2013.4-3a.comment

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Our Dermatol Online. 2013; 4(4): 462
Date of submission:  05.09.2013 / acceptance: 23.09.2013
Conflicts of interest: None
 
CUTANEOUS TB PROFILE IN NORTH WEST PUNJAB, INDIA: A RETROSPECTIVE DATA ANALYSIS
by

Tejinder Kaur, Alpna Thakur, Kritika Pandey, Suresh Kumar Malhotra, Karan Jit Pal Singh Puri

COMMENT:

Elena Chiticariu, MD PhD1, Anca Chiriac MD PhD2, Prof. Caius Solovan1

1Dermatology,University of Medicine and Pharmacy,Timisoara-Romania
2Nicolina Medical Center, Department of Dermatology, Iasi-Romania
E-mail: ancachiriac@yahoo.com 

 
Although it is a “disease of antiquity”, nicely described by Kaur T et al, tuberculosis is still a challenge in the modern medicine. The authors highlighted the role of HIV coinfection, but we don’t have to forget about the role of anti-TNF therapies (widely prescribed nowadays) in reactivating tuberculosis infection, especially in endemic regions [1]. Another important point that we could observe here is the important number of cases with a negative Mantoux test (approximately 36%). As we showed previously, Mantoux or tuberculin skin test (TST) is not a reliable technique in detecting the infection. We registered positive tuberculin skin test (defined in the context of biologic therapy as induration >5 mm) in 51% of nondermatologic subjects, respectively 70% of the patients with psoriasis [2]. Among them, 50% of psoriatic patients and 28% of nondermatologic subjects had an induration >10 mm (unpublished data). We have also reported the reactivation of TB under anti-TNFα therapy [3]. According to World Health Organization, the incidence rate of tuberculosis in Romania was estimated to 101/100000 population [4]. However, even if Romania is an endemic country, we mostly see pulmonary tuberculosis, cutaneous tuberculosis being very rare. Thus, we need to compliment the authors for a very clear and didactic presentation of different forms of cutaneous tuberculosis.
 
REFERENCES
1. Hernandez C, Cetner AS, Jordan JE, Puangsuvan SN, Robinson JK: Tuberculosis in the age of biologic therapy. J Am Acad Dermatol. 2008;59:363–80.
2. Solovan C, Chiticariu E, Timofte A, Stoia-Djeska I: Tuberculosis infection versus anti-tumor necrosis factor therapy: screening challenges in psoriatic patients. J Drug Assessment. 2012;1:65-7.
3. Solovan C, Chiticariu E: Psoriasis, Anti-Tumor Necrosis Factor Therapy, and Tuberculosis: Report of Three Challenging Cases and Literature Review. Infectious Diseases and Therapy. 2013;2:59-73.
4. Global tuberculosis report 2012, World Health Organization, 2012. http://www.who.int/tb/publications/global_report/en/


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