Medical Care
Treatment is directed at eradicating the underlying mycobacterial infection. Tuberculosis treatment guidelines may vary from region to region and from different authorities (ie, the World Health Organization [WHO] and the Centers for Disease Control and Prevention [CDC]). Currently, for patients with active tuberculosis, a 4-drug therapy with rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) is recommended to avoid the development of resistance. Papulonecrotic tuberculids respond promptly to appropriate antituberculosis therapy. New lesions cease forming within days to weeks after therapy is initiated, and existing lesions heal rapidly, usually within weeks. A minimum of 6 months of antituberculosis therapy is recommended. Recurrences rarely occur after appropriate therapy.
Also see the Medscape Drugs & Diseases articles Tuberculosis and Tuberculosis Organism-Specific Therapy, as well as the World Health Organization guidelines, Recommendations for Investigating Contacts of Persons with Infectious Tuberculosis in Low- and Middle-Income Countries. [22]
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Bilaterally symmetric papulonecrotic lesions on the lower extremities.
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Papulonecrotic tuberculid. Higher magnification shows better detail of the area of necrosis surrounded by a granulomatous process. Courtesy of Prof Oscar Tellechea, MD, and José Carlos Cardoso, MD.
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Papulonecrotic tuberculid. Multinucleated giant cells are noted within the granulomas. Courtesy of Prof Oscar Tellechea, MD, and José Carlos Cardoso, MD.
