 (13.3%) cases with LV and 9/40 (22.5%) cases with SFD. Systemic involvement was seen in 16 (21.3%) children, of whom 3 (18.8%) had LV and 13 (81.3%) SFD. The lungs were the most common organs involved in 8 (50.0%) children followed by bone(s) in 4 (25.0%), abdomen in 2 (12.5%), and both lung and bone in 1 (6.3%) child. In contrast to adults, girls outnumbered boys in the childhood series; SFD was a common form of presentation in contrast to LV and TVC, tuberculous gumma and tuberculids were noted less often. In both children and adults, Mantoux reactivity did not correlate with the extent of the disease; patients with disseminated disease were found to be less often vaccinated with BCG and regional lymphadenopathy was noted more often in patients with disseminated disease.
Conclusions:
In the whole spectrum of cutaneous tuberculosis, there is a proportion of patients with dissemination (systemic involvement) who are of great epidemiological significance as they require a change in the standard therapeutic regimens recommended for cutaneous tuberculosis.