Scrofula cutaneous tuberculosis

Introduction to spastic skin tuberculosis Scrofulartuberculoderm (scrofulartuberculoderm), also known as liquefied skin tuberculosis (colliquativetuberculoderm), is one of the most common skin tuberculosis lesions caused by Mycobacterium tuberculosis. Tuberculosis is often accompanied by other tissues or organs, of which lymph node tuberculosis, bone and joint tuberculosis are most common. Occurs in the neck, underarms, upper chest, groin, etc., the primary spastic skin tuberculosis, also known as tuberculous gummite (tuberculous gumma), from the bloody disseminated, nodules Located on the extremities, not connected to glands, bones or other tissues. The characteristics of the lesion are: no painful nodules at the beginning, gradually developing ulcers or fistulas, and excretion of thin pus. The course of the disease is slow, and it can be delayed and form chronic infection. basic knowledge The proportion of illness: 0.002/% Susceptible people: no special people Mode of infection: respiratory transmission complication:

Causes of spastic skin tuberculosis

(1) Causes of the disease

Secondary to their own lymphatic tuberculosis or bone, joint tuberculosis, tubercle bacilli directly spread by the infected lesions, or through the blood, lymphatic vessels spread to the skin tissue to cause skin tuberculosis.

(two) pathogenesis

After the first invasion of Mycobacterium tuberculosis, it is phagocytized by neutrophils and macrophages. However, since macrophages are not activated, the lytic activity is weak, so that the bacteria in the cells cannot be eliminated and continue to multiply, causing cell infiltration and chronic formation. Granuloma, while bacterial antigens stimulate B cells and T lymphocytes, respectively, so that the body obtains specific immunity, produces antibodies and sensitized lymphocytes, because the bacteria are more hidden in the cells, so the humoral immunity is not strong, when sensitized When T lymphocytes are again contacted with Mycobacterium tuberculosis or phagocytic cells containing Mycobacterium tuberculosis, they release a series of immune effectors that attract and activate macrophages, enhance their phagocytosis and bacteriolysis, and transform themselves into macrophages and Epithelioid cells form nodules in tissue morphology.

Therefore, in histopathology, early non-specific inflammatory reactions, mainly neutrophils have lymphocytic infiltration, and can find tubercle bacilli, when the damage is more mature, tuberculous granuloma changes can be seen, by multinucleated giant cells and epithelioid cells Composition, the center is caseous necrosis, peripheral lymphocytes infiltration, sometimes surrounded by solid connective tissue, lesions at the collagen and elastic fibers are destroyed, less blood vessels and lymphatic vessels, but many new blood vessels can be seen at the edges And lymphatic vessels, no change in the beginning of the epidermis, followed by secondary atrophy.

Spastic skin tuberculosis prevention

Strengthen health promotion, popularize knowledge about tuberculosis prevention, and enable the masses to do self-examination and mutual supervision, conduct regular health checkups, early diagnosis, early treatment, eliminate infection sources, and eliminate infection routes.

Carry out BCG vaccination to enhance the body's resistance. Effective vaccination prevents the disease from occurring. For patients who have been infected with tuberculosis, if there is a corresponding skin condition, it should be diagnosed early.

Spastic skin tuberculosis complications Complication

Tuberculosis of the skin mucosa causes damage to the integrity of the skin's mucous membranes, so it can cause skin bacterial infections or fungal infections due to scratching, usually secondary to low constitution, or long-term use of immunosuppressive agents and fungal infections such as onychomycosis. Such as concurrent bacterial infections may have fever, skin swelling, ulceration and purulent secretion and other performance. Severe cases can lead to sepsis, which should be brought to the attention of clinicians.

Spastic skin tuberculosis symptoms common symptoms skin adhesion joint subcutaneous nodules

Spastic skin tuberculosis occurs in the neck, followed by underarms, groin and upper chest.

1. Subcutaneous painless nodules: The subcutaneous nodules of the size of soybeans at the beginning, the boundary is clear, hard, painless, free to move, and the skin of the nodules is normal.

2. Nodular adhesions, caseous necrosis: After several months, the nodules increased, increased, and adhered to the skin, showing a deep red color, and gradually softened to produce caseous necrosis.

3. Ulcer and fistula formation: After the nodule is worn, after ulceration, the cheese-like substance and the thin pus are discharged to form an ulcer.

The ulcer has a large bottom and a small mouth. It is narrow or elliptical. The base is uneven, pale and has a loose, soft or microstriped solid granulation tissue. The upper part of the ulcer is usually thin and tough, red or brown. The edge is sneak, often does not change color, and sometimes becomes red or purple due to the expansion of the pustule inside the fistula.

4. Irregular banded scars: Damage continues to occur, some have been healed, some have just hair, often arranged in a strip-like distribution of polymorphic lesions, scars are also banded, irregular, bundled or bridge shaped , rugged.

Examination of spastic skin tuberculosis

1. Tuberculin test: The immunity of the body to tuberculosis can be measured. The positive reaction indicates that there is a tuberculosis infection, or the immunity has been established; the strong positive reaction indicates that there is active tuberculosis in the body.

2. Smear microscopy: Take a direct smear of pus or cheese-like necrosis at the lesion to find M. tuberculosis.

X-ray or radio: Helps detect tuberculosis in tuberculosis or other organs.

Diagnosis and diagnosis of spastic skin tuberculosis

diagnosis

1. History: A history of tuberculosis infection with organs or tissues.

2. Typical clinical symptoms: banded nodules, ulcers, fistulas and irregular bundles of scars.

3. Laboratory examination: The tuberculin test is strongly positive

Differential diagnosis

1. syphilis: occurs in the forehead, scalp and calf, develops rapidly, quickly ruptures, often only one, regular and tidy, such as ulcers have a chisel edge, the edge is solid, not related to lymph, syphilis serum test Positive, often adult, with a history of smelting and history of sexually transmitted diseases.

2. Actinomycosis: mainly located in the mandibular angle, even spread to the mandible, there are many fistulas without bundles of scars, the secretions of the pus have sulphur-colored particles, microscopic examination can find actinomycetes.

3. Sporotrichosis: rapid development, shallow damage, often along the lymphatic vessels, can be identified by biopsy, mold culture and treatment trials.

4. Chronic ulcerative pyoderma: acute onset, often located in the scalp, armpits, groin and calves, local lymphadenitis is rare, if there is lymphadenitis, the inflammation is more obvious, more painful, more ulcers The pus is secreted, and small pustules are scattered around the ulcer.

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