Indian Journal of Dermatology
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Year : 2005  |  Volume : 50  |  Issue : 4  |  Page : 231-232
Papulo necrotic tuberculid :An imitator

Department of Skin & VD, V.S.S Medical College, Burla, Orissa, India

Correspondence Address:
C S Sirka
Department of Skin & VD, V.S.S Medical College, Burla, Orissa
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A 22 year old female presented with asymptomatic papules, pustules and crusted lesions appearing in crops over the extensor aspect of both upper and lower limbs, palms and soles and sun exposed part of the back. She also had hypopigmented atrophic scars over the extremities and hyperpigmented macules on palms and soles. She had not responded to topical antibiotic creams and broad spectrum antibiotics in the past. VDRL test was non-reactive and the results of skin biopsy and Mantoux test were suggestive of papulonecrotic tuberculid. She was treated with antitubercular therapy and appearance of new lesions stopped within 4 days.

Keywords: Papulonecrotic tuberculid, Hematogenous dissemination, Varioliform scar.

How to cite this article:
Sirka C S, Jena S, Padhi T, Mishra S, Mohanty P. Papulo necrotic tuberculid :An imitator. Indian J Dermatol 2005;50:231-2

How to cite this URL:
Sirka C S, Jena S, Padhi T, Mishra S, Mohanty P. Papulo necrotic tuberculid :An imitator. Indian J Dermatol [serial online] 2005 [cited 2022 Jul 3];50:231-2. Available from:

   Introduction Top

Papulonecrotic tuberculid is an asymptomatic, chronic disorder occurring in crops associated with an underlying or silent focus of tuberculosis. It is symmetrically distributed over the extensors of extremities, dorsum of hands and feet, face and ear.[1] Young adults are predominantly affected and females are favoured in a ratio of 3:1. Tuberculin test is positive and may even generate a necrotic reaction. It responds to antitubercular therapy and it is believed that the cutaneous lesions are induced by hematogenous dissemination of tubercle bacilli to the skin.

   Case report Top

A 22 year old female agricultural worker presented with asymptomatic papules, papulopustules and crusted lesions appearing symmetrically over the extensor aspect of both upper and lower limbs, exposed part of the lower back and also on palms and soles. On examination, she had hypopigmented varioliform scar over the extremities and back and regressed lesion on the palms and soles appearing as hyperpigmented macules. The lesions were coming in crops since last 1 year. She was prescribed a number of broad spectrum antibiotics in the past but did not respond to any of them. There was no history of contact or any genital ulcer and there was also no history of any seasonal variation.

All the routine investigations were within normal limits. VDRL test in serial dilution was non-reactive and X-ray chest did not reveal any abnormal finding. However, Mantoux test was strongly positive (23x25mm induration) and histopathological study of the lesions was suggestive of papulonecrotic tuberculid. She was treated with the four; drug regimen of antitubercular thrapy. New lesions stopped appearing within 4 days and all the residual lesions healed within 7-8 days leaving behind atrophic scars.

   Discussion Top

Apart from its typical locations i.e., extensor aspect of the extremities papulo necrotic tuberculid can involve buttocks, face, eyelids and even glans penis.[2] However, involvement of palms and soles has not been described. In our case, the condition mimicked secondary syphilis because of the involvement of palms and soles. Similarly, presence of lesions only on the exposed parts and particularly involvement of only the sun exposed area of the back pointed towards the diagnosis of polymorphous light eruption (PMLE) and secondarily infected papular urticaria. Pityriasis lichenoides acquta can cause similar type of lesions and may even occur on the palms and soles. However, strongly positive tuberculin test, suggestive histopathological findings and above all complete remission of the disease after the institution of antitubercular therapy confirmed the condition to be a case of papulo necrotic tuberculid.[3]

We present this case for its atypical manifestations and the close clinical features it shared with secondary syphilis, PMLE and papular urticaria.

   References Top

1.Kullavanijaya P, Sirimachan S, Suwanlaroj S. Papulonecrotic tuberculid, necessity of long-term triple regimens. Int J Dermatol 1991; 30:487-90.   Back to cited text no. 1    
2.Kumar B, Sharma VK. Papulonecrotic tuberculid on glans penis. Dermatologica 1987;174:151-2.   Back to cited text no. 2  [PUBMED]  
3.Wilson Jones E, Winkelman RW. Papulonecrotic tuberculid : a neglected disease in Western countries. J Am Acad Dermatol 1986;14 : 815-26.  Back to cited text no. 3    


[Figure - 1], [Figure - 2]


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