Granulomatous mycobacterial infections of the skin

Clinical features of cutaneous granulomatous mycobacterial infections

 Dermatology  Infectious Diseases  MRCP

TBLeprosyFish tank granulomaBuruli ulcer
other namesLupus vulgaristuberculoid leprosySwimming pool granulomaBairnsdale ulcer, Searls ulcer
organismMycobacterium tuberculosisMycobacterium lepraeMycobacterium marinum or Mycobacterium balneumMycobacterium ulcerans
appearance picturepicture
presentationProgressive reddish-brown 'apple-jelly' nodules.Endemic tropical areas. Starts as small hypopigmented spot. Becomes red patch with raised borders or pale spot.Non-healing cut to finger developing a red tender plaque.Painless subcutaneous nodule or pimple developing over weeks into large undermined ulcer. Endemic areas tropics, Africa, Australia.
managementAnti-tuberculous treatmentAntibiotics dapsone, rifampicin and clofazimine (and others). Oral corticosteroids and thalidomide useful for preventing nerve damage.Antituberculous drugs, cotrimoxazole, and high doses of minocycline have been advocated.Surgical excision and grafting. Antibiotics have little role Rifampicin with streptomycin or clarithromycin.
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James DG. A clinicopathological classification of granulomatous disorders. Postgrad Med J 2000 Jan;76(898):457–465. Available from: http://pmj.bmj.com/content/76/898/457

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