Drug-resistance and its impact on cutaneous tuberculosis

Adhyatm Bhandari; Rahul Mahajan; V Ramesh

doi:10.4103/idoj.idoj_27_22

Drug-resistance and its impact on cutaneous tuberculosis

Indian Dermatol Online J. 2022 Sep 5;13(5):570-577. doi: 10.4103/idoj.idoj_27_22. eCollection 2022 Sep-Oct.

Authors

Adhyatm Bhandari¹, Rahul Mahajan¹, V Ramesh²

Affiliations

¹ Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
² Department of Dermatology and STD, ESIC Medical College and Hospital, Faridabad, Haryana, India.

Abstract

Drug resistance in tuberculosis is a universal health problem, with India and China having the highest number of multidrug resistant tuberculosis (MDR-TB) cases globally. As cutaneous tuberculosis (CTB) accounts for 1.5% of all extrapulmonary tuberculosis, drug resistance in CTB remains less discussed and understood. The sensitivity and specificity of the routine diagnostic workup for CTB are low compared to pulmonary tuberculosis. Therefore, identifying drug resistance becomes challenging and needs a high index of suspicion. Molecular techniques such as polymerase chain reaction (PCR), line probe assays, DNA microarray, and sequencing help us to identify tubercular bacilli and drug resistance early. Prompt initiation of effective therapy reduces disease-related morbidity and mortality and makes the patient non-contagious. Lately, World Health Organization (WHO) has recommended using "all oral longer MDR TB regimen" for pulmonary and extrapulmonary drug-resistant TB instead of a painful older regimen requiring long term therapy with injectables. This review focuses on the drug resistance in CTB, various methods and newer techniques to diagnose them and recent updates on treatment guidelines.

Keywords: Cutaneous tuberculosis; drug resistance; updates.

Publication types

Review