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Journal of the American Academy of Dermatology
Volume 14, n° 5P1
pages 815-826 (mai 1986)
Doi : 10.1016/S0190-9622(86)70099-6
Papulonecrotic tuberculid: A neglected disease in Western countries

Edward Wilson-Jones, F.R.C.P., F.R.C(Path) , Richard K. Winkelmann, M.D., Ph.D., F.R.C.P.
Institute of Dermatology, University of London, and the Mayo Clinic and Mayo Foundation, Rochester 

aReprint requests to: Dr. E. Wilson-Jones, Institute of Dermatology, St. John's Hospital for Diseases of the Skin, 5 Lisle St., Leicester Square, London, WC2H 7BJ, England.

Papulonecrotic tuberculid was diagnosed in twelve young patients demonstrating symmetric scattered papulopustular necrotic lesions of the extremities. The diagnosis was supported by a strongly positive Mantoux reaction in all cases, evidence of preexisting or past tuberculosis in eight patients, characteristic histologic findings, and a prompt resolution with antituberculosis therapy. Recurrence of the skin lesions in three patients treated only with isoniazid or with para-aminosalicylic acid and isoniazid indicates the necessity for combination treatment with several antituberculosis drugs. A detailed study of twenty biopsies indicates that the primary lesion is a subacute lymphohistiocytic vasculitis that causes thrombosis and destruction of small dermal vessels. These changes lead to an infarctlike lesion with coagulation necrosis of dermal tissue. In eleven instances a well-marked palisaded histiocytic reaction was seen around necrotic areas, calling into question the differential diagnosis of granuloma annulare or Churg-Strauss granulomatosis.

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 Supported in part by the Eleanor Naylor Dana Charitable Trust and the Kieckhefer Foundation

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© 1986  Published by Elsevier Masson SAS.