From the Research
Management of skin manifestations of tuberculosis (TB) requires prompt referral to a specialist for diagnosis and treatment, with a standard four-drug regimen of isoniazid, rifampin, ethambutol, and pyrazinamide for 2 months, followed by isoniazid and rifampin for an additional 4 months, as recommended by the most recent study 1. The skin manifestations of TB can present as lupus vulgaris, scrofuloderma, tuberculosis verrucosa cutis, tuberculous gumma, or tuberculids.
- Initial management includes a standard four-drug regimen of isoniazid (5 mg/kg/day), rifampin (10 mg/kg/day), ethambutol (15-25 mg/kg/day), and pyrazinamide (15-30 mg/kg/day) for 2 months, followed by isoniazid and rifampin for an additional 4 months.
- Patients should be referred to a dermatologist for skin biopsy and to an infectious disease specialist or pulmonologist for comprehensive TB management.
- Laboratory testing should include tuberculin skin test, interferon-gamma release assay, chest X-ray, and culture of skin specimens.
- Treatment adherence is crucial to prevent drug resistance, and patients should be monitored for medication side effects such as hepatotoxicity, with pyridoxine (vitamin B6, 25-50 mg daily) given with isoniazid to prevent peripheral neuropathy, as noted in a study on cutaneous tuberculosis management 2. The skin lesions typically respond gradually to treatment, with complete resolution expected after the full course of therapy, and a therapeutic trial of 6 weeks with four drugs appears adequate to prove or disprove the diagnosis, as shown in a study on the response to antitubercular therapy in cutaneous tuberculosis 3.
- Cutaneous adverse drug reactions (CADRs) are common, with a study finding that 5.7% of patients developed CADRs, including morbiliform rash, erythema multiforme syndrome, urticaria, and others, with pyrazinamide being the commonest offending drug 4.
- Referral to a specialist is crucial for diagnosis and treatment, as well as for monitoring and managing potential side effects and complications, with the goal of improving morbidity, mortality, and quality of life outcomes.