Cutaneous tuberculosis is dangerous. The M. tuberculosis complex causes 1.5–3% of extrapulmonary cases. This chronic illness needs long care. Tuberculous primary complex, commonly known as primary inoculated tuberculosis, is a rare (1%) clinical and histological diagnosis. To provide a histopathological case of primary skin tuberculosis with an unusual clinical presentation and immunization mechanism, to emphasize the significance of early detection to minimize sequelae and infections. A 52-year-old man has rheumatoid arthritis and systemic hypertension. It started with a unilateral localized dermatosis affecting the head in the left malar region characterized by an erythematosus papule of 2 mm in diameter, which at 2 weeks evolved into a 3 mm ulcer accompanied by pain and edema. The injury evolved every month to malar region, eyelids and left atrial pavilion consisting of a 15 cm erythematous myxedematous plate, was evaluated and treated with multiple antimicrobials without improvement, trauma was ruled out, skin biopsy was taken in the presence of two alcohol-resistant acid bacilli and by computed tomography infection by mycobacteria was excluded, skin tuberculosis was diagnosed of the primary skin complex type and treatment was initiated showing clinical improvement at 4 weeks and resolution at 8 months of treatment. The diagnosis of cutaneous tuberculosis presents a significant challenge owing to the diverse range of morphological manifestations. The manifestations observed in these cases have the ability to imitate various skin diseases, encompassing both infectious and non-infectious conditions. Moreover, it is imperative to exclude the existence of systemic tuberculosis in every instance.