بسم الله الرحمن الرحيم.

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Presentation transcript:

بسم الله الرحمن الرحيم

TUBERCULOSIS OF THE SKIN

Results of infection depend on: Causative agent: Mycobacterium Tuberculosis Results of infection depend on: Number and virulence of the bacilli. Mode and site of inoculation. Natural resistance & immunological response of the host.

Tuberculomas True Tuberculous Lesions Tuberculides Invasion of the skin by TB bacilli Tuberculides Immunologic response to haematogenous dissemination of TB bacilli or their products

True Tuberculous Lesions Primary TB of the Skin Skin affection in a person who has no previous exposure to TB bacilli Exogenous Secondary TB of the Skin Skin affection in a person who has been previously exposed to TB bacilli Exogenous Endogenous

Primary TB of the Skin Primary Cutaneous Complex: Exogenous infection. Children usually. Small undermined ulcer at site of inoculation + Lymphangitis + Regional lymphadenitis.

REMEMBER Primary TB Complexes: 1) Primary pulmonary complex (Ghon’s focus). 2) Primary tonsillar complex. 3) Primary intestinal complex. 4) Primary cutaneous complex.

Secondary TB of the Skin Endogenous Infection (Secondary spread) Good Immunity Lupus Vulgaris. Poor Immunity Haematogenous spread (Acute Miliary TB). Direct extension Scrofuloderma. Exogenous Infection (Reinoculation TB) Good Immunity TB verrucosa cutis. Poor Immunity TB ulcer (TB orificialis).

Endogenous Infection (Good Immunity): Commonest type (Chronic & localized) Lupus Vulgaris Mostly in children. Secondary extension of a primary lesion. Blood born infection. Face and neck. Plaques, nodules (APPLE JELLY). Ulceration. Scarring and marked tissue destruction.

Endogenous Infection (Poor Immunity): Haematogenous (Acute Miliary TB) Haematogenous dissemination in an immunosuppressed patient with TB. Profuse crops of bluish papules, erythematous nodules, vesicles, pustules, hemorrhagic lesions, small ulcers. Direct Extension (Scrofuloderma) Affection and breakdown of the skin overlying a TB focus (LN / Bone / Joint). Bluish red nodules undermined ulcers, numerous sinuses and fistulae. Scarring (Irregular adherent masses).

Exogenous Infection (Reinoculation): Good Immunity (TB Verrucosa Cutis( Warty plaque Hands usually Poor Immunity (TB Orificialis) Affection of mucosa or skin adjoining mucosal surface in a patient with pulmonary, intestinal or urogenital TB Painful resistant small shallow ulcer with undermined edges

Tuberculides Immunologic response to haematogenous spread of bacilli or their products HIGH IMMUNITY. NO BACILLI AT THE LESION. Bilateral and symmetrical 1) Micropapular (Lichen scrofulosorum). 2) Papular (Papulonecrotic tuberculids). 3) Nodular (Erythema Induratum).

Diagnosis: Positive culture of mycobacterium TB. Guinea pig inoculation. Clinical history and signs. Presence of TB focus. Presence of TB bacilli in lesions. Histopathology. Tuberculin test. Effect of specific therapy.

Treatment: INH. Rifampicin. Ethambutol. Streptpmycin. Initial phase: 3 drugs Continuation phase (Several months): 2 drugs

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