MMed (Dermatology), Faculty of Health Sciences, University of the Witwatersrand / Introduction: Cutaneous tuberculosis (TB) accounts for about 2 - 3% of all cases of tuberculosis. It is as a result of direct infection of the skin or immune responses to antigenic components of Mycobacterium tuberculosis, known as tuberculids. In sub-Saharan Africa around 70% of patients with tuberculosis are co - infected with the human immunodeficiency virus (HIV). The prevalence of HIV in South Africa is approximately 11.4%. There are no studies in South Africa on the manifestations of cutaneous tuberculosis in the setting of HIV infection. Aims: The objectives of this study were to determine the clinical and histopathological spectrum of cutaneous tuberculosis in the Johannesburg area and to assess the correlation of HIV infection and CD4 count, on the clinical and pathological presentation. Patients and Methods: This was a prospective, hospital-based study conducted over a period of 3 ½ years from Oct 2004 - March 2008. A total of 74 patients diagnosed with cutaneous tuberculosis who were seen during the above mentioned period were enrolled for the study. Patients were enrolled from the three academic hospitals, Johannesburg, Chris Hani Baragwanath and Helen Joseph. Inclusion criteria included patients aged 10 years and older diagnosed with cutaneous tuberculosis. Patients from whom consent could not be obtained and those with lesions caused by non-tuberculous mycobacteria were excluded from the study. v The diagnosis was based on clinical and histopathological features as well as supportive diagnostic tests. Data was captured onto Epi-Info spreadsheet and then analyzed using STATA data software. Results: The entire clinical spectrum of lesions of cutaneous TB was seen with the exception of the nodular and phlebetic tuberculids. Erythema induratum, a tuberculid was the most common form of cutaneous TB accounting for more than a third (36.5%) of all cases. Scrofuloderma was the most common true infection accounting for about 29.7% of all cases. HIV-TB co-infection rate was 61.4%. The histology ranged from a granulomatous inflammation with absence of bacilli to a diffuse inflammation with abundance of bacilli. Conclusions: Despite the high prevalence of TB and high TB-HIV co-infection rate, cutaneous tuberculosis infection is still relatively uncommon. There is a however a relative increase in the frequency of true infections particularly scrofuloderma in comparison with the studies done previously here in South Africa. The association between HIV positive status and true infections was statistically significant with p = 0.024 and was not found to be statistically significant between HIV positive status and tuberculids with p = 0.71.