1. بسم الله الرحمن الرحيم

2. TUBERCULOSIS OF THE SKIN

3. 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.

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

5. 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

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

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

8. 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).

9. 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.

10. 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).

11. 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

12. 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).

13. 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.

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

15. THANK YOU