Lichen scrophulosorum

Hebra 1860.

Tuberculosis cutis lichenoides.

In the course of a Tbc infection, lichenoid papules occur with hyperergic immunity.

Particularly common in childhood and adolescence.

Strong immune reaction in the context of a Tuberculosis infection.

• Symmetrically, perifollicularly and follicularly arranged, yellow-brown, erythematous papules.

• Anamnesis.
• Clinic.
• Tuberculin test (Mendel-Mantoux).  
• Quantiferon test. 
• Biopsy.
• To exclude system involvement:
• Thorax X-ray or CT thorax.
• Sonography of the abdomen and kidneys.
• In the morning (fasting up to 4h) on 3 consecutive days sputum must be collected.
• In the morning, give urine on 3 consecutive days (fluid restriction the evening before!).
• Bronchoalveolar lavage (BAL).

• Especially on the lateral trunk.

Tuberculoid structures, Langhans giant cells, necroses. 

• Spontaneous healing within weeks.
• Ganglion relapses.

Topical therapy.

Elocom.

Therapy scheme:

The initial phase should last 8 weeks/2 months. During this time the majority of bacteria are killed. In the following therapy phase (which lasts for months), an attempt is made to eliminate the remaining bacteria. The antituberculous therapy should be continued for at least 2 months after the absence of skin symptoms.

The therapy should last individually between 12-24, but at least 6 months!

Induction phase (2 months):

• Rifampicin p.o. 10 mg/kg bw/ d
• Isoniazid p.o. 5 mg/kg bw. (with Vitamin B6)
• Pyrazinamid p.o. 35 mg/ bw/ d if necessary combination with allopurinol!
• Ethambutol p.o. 15 mg/kg bw/ d
• A clear improvement can be seen in the vast majority of cases after 1 ½ month.

Consolidation phase:

• Induction phase (2 months):
• Rifampicin p.o. 10 mg/kg bw/d
• Isoniazid p.o. 5 mg/kg bw. (with Vit B 6)
• Ethambutol p.o. 15 mg/kg bw/d (may also be omitted if isoniazid resistance has been excluded)
• HIV Patient: Therapy must be done at ≥ for 7 months. Ethambutol should be replaced by streptomycin p.o. 15-20 mg/kg bw/d (from > 60 years max 750 mg) in case of additional therapy with NNRTI.

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2.  Joshi HS, Zacharia A , Warrier A. Lichen scrofulosorum. BMJ Case Rep 2014;2014. 
3.  Patra S, Patro B, Patel R, Aneja S , Sarkar D. Lichen scrofulosorum presenting as pyrexia of unknown origin. J Coll Physicians Surg Pak 2014;24:141-2. 
4.  Singal A , Pandhi D. Lichen scrofulosorum and endometrial tuberculosis: a novel association. Int J Dermatol 2016;55:322-4. 
5.  Tobita R, Sumikawa Y, Imaoka K, Murata S, Dekio I, Maruyama R et al. Lichen scrofulosorum caused by pulmonary Mycobacterium avium complex (MAC) infection. Eur J Dermatol 2011;21:619-20.