cutical tuberculosis

8/11/2019 Cutical Tuberculosis

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CUTICAL TUBERCULOSIS

dr. Kristo A. Nababan, Sp.KK

epartment of Skin and Genital Health of Medical Faculty of

USU


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INTRODUCTION

Developing countries

Lower socioeconomic EPIDEMIOLOGY

Western countries : lupus vulgaris

Tropical region (Indonesia) affected by

scrofuloderma and cutical verucose tuberculosis

Children and younger adults

Transmission : inhalation, direct inoculation on

skin ETIOLOGY

Tuberculosis Mycobacterium : 91.5%

Atypical mycobacterium : 8.5%


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BACTERIOLOGY

Tuberculosis mycobacterium -

Features : Acid resistant

Unmovable

Aerobe

Optimal growth temperature 37C

Bacteriologic examination consists of : Microscopic culture ( Ziehl Neelsen coloring

agent)

Culture ( Lawenstein Jensen culture)

Experimental animal

Biochemical test

Resistance test


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CLASSIFICATION :

1. Pure skin tuberculosis The causative germs are found in skin abnormality

accomplished by typical histophatological features

Primary cutical tuberculosis

Primary tuberculoss inoculation /cancer tuberulosis Cutical milliaris tuberculosis

Tuberkulosis kutis sekunder

- Skrofuloderma

- Verukosa cutial Tuberculoss Cutial gumosa tuberculoss

Cutical oriphicialis tuerculosis

Lupus vulgaris


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2. TuberculoidIt is a reaction of ID -- on skin abnormality, the

causative agent unfound, the germ is found in otherplaces of body ( lung)

Papulae Papulonecrotic tuberculosis

Liken schlofulosorum

Granulomae and ulceronodulus

- Erythema nodosum

- Erythema induratum bazin


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PATHOGENESIS Directly transmission to skin from organ under

the skin infected by tuberculosis (scrophuloderma) Direct transmission on skin around oriphisum

(cuticle oriphisialis tuerculosis)

Hematogenously transmission (lupus vulgaris)

Direct transmission of the mucosa infected bytuberculosis (lupus vulgaris)

The germ directly penetrate into the skin with thereduced local resistance (cutical verucose

tuberculosis)


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CLINICAL PHENOMENOSPURE CUTICAL TUBERCULOSIS

a. PRIMARY CUTICAL TUBERCULOSIS

1.CANCHRE TUBERCULOSIS

Primary affect papule, pustule, indolen ulcus aroundlivide.

Budding time : 2 3 weeks

Limphangitis, lymphadenitis after primary affect (positive tuberculin).

All above : primary complex

Ulcus with unduration: chancre tuberculosis


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Chancre Tuberculosis


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2. CUTICAL MILIARIS TUBERCULOSIS

- Transmission into skin from the focuson body

- Tuberculin test : negative

- Erytheme is tightly bordered :papule, vesicle, and pustule,squamous, throughout purpura

- Prognosis : bad


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b. SECONDARY CUTICAL TUBERCULOSIS1.SCROPHULODERM

Travel of percontinuitatum from the organ under

the skin infected by tuberculosis (, gland secretion,joint, bone). Location neck : from tonsil or lung

armpit : from pleura apexhip fold : from extremity

Initial : tuberculosis lymphadenitis (KGB : withoutacute inflammation).

Perodentiticattachment of gland to thesurrounding tissues.

Disposition gradually (cold abcess)broken fisteldisorganized extension, livide around,tertutup pus seropurulen sikatrik skin bridge

DD : limphosarkoma, lymphoma malignum,hidrodentitis spurative , LGV


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Schrophuloderm


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Schrophuloderm


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CRITERION OF SCROPHULODERM

RECOVERY

1. All the phystel and ulcus have closed

2. All the limph decreased ( < 1 cm and

hard consistency)

3. Cycatric is non erythematous

4. LED reduced


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2. CUTICAL VERUCOSE TUBERCULOSIS

Exogenously Predilection : back of arm, lower leg,

feet trauma

Crescent moon travel ofserpiginose Lenticular papule above

erythematous macula


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CUTICAL VERUCOSETUBERCULOSIS


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3. CUTICAL GUMOSA TUBERCULOSIS

Hemathogenously ( from lung) ,

subcutant infiltrate, tightlybordered, biannual softer,and descructive.DD : guma syphilis, phrambusia,

profundae mychosis


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4. CUTICAL ORIPHISICALIS TUBERCULOSIS

Around oriphisum

- Pulmonary tuberculosis

ulcus in mouth, lip- Digestive tuberculosis ulcus around anus- Urine bladder tuberculosis genital ulcus

The resistance is so lack, ulcus reverberated, wall divided.


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5. LUPUS VULGARIS- Predilection : face, body and extremity

- Red nodus changed into yellow by pressure (

apple jelly color)

- Confluent to form plaque, destructive,ulcus

- Involutioncicatris

- Serpiginose feature (+)


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TUBERCULOID : a. Papule

1. PAPLONECROTICAL TUBERCULOSIS

- Shape : papulonecrotic, papulo pustule- Location : facial, body, extensor extremity

- Erythematose papule, waved, enlargedgradually into pustule crustae necrotic

tissue within 8 weeks recovered by cicatric- The disease can last for many years


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2. LIKEN SKLOFULOSORUM- Particularly in children

- papule milliard, the color likes a skin or erythematose- Self structured : grouped with softer squamous

- Predilection : chest, abdomen, back, sacrum

- Residive chronic

- Recovered with cicatric


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b. GRANULOMA ULSERONODULUS

ERYTHEME NODOSUM

Extensor extremity

Nodus : erytheme nodusDD : ENL

Reaction of ID due to streptococcus B

hemolyticus

Allergy against medications, rheumatic fever


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2. INDURATUM BAZIN ERYTHEME

- Erytheme and nodus nodus indolen

- Predilection on flexor extremity- Supuration to form ulcus

- Sometimes without suppuration --- regression ---

hypotropic- Residive chronic


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ARTIFICIAL EXAMINATION- Laboratory : higher LED

- Bacteriologic : BTA, culture

- Hystopathologic : more important than bacteriologic

- Tuberculine test

TREATMENT- Regularly to avoid resistance ( uninterrupted)

- Should be combined, minimall of 2 bacteriocidal medications (

combined INH + 2 or 3 types of other bacteriosidal

- Correct general condition

PROGNOSIS

Adequate, if the treatment meets the requirements


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MEDICATION

Standard Regimen (6 month)1. Initial phase ( daily medications for 2 months)

Dewasa Anak

a.Isoniazid

+

b.Rifampicin > 50 kg

+ < 50 kg

c.Pyrazinamid > 50 kg

+ < 50 kg

Etambutol > 60 kg

atau < 60 kg

Streptomicin

300 mg

600 mg

450 mg

2 gr

1,5 gr

15 mg/KgBB

25 mg/KgBB

3-4 gr IM

5-8 mg/KgBB

10-12 mg/KgBB

20-35 mg/KgBB

Tdk direkomendasikan

15-20 mg/KgBB


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2.Continuous phase ( 2 medications for 4months) isoniazid + riphampicin (with the

same dosage as in the table)


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Phase 1 : intensive ( initial).

- To eradicate active terms

- To divide as quick as possible and

- as much as possible

Phase 2 : continued

Sterilization

To eradicate germs grown gradually


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METHOD OF ADMINISTRATION AND SIDE EFFECT

Name of drug Methode of administration Side effec

INH (H) Per os, single dosage NeuriticGgn hepar

Rifampicin (R) Per os, single dosage Ggn hepar

when the bounce is void

Hypersensitivity

Thrombocytopenia

Pirazinamide (Z) Per os, devided dosis Ggn hepar

Streptomycin Per injection of IM Ggn N.VII disorder,especially vestibularisbranch.

VestibularisGgn hepar


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cutical tuberculosis

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