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  • Skin Tuberculosis - Causes, Symptoms and Treatment. MF.

    Skin tuberculosis is a disease that occurs as a result of lymphohematogenous spread of tuberculosis infection, also affecting subcutaneous fat.

    Causes of skin tuberculosis

    The disease is caused by mycobacteria tuberculosis, both human and bovine type. Infection is more often observed in childhood, both through the external and through the internal environment( from other organs).Currently, skin tuberculosis is very rare.

    Since the skin is a medium that is not favorable for growth and propagation of the pathogen, infection from the external environment is possible only with massive infection through the damaged skin. In such cases, the primary affect occurs at the site of penetration of the pathogen.

    Secondary forms develop in people against a background of reduced immunity in persons who have undergone tuberculosis of other localizations.

    Skin tuberculosis can be infected from a tuberculosis patient of any localization.

    Symptoms of skin tuberculosis

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    1. Primary tuberculosis.


    A. Acute primary tuberculosis:
    - primary tuberculous affect;
    - acute billion tuberculosis;
    - scrofoluloderma primary( hematogenous).
    B. Chronically current primary tuberculosis:
    - secondary scrofolulum;
    - fungal tuberculosis;
    - disseminated forms of skin tuberculosis( erythema compacted, papulonecrotic tuberculosis-disseminated one-billionth tuberculosis of the face, rosace-like tuberculosis of Lewandowski, scrofula).
    2. Secondary tuberculosis.
    - lupus erythematosus;
    - exogenous forms of skin tuberculosis:
    a) warty tuberculosis;B) billion - ulcerous tuberculosis.

    The primary tuberculous affect of is more common in children. On the skin there are single nodules, pustules, erosion or ulcers with an inflammatory reaction of the surrounding tissue, accompanied by an increase in the number of located lymph nodes.

    Acute billionth tuberculosis of the skin is a heavily leaking form, often with a fatal outcome. At present, almost does not occur. Characterized by a rash on the skin of the trunk and extremities of pinkish papules with a cyanotic shade, in the center of which there are sores.

    Scrofululoderma primary appears more often in children, most recently in elderly people and people taking long-term corticosteroid therapy. In the deep layers of the skin there are one or several painful knots, further increasing, the skin over them acquires a cyanotic shade. Possible the formation of a cold abscess, which can be opened with the formation of a fistula. When healing, deep scars form.

    Scrofululoderma secondary differs from the primary in that it is associated with lymph nodes, deep ulcers and coarser scars.

    Fungal tuberculosis usually occurs in the area of ​​fistulas and ulcers in patients with bone tuberculosis. Cyanotic, malo-painful, dense infiltrates are formed. Occurs secondary infection and they acquire a mushroom shape. It is extremely rare.

    Condensed erythema occurs in two forms: knotty Bazin and ulcerative Hutchinson, is the most common form of skin tuberculosis. On the folding surfaces of the shins, often symmetrically, are poorly knotted nodes, dense. As the lymph nodes increase, the skin over them acquires a pinkish-cyanotic shade. Later on, ulcers with granulations on the bottom are formed in the center.

    Papulonecrotic tuberculosis manifests itself symmetrically located on the skin of the face, the auricles, thorax, abdomen, extensor surfaces of the extremities, buttocks of painless, dense knots. It is characterized by hyperemia, the presence of telangiectasias( vascular cobwebs and sprouts), pinkish papules with pustules in the center, dried in a crust, after the rejection of which a scar is formed.

    Diarrhea scrofulous is more common in children and adolescents, it is not common nowadays. Characterized by the appearance on the skin of the side surfaces of the chest and abdomen, upper and lower extremities of symmetrically located dense nodules with scales on the surface.

    Tuberculosis lupus is located primarily on the face skin. The primary element is the lumpoma tubercle - globular, pinkish, soft, painless.

    Lupus

    Warty tuberculosis of the skin occurs as a result of contact of the skin with infected sputum, mainly from surgeons, veterinarians, pathologists with damage to the skin of hands when working with contaminated material. It is rare.

    Warty tuberculosis of the skin

    Milliarno-ulcerous tuberculosis occurs in bacterioscoppers on the mucous membranes or in places where the skin passes to the mucous membrane, around natural openings. It begins with the appearance of a dense, pink nodule, suppurating, ulcerating. Painful ulcers can grow to a depth of 1.5 cm at the bottom of the ulcers are found yellow grains Trely - the smallest abscesses. Sometimes there is an increase in nearby lymph nodes.

    Tests for suspected skin tuberculosis

    Produce tuberculin diagnostics, starting with Pirke's skin test, with a negative reaction put a Mantoux test. If the process is chronic, the sample may be negative.

    Bacteriological diagnostics are performed in patients with scrofululoderma, ulcerative forms of condensed erythema and lupus. For research take pus from ulcers, punctate from the nodes. A biopsy is best performed after 1.5 months from the onset of the disease, as tuberculosis structures are formed at this time.

    Radiologic examination of the lungs is also performed to exclude their defeat.

    In case of tuberculous lupus, there are two characteristic symptoms: "apple jelly" - when pressing glass, the yellowish shading of brighter brownish infiltrates and the Pospelov symptom - when pressed with a button probe, an impression is formed.

    If you find the above symptoms, you should contact the dermatologist for a complete examination. Then, if the diagnosis is confirmed, the patient will be sent to the TB doctor for further examination and choice of treatment tactics.

    Treatment of skin tuberculosis

    Treatment of skin tuberculosis is carried out in the same way as treatment of pulmonary tuberculosis. The main drugs are: isoniazid, rifampicin, ethambutol, pyrazinamide and streptomycin. Local splitting of single foci with streptomycin. Use of hepatoprotectors, since antibiotics affect liver function.

    Tuberculosis of the skin is very treatable if you do not skip tablets. Duration of treatment is from 6 months to 2 years, depending on the severity of the process and the resistance of the mycobacterium to antibiotics. At the initial stages it is better to undergo inpatient treatment, at least two months, with the subsequent transition to outpatient control.

    Folk remedies

    For tuberculosis it is useful to take in the form of infusions and broths: mother-and-stepmother, quince, eucalyptus, elderberry, aloe, cowberry, sporach, spruce, strawberry, walnut, lilac, pine, licorice, plantain. Koumissotherapy has always been acceptable for tuberculosis( high-grade protein and vitamins).Before taking any folk remedy, it is better to consult a doctor.

    Diet for skin tuberculosis

    During treatment, a high-protein diet is needed - fish, meat, dairy products, milk. It is necessary to increase the calorie content of food with the help of sugar, honey, bakery products, etc. The food should be strengthened, but not excessive. It is necessary to eat more vegetables and fruits. Do not restrict the liquid.

    Rehabilitation after tuberculosis of the skin

    Rehabilitation includes possible treatment from a cosmetologist or surgeon in connection with the formation of rough scars on the skin.

    Complications of skin tuberculosis

    Complications include: the formation of cold abscess, flaccid ulcers, fistula.

    Forecast of skin tuberculosis

    With proper treatment, recovery always occurs.

    There is almost no lethal outcome for skin tuberculosis, it is possible with a generalized lesion with tuberculosis, for example, bones and lungs.

    Prevention of skin tuberculosis

    Prevention includes the exclusion of contact with a patient with tuberculosis, if any. For children, this is the vaccination of BCG to form immunity to tuberculosis. For adults, annual fluorography.

    Doctor phthisiatrist Kuleshova LA