Cutaneous Tuberculosis: A Clinical and Epidemiological Analysis in a High-Burden Region
Asmah Afzal, Firdous Iqbal, Sameera Ali
Keywords: Cutaneous tuberculosis, lupus vulgaris, histopathology, epidemiology, diagnostic challenges
ABSTRACT
Introduction: Cutaneous tuberculosis, though representing a small subset of extrapulmonary tuberculosis, poses a significant dermatological challenge in endemic regions such as Pakistan. Despite its prevalence, it remains underreported due to diagnostic limitations and low clinical suspicion.
Objective: This study aims to analyze the clinical and epidemiological profile of cutaneous tuberculosis and highlight diagnostic challenges in a high-burden setting.
Methods: A cross-sectional study was conducted at the Pathology Department in collaboration with the Dermatology Department, Central Park Teaching Hospital, Lahore, from July 2023 to December 2023. Forty newly diagnosed, histopathologically confirmed cases of cutaneous tuberculosis were included. Detailed clinical histories, physical examinations, Mantoux tests, and skin biopsies were performed. Statistical analysis was carried out using SPSS version 24.0.
Results: The most common CTB variant was lupus vulgaris (52.5%), followed by scrofuloderma (30%), tuberculosis verrucosa cutis (12.5%), and lichen scrofulosorum (5%). The majority of patients were aged 21–30 years (35%), with a male predominance (65%) and strong association with low socioeconomic status (77.5%). Cervical involvement was most frequent (27.5%). Despite 70% of patients being BCG-vaccinated, cutaneous tuberculosis still developed. Histopathology revealed granulomatous inflammation in all cases, but acid-fast bacilli were not detected.
Conclusion: Cutaneous tuberculosis remains a relevant public health concern in endemic regions. Early clinical recognition, histopathological evaluation, and enhanced diagnostic tools are essential for accurate diagnosis. Public health strategies focusing on awareness, improved vaccination efficacy, and broader screening programs are necessary to control the burden of cutaneous tuberculosis.
Keywords: Cutaneous tuberculosis, lupus vulgaris, histopathology, epidemiology, diagnostic challenges