Papulonecrotic Tuberculids Clinical Presentation
- Author: Manuel Valdebran, MD; Chief Editor: William D James, MD more...
The characteristic lesions are small, erythematous, inflammatory papules that undergo central ulceration and heal spontaneously within weeks, leaving a varioliform scar.
Lesions arise in symmetric crops, typically with an acral predilection. Characteristically, lesions develop over the extensor surfaces, particularly the knees, the elbows, and the dorsum of the hands and the feet, although widespread involvement may be present.
New lesions form as older lesions resolve, giving the eruption a polymorphous appearance.
Oral lesions have not been reported to date.
Papulonecrotic tuberculids have been reported to coexist with lesions of erythema induratum, as well as lichen scrofulosorum. In several reports, cutaneous lesions resolved with appropriate antituberculosis therapy.
Physical examination findings may be as follows:
Distribution: Lesions arise in symmetric crops, typically with an acral predilection. Characteristically, lesions develop over the extensor surfaces, particularly the knees, the elbows, and the dorsum of the hands and the feet, although widespread involvement may occur. Involvement of the glans penis has also been reported.
Color: Hyperpigmented to erythematous papules with central crusting are seen early, and the lesions generally heal with scarring.
Lymph nodes: In one study, as many as one third of the cases were associated with cervical lymphadenopathy, and some patients developed scrofuloderma.
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