Lupus

TB skin - a very extensive and diverse in its manifestations group of dermatoses, the emergence and development of which is caused by the penetration of the skin and subcutaneous tissue tubercle bacilli. In almost all cases, tuberculosis is a secondary skin lesions and endogenous. The pathogen usually enters the skin and subcutaneous tissue lymphohematogenous by foci of TB in other organs, sometimes the infection penetrates the skin at a stretch - from the affected neighboring organs; very rare exogenous infection of the skin - through the damage.

There are focal (vulgar lupus skrofuloderma, verrucous and ulcerative tuberculosis) and disseminated (papulonekrotichesky tuberculosis and induratum erythema) form of skin tuberculosis.

Vulgar (vulgaris, TB) lupus usually occurs in school age with the appearance of several lyupom - small yellowish-pink flat soft bumps exhibiting at diascopy translucent yellowness (the phenomenon of "apple jelly"), and a pressure-sensitive probe bellied -extremely softness and vulnerability (the phenomenon "probe"). Gradually lipomas increase in size and number, can be covered with scales, ulcerate. After healing of ulcers or resorption lipomas are smooth thin white atrophic scars resembling crumpled tissue paper. Favourite localization: face (nose, upper lip, cheeks, ears), buttocks, legs. Often the affected mucosa of the mouth, where the process usually takes on the character of ulcerative ulcers are painful. Due to the destruction of the affected areas may occur disfigurement of the patient's appearance (the destruction of the nose, lips, ears). Current chronic process, torpid, with the deterioration in the cold season; It may be complicated by erysipelas and skin cancer.

Lupus should be distinguished from tertiary syphilis Bugorkova and lupus. In tertiary syphilis deprived yellowish bumps are dense texture, characterized by rapid evolution to form a "mosaic of scars," never appear in the old place, do not give the phenomena of "probe" and "apple jelly"; serological tests for syphilis (RVs, RIF, RIBT) positive. Red (erythematous), lupus does not usually begins in childhood, appears symmetrical erythematous spots with tightly seated grayish scales, do not ulcerate, recurs and worsens in the spring and summer, rarely affects the mucous membranes, does not give the phenomena of "apple jelly" and "probe" .

Skrofuloderma (kollikvativny lupus) on the observed mainly in children and adolescents suffering from tuberculosis subcutaneous lymph nodes, with which the process moves to the subcutaneous fat; Infection can occur by hematogenous. In the submandibular region, on the neck, chest, legs appear single or multiple bluish-red nodes, followed by the central softening and the formation of deep soft, almost painless ulcers with overhanging edges, connected by a deep fistuleznymi moves. The current process with a chronic tendency to spontaneous healing. After healing ulcers are wrong "mostikoobraznye" scars.

Verrucose lupus occurs when exogenous infection of the skin, often in connection with the profession (for pathologists, slaughterhouse workers -From figurative name "corpse hump"). Typically the fingers or the back of the hand formed small painless infiltration of bluish-red color with a warty growths on the surface is subsequently subjected to scarring.

Ulcerative tuberculosis of the skin seen in sharply weakened patients with active TB in the lungs, intestines, kidneys. Skin lesions occur as a result of autoinoculation sputum, feces or urine containing tubercle bacilli. On the mucous membranes and skin in natural holes as small soft painless ulcer with overhanging edges and uneven bottom, with tiny abscesses (Trelew point). The bottom of the ulcers may be covered with crusts.

Papulonekrotichesky lupus occurs at an early age in the form of small bluish-red nodules with necrotic scab in the center, which are backsliding "stamped scars." Eruptions are arranged symmetrically, mainly on the legs and buttocks. Subjective feelings are absent. Process Flow relapsing.

Induratum (compacted) erythema, usually observed in young women in a deep dense painless bluish-red nodes localized on the legs. Units often ulcerate formed ulcers differ torpid course. The process is prone to relapse in the autumn and winter.

The diagnosis of tuberculosis of the skin is based on history, clinical features, the presence of lesions of other organs, positive tuberculin test, isolation of tubercle bacilli from ulcerative lesions. In severe cases, the skin produces histopathological study, experimental animals vaccinated and presumptive treatment.

Treatment is carried out in accordance with the general principles of TB treatment. Typically, a comprehensive treatment of streptomycin, ftivazid, rifampicin in high therapeutic doses. Spend one main and two reinforcement (anti-relapse) course. The duration of the basic course of 6 months, fixing - 3 months. The intervals between courses of 4-6 months. In conjunction with the specific drugs prescribed to patients bracing means, fortified diet, rational mode. In ulcerative forms used disinfectant wash and ointment.

Forecast favorable in most cases.