Tuberculosis cutis

Description:

The damages of skin caused by tubercular mycobacteria represent group of the diseases differing on clinical and morphological manifestations and an outcome.

Tuberculosis cutis symptoms:

The combined disturbances of physiological functions of skin with reduced immunity, and also development of a sensitization of an organism (hypersensitivity) can lead to developing of a tuberculosis cutis. These factors exert a great influence on allergenic ability of a mycobacterium and increase its aggression or virulence. There is a direct dependence between activity of allergization and a condition of nonspecific immunity. Allergization is more active at weak nonspecific immunity. The sensibilizing influence of a mycobacterium of tuberculosis is confirmed by hypersensitivity of the TB patient to tuberculine (to drug of tuberkulinovy tests when carrying out a Mantoux test). Tubercular allergization is confirmed local (in a tuberculine injection site) and focal reaction (there can be an aggravation in the centers of skin tuberculosis), and also the general reaction of all organism (a fever, weakness, fervescence). It is possible to confirm the tubercular nature of skin pathology by means of direct detection of the activator in the struck fabrics, and also sowings of mycobacteria on mediums. In general for statement of the exact diagnosis comprehensive examination is shown. In particularly complex cases trial treatment is carried out.
The tuberculosis cutis has the various clinical forms. They depend on many factors. One of leaders is an immunobiological reactivity of skin, more precisely, degree of its expressiveness. An important role is played also by age of patients. One clinical forms begin at children's and youthful age, others - at adults. Considerable value has also climate which or suppresses life activity of a mycobacterium, or strengthens it.

So, the tubercular lupus very seldom occurs among the population of the southern areas (the Caucasus, Central Asia, the Crimea). The tubercular stick gets into skin in two ways. The first way of penetration is connected with direct contact of the sick person or an animal with skin of the healthy person. In this case hit of a mycobacterium of tuberculosis in skin happens through damages to epidermis (grazes, cracks, wounds). It is an exogenous way which meets seldom. The second way - endogenous at which the infestant gets into skin with a blood flow or on absorbent vessels from the body affected with tuberculosis. Can be such bodies: lungs, bones, kidneys, etc. Hematogenous and lymphogenous ways meet considerably more often. In fact it is the metastatic way of infection leading to development of a disseminated miliary tuberculosis cutis, scattered forms of a tubercular lupus etc. Implementation of the causative agent of tuberculosis in skin can happen from the next, affected with tuberculosis bodies to a phlegm, urine, a stake, i.e. at TB patients of intestines specific process of skin around an anus can develop, and at patients with a pulmonary form of tuberculosis the mucous membrane of an oral cavity etc. is surprised.

There are two forms of a tuberculosis cutis - localized, or focal, and disseminated, an indurative erythema of Bazen. The disseminated (widespread) tuberculosis cutis is a miliary, papulonecrotic tuberculosis, deprive scrofulous.

Tuberculosis cutis reasons:

Cause of illness - Koch's mycobacterium. Tubercular diseases of skin develop, as a rule, for the second time at the persons who earlier had or having now tuberculosis of other bodies. Primary damage of skin - a tubercular chancre - is observed extremely seldom because of barrier function inherent to skin.

Treatment of the Tuberculosis cutis:

Treatment:  tuberculostatic chemotherapy, funds allocated for increase in a host defense, normalization of exchange disturbances. At treatment ostatika need to consider stability of mycobacteria to a tubercle and to prevent it. Tuberculostatic drugs on therapeutic effect are divided into the following groups:

    * I - the most effective remedies: isoniazid, rifampicin;
    * II - drugs of average efficiency: Ethambutolum, streptomycin, Prothionamidum (Etioniamidum), Pyrazinamidum, Kanamycinum, флоримицин (Viomycinum);
    * III - drugs of moderate activity - PASK, Tibonum (thioacetazone).

It is carried out in two steps. At the first stage appoint not less than 3 drugs within 3 months, and on the second - 2 drugs daily or 2-3 times a week (an intermitgiruyushchy way). In 3-4 months usually change a combination of drugs for the prevention of medicinal stability. In dermatological practice treatment is usually begun with a combination of rifampicin and an isoniazid, sometimes add Pyrazinamidum to it. Then these drugs replace with streptomycin, Ethambutolum, PASK. The basic course lasts on average 10-12 months. Appoint powders with PASK, an isoniazid to ulcer defects.