title: The effect of topical calcipotriol or zinc on tuberculin skin tests in hospitalised South African children.
abstract: BACKGROUND
  The tuberculin skin test (TST) is used to help diagnose tuberculosis (TB) in acutely ill hospitalised children. OBJECTIVE To investigate the potential augmentative effect of topical calcipotriol (a vitamin D analogue) or zinc on TST induration.
  
  
  METHODS
  Three TSTs were performed among 64 hospitalised children; each site was covered with topical aqueous cream (control), calcipotriol or zinc and assessed 24 and 48 h later by investigators blinded to all topical applications.
  
  
  RESULTS
  TSTs were reactive in 15 (23.4%) children, of whom 13 (20.3%) were TST-positive. Topical calcipotriol and zinc induced TST positivity in two children with reactive but negative control TSTs. These treatments, however, did not significantly increase TST positivity rates. In children with reactive TSTs, the median 48 h induration diameter was not significantly different between the control, calcipotriol- or zinc-treated groups, which were respectively 12.0 (25%-75% IQR 5.0 - 18.0), 14.0 (25%-75% IQR 10.0 - 15.0) and 12.0 (25%-75% IQR 8.0 - 15.0) mm. Topical treatments did not induce TST reactivity or TST positivity in children with culture-confirmed TB disease (n = 4), human immunodeficiency virus infection (n= 18) or kwashiorkor (n = 9).
  
  
  CONCLUSIONS
  Topical calcipotriol or zinc does not induce TST reactivity or significantly increase TST positivity rates in acutely ill hospitalised children. However, further studies are required to assess the effects of topical treatments on TST positivity in severely malnourished children.
authors.affiliation: Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: S G
authors.initials: SG
authors.lastname: Lala
authors.affiliation: Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: K B
authors.initials: KB
authors.lastname: Parbhoo
authors.affiliation: Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: C
authors.initials: C
authors.lastname: Verwey
authors.affiliation: Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Khan
authors.affiliation: Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Z
authors.initials: Z
authors.lastname: Dangor
authors.affiliation: Vaccine Preventable Diseases, Department of Science and Technology, National Research Foundation, Gauteng, South Africa.
authors.forename: D
authors.initials: D
authors.lastname: Moore
authors.affiliation: Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: J M
authors.initials: JM
authors.lastname: Pettifor
authors.affiliation: Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: N A
authors.initials: NA
authors.lastname: Martinson
mesh_terms: D000279:Administration, Cutaneous; D002117:Calcitriol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003879:Dermatologic Agents / Q000008:administration & dosage*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D013019:South Africa; D013997:Time Factors; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis*; D019287:Zinc Sulfate / Q000008:administration & dosage*
chemical_list: D003879:Dermatologic Agents; C055085:calcipotriene; D019287:Zinc Sulfate; D002117:Calcitriol