Tuberculids

Last Updated: 2019-08-26

Author(s): -

Darier 1896. 

Id reaction of the skin during a hyperergic phase of a tuberculosis infection.

A distinction is currently being made:

Papulonecrotic tuberculide.

Tuberculosis cutis lichenoides.

Erythema induratum. Depending on the disease.

Depending on the disease.

Important for the diagnosis position are that...

...organ tuberculosis.

... a clinical substrate is present.

... a distinctly positive tuberculin test was made.

... the symptoms subside after antitubercular therapy.

Therapy regimen:

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) the remaining bacteria are eliminated. The anti-tubercular therapy should be continued for at least 2 months after the skin is free of 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 Vit B 6)

Pyrazinamide p.o. 35 mg/ bw/ d possibly in 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 months.

- 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 isoniazide resistance is excluded)

HIV Patient: Therapy must take place at ≥ for 7 months. Ethambutol should be replaced by streptomycin p.o. 15-20 mg/kg bw/ d (from > 60 J. max 750 mg) for additional therapy with NNRTI.Tuberculid in a child: transformation from papulonecrotic to lichen scrofulosorum. Pediatric Dermatology 2003;20:91-3. 
 Aires NB, Santi CG , Nico MMS. Tuberculid of the Glans Penis. Acta Derm Venereol 2006;86:552-3. 
 Degitz K, Steidl M, Thomas P, Plewig G , Volkenandt M. Aetiology of tuberculids. The Lancet 1993;341:239-40. 
 Garb J. Tuberculosis cutis colliquativa (tuberculous gummas) healed rapidly with local application of promin jelly; report of a case. Arch Derm Syphilol 1948;58:308-13. 
 Jordaan HF, Van Niekerk DJT , Louw M. Papulonecrotic Tuberculid. The American Journal of Dermatopathology 1994;16:474-85. 

1. Tuberculid in a child: transformation from papulonecrotic to lichen scrofulosorum. Pediatric Dermatology 2003;20:91-3. 
 Aires NB, Santi CG , Nico MMS. Tuberculid of the Glans Penis. Acta Derm Venereol 2006;86:552-3. 
 2. Degitz K, Steidl M, Thomas P, Plewig G , Volkenandt M. Aetiology of tuberculids. The Lancet 1993;341:239-40. 
 3.Garb J. Tuberculosis cutis colliquativa (tuberculous gummas) healed rapidly with local application of promin jelly; report of a case. Arch Derm Syphilol 1948;58:308-13. 
 Jordaan HF, Van Niekerk DJT , Louw M. Papulonecrotic Tuberculid. The American Journal of Dermatopathology 1994;16:474-85.