When Lillian (not her real name) noticed a peculiar skin rash on her face, she thought nothing much of it and disregarded it as an allergic reaction to either proteins or the cosmetic product she was using. After several visits to a dermatologist, the rash instead of healing developed into ulcerous pimples with abscess. This is when she became concerned because once the pimple burst they never healed and instead formed a scar. She sought specialized treatment and after a skin biopsy she was diagnosed with tuberculosis of the skin, something she had never heard of or even knew existed. She was put on treatment but somewhere along the way she opted to go for a skin graft but the resulting wound was not healing.  She was advised to restart her treatment and was subsequently counseled on the importance of adherence. She complied and has now finished her treatment though she still has some scarring on her face that looks like a burn scar.  Having tuberculosis especially on her face was quite challenging to her.  She had and still does have issues with her self esteem and confidence but with time she hopes life will go back to how it once was. She remembers having to constantly cover her face to hide the skin condition.

“I found it very hard to explain to people that I was suffering from TB because they never understood or seemed to believe. They thought I was infected with the HIV virus,” She says. “I looked as if I had been burnt  and I could never leave the house without a scarf to cover my face,” Lillian adds.

Tuberculosis is an airborne disease that usually affects the respiratory system and is caused by bacteria called “mycobacterium tuberculosis”. Tuberculosis can also affect the gastro-intestinal system, the central nervous system, lymphatic cells, bones, joints and even the skin with exception of hair and nails. Its typical symptoms are a chronic cough that lasts for more than 2- 3 weeks with a blood-tinged sputum, weight loss and high fever. When it affects the lungs, TB is referred to as pulmonary Tuberculosis but when it affects any other part of the body it is referred as Extra Pulmonary Tuberculosis.

 The occurrence of HIV infection has been responsible for an increased frequency of both pulmonary and extra pulmonary tuberculosis. Kenya continues to treat more and more TB patients each year. However, widespread co-infection with HIV (close to 48 percent of new TB patients) makes TB treatment difficult.  Fighting the global TB epidemic has been complicated by AIDS. The two diseases are now fueling each other. The HIV virus ravages the immune systems of those it infects, leaving the door open for TB. In turn, TB is a common killer of people with AIDS. People infected with TB may not feel ill or show any symptoms if their immune system can keep the bacteria under control but when someone’s immune system is weakened, the chances of becoming sick are greater.

When people infected with whichever strain of Tuberculosis cough, sneeze or spit, they propel the germs to cause TB into the air and another person can be infected by inhaling only a few of these germs. At the time of primary infection the Tuberculosis bacteria may be spread by the blood to other organs of the body outside the lungs.  In a person who has high immunity they are destroyed, but if one is immune deficient they may lie dormant for months or years before causing the disease.  Bacteria may also be coughed from the lungs and swallowed subsequently entering the lymph nodes of the neck or parts of the gastro intestinal tract. According to a 2010 WHO fact sheet, if left untreated, each person with active Tuberculosis will infect an average of 10 and 15 people every year. Kenya has been ranked 13th on the list of 22 high burden Tuberculosis countries in the world and has the fifth highest burden in Africa.  According to the World Health Organization’s (WHO’s) Global TB Report 2009, Kenya had approximately more than 132,000 new TB cases and an incidence rate of 142 new sputum smear-positive (SS+) cases per 100,000 population

When the TB bacteria affects the skin, it causes TB of the skin also known as Tuberculosis of the skin or “Cutaneous Tuberculosis”. Tuberculosis of the skin manifests itself as an itch that results to rashes which quickly develops into toxic epidermal necrolysis – a rare life threatening dermatological condition characterized by the detachment of the top layer of the skin form the lower layer of the skin all over the body. Tuberculosis of the skin is not very common and can take a number of forms, the most notable is Lupus Vulgaris where the facial skin changes and gives patients a wolf like symptom.

Tuberculosis of the skin is highly variable in its clinical presentation in that it manifests itself in many ways it can start with a boil, an itch or pimple, a skin rash, ulcers and small swellings depending on someone’s immunity. In the body it is spread through blood and the body’s lymphatic fluids.   Tuberculosis of the skin can be mistaken for leprosy or cancer of the skin. Whereas in pulmonary Tuberculosis, diagnosis can be by sputum test, chest x-rays and tuberculin skin test, for tuberculosis of the skin to be diagnosed a skin biopsy or culture has to be made for confirmation.

 People at risk of acquiring Tuberculosis of the skin include, alcohol and intravenous drug abusers and people with certain diseases and conditions such as diabetes, cancer and HIV, and this is largely due to the fact that their immune system is already compromised.

A person infected with TB can be treated by taking several drugs for 6 to 8 months. It is very important that people who have tuberculosis finish their medicine, and take drugs exactly as prescribed.  If they stop taking their drugs too soon, they can become sick again, similarly if they do not take the drugs correctly, the germs that are still alive may become resistant to drugs. Tuberculosis that is resistant to drugs is harder and more expensive to treat.

If you think you have been exposed to someone with Tuberculosis, you should contact your doctor or local health department about getting a TB skin test or a special TB blood test. Be sure to tell the doctor or nurse when you spent time with the person who has TB.

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