Revisiting Cutaneous Tuberculosis: Clinical Patterns, Diagnostic Challenges and Therapeutic Perspectives—A Narrative Review

Abstract

Cutaneous tuberculosis (CTB) is a rare yet clinically significant form of extrapulmonary tuberculosis caused primarily by Mycobacterium tuberculosis infection of the skin. Although it constitutes only a small fraction of total TB cases, CTB continues to present diagnostic and therapeutic challenges, particularly in endemic regions. This narrative review comprehensively summarizes current knowledge on the epidemiology, clinical patterns, diagnostic strategies, and management approaches of CTB, highlighting emerging perspectives and gaps in clinical practice. The disease exhibits a wide clinical spectrum, including lupus vulgaris, scrofuloderma, tuberculosis verrucosa cutis, and tuberculids, which reflect variations in host immunity and routes of infection. Diagnosis remains challenging due to its polymorphic presentation and similarity to other granulomatous dermatoses; while histopathology, Ziehl–Neelsen staining, and culture offer limited sensitivity; molecular techniques such as GeneXpert and PCR have enhanced diagnostic accuracy. Standard anti-tubercular therapy continues to be the mainstay of treatment, though drug-resistant cases necessitate individualized regimens. Early diagnosis and strict adherence to therapy are vital to prevent chronic disfigurement and relapse. Despite recent advancements, CTB remains under-recognized, underscoring the need for greater clinical awareness, improved laboratory capacity, and integrated collaboration between dermatology and infectious disease specialties to effectively address this neglected but important manifestation of tuberculosis.

Keywords: Cutaneous tuberculosis, Mycobacterium tuberculosis, diagnostic challenges, clinical spectrum, anti-tubercular therapy.