The clinical and histopathologic features of cutaneous tuberculosis are dependent on the balance struck between the resistance and sensitivity of the host and the virulence and number of the invading organism (Mycobacterium tuberculosis). A certain degree of inherent resistance exists in the tissues of the normal person, which is gradually augmented over a period of years after primary infection, a hypothetic immunizing response to tubercle bacilli known as acquired immunity. While primary infection is relatively innocuous in children, an exogenous reinfection is liable to be an activating process (superinfection) if the acquired immunity is not sufficiently developed. Tuberculous infection is a constant liability, whether it is active, inactive or "healed" by fibrosis and calcification or by resorption, as extension and dissemination may occur at any time the resistance is weakened and endogenous reinfection results. The longer the mechanism of acquired resistance is operative, the greater the immunity of the subject
CRAWFORD S. SMALL NODULAR NONCASEATING TUBERCULODERM: MODES OF INFECTION AND LOCALIZATION, WITH REPORT OF A CASE. Arch Derm Syphilol. 1939;40(6):950–961. doi:10.1001/archderm.1939.01490060088008
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