Being a life-threatening disease affecting the upper layer of the epidermis, the disease, skin tuberculosis is a pathology of the skin with a chronic course characterized by recurrent recurrences with an increase in symptoms characteristic of the disease. The provoking factor for the emergence of deterioration of the state are such reasons as the inadequacy of the antituberculous treatment performed before, the immunity of the organism to the medicines used and the gradual adaptation to the active components of the strains of the disease. Modern methods of treatment allow not only to stabilize the general condition of the patient, but also to reduce the degree of symptoms, to accelerate the end of the relapse period and to provide the patient with greater resistance to provoking factors that exacerbate the disease.
As an extrapulmonary type of tuberculous lesion, skin tuberculosis can be considered one of the most dangerous dermatological lesions, which tends to progress rapidly and has a pronounced symptomatology that adversely affects the general condition of the patient. The duration of the course of this disease is particularly long, and since in the early stages of development this defeat of manifestation is minimal, its diagnosis usually occurs already at more advanced stages, when treatment is difficult and the disease flows into a chronic form.
Features of the disease
Tuberculous skin lesions have a pronounced blurriness of their manifestations, which is also one of the reasons for the difficulties in diagnosing this skin disease. Inconsistency of the manifestations of standard and common clinical forms of the disease with the available in practice manifestations that can be individual in each specific case is a feature of this disease. This circumstance does not allow to create a single classification combining the signs and manifestations of a variety of the disease, to form a generally accepted scheme of therapeutic effect, which could be used for the speedy removal of the main symptomatology.
Since the diagnosis of skin tuberculosis is difficult for many of the reasons listed above, the consequences of neglected forms of lesion often lead not only to the emergence of a chronic form of pathology, but also to the appearance of a negative impact on the appearance of the patient, and in some cases, to his disfigurement. The majority of cases of infection with skin tuberculosis are detected and detected already at the late stage of the disease( developing over 5 years and even more), which is the reason for the difficulty of developing the most effective treatment regimen. The consequences of this dermatological lesion persist for life and require constant correction and attention to the health of the epidermis.
Papulonekrotic skin tuberculosis( photo)
Today, there is a definite classification of skin tuberculosis, which presupposes the presence of certain manifestations of affection in the patient, the specific course and development of the pathological process that allows him to be classified as a specific type of disease.
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Separate all types of this lesion into two main groups:
- True tuberculosis of skin , which has additional names localized, bacterial, granulomatous.
- The lesions of the upper layer of the epidermis , which result from predominantly allergic skin diseases. It can be vasculitis, immune inflammation, hyperergic skin inflammation.
Most of the diagnosed cases of skin tuberculosis belong to the first group of the true species, but there is also an intermediate type of disease that stands apart from the listed two. This is a lichenoid variety of the disease, which can be placed in the tuberculoid subgroup of skin lesions.
The second group includes lesions of the skin that have nonspecific manifestations and allergic causes. The specific originality of manifestations of pathologies of this group can combine non-specific manifestations of this disease and the presence of tuberculous tubercles on the surface of the skin, which are usually diagnosed by histological examination.
There is also the following division of the subtypes of skin tuberculosis:
- primary tuberculosis - it occurs at the sites of penetration into the upper epidermis layer of pathogens, usually it occurs in people who have not been vaccinated and not ill with tuberculosis;
- warty tuberculosis of the skin , also occurs at sites where the causative agent is introduced into the skin, but it appears in people who have been vaccinated and have been ill with the disease;
- ulcerative form of tuberculosis of the skin , arising in the thickness of the mucous membranes and having specific external manifestations and a characteristic course of the pathological process. Most often this type of skin tuberculosis affects men, while small nodules around the natural holes on the mucous membranes are quickly disintegrating and in their place ulcerous surfaces with an uneven bottom are found. Sores can gradually fuse and occupy large areas;
- is a tuberculosis of the face , in which the smallest rashes of gelatinous consistency from light to dark brown are diagnosed on the surface of the face skin. After they completely pass, small scars remain in their place, negatively affecting the appearance of the person;
- is a type of condensed tuberculosis of the skin , which most often occurs in young women and girls. It is characterized by the presence on the skin of the face of deep globular neoplasms that stand out on the skin and after the disappearance leave traces on the skin.
The peculiarities of the manifestation of the listed varieties of the considered disease make it possible to classify them as a certain type, however often marked blurring of the symptoms often complicates not only the process of diagnosing the disease, but assigning it to a certain type.
Skin tuberculosis in children
Symptoms and first signs of
The first manifestations of negative changes that are typical for the development of skin tuberculosis can be considered the appearance on the upper layer of the epidermis of globular neoplasms that have a pronounced cutaneous shaft along the perimeter and, as they heal, fibrosis appears on the skin.
Skin in the course of development of the disease loses its evenness and healthy appearance, its hue may change slightly. As the progression increases, the convexity of these formations increases, inside the eruptions there may be a jelly-like content. In the places of introduction of mycobacteria, the formation of an infiltrate is revealed, which has a negative effect when spilling onto healthy skin, infecting it and thereby increasing the areas of the dermis.
To prescribe a treatment regimen, you must first confirm the diagnosis of "skin tuberculosis".The above classification will help relate the symptomatology to a particular type of disease, but due to the special vagueness of the manifestations, this pathology is often determined at an already advanced stage of development.
For the diagnosis of the disease by a doctor, first of all, external manifestations in the form of rashes, the appearance of changes in the skin condition are studied. The subjective feelings of the patient will help the dermatologist make a more complete picture of the current disease.
Also for differential diagnosis, the following methods are used:
- histological examination of skin at the sites of their lesion;
- staining by the Tsilya-Nelsen method of skin slices;
- laboratory tests for blood and urine tests.
Also to clarify the diagnosis, ultrasound of the skin, nails and subcutaneous fat.
Treatment of skin tuberculosis
The methods of therapeutic effect are appointed by the attending physician-dermatologist, which, taking into account the individual characteristics of the organism and the degree of neglect of the pathological process, will help to make the most effective scheme of treatment. Adults receive medication with strong enough medications that affect the formation of rashes on the surface of the skin and the activity of mycobacteria.
In childhood, the treatment of skin tuberculosis should be carried out only under the supervision of a doctor and after the appointment of a treatment regimen. Dosage is selected depending on the current symptoms and the susceptibility to the treatment. In the presence of severe negative manifestations, treatment should be corrected taking into account the sensitivity of the child's organism to the medicines used.
To eliminate the most obvious and unpleasant manifestations of this dermatological lesion, such therapeutic and physiotherapeutic methods as UV irradiation, the use of magnetotherapy to increase the body's resistance and stimulate the immune system of the body are usually used. It is also recommended to make certain adjustments to the nutrition of the patient, which also positively affects the body's resistance and speeds up the healing process.
Normalization of the patient's day regimen, elimination of causes for constant stress and depressive state also positively influence the process of recovery. For tuberculosis of skin of any kind it is recommended to combine medicinal effect on the body and medical treatment, which increases the rate of manifestation of the positive dynamics of treatment.
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By medicamentous method
To drugs that cope well with the main symptomatology of skin tuberculosis, include:
- drugs with moderate activity - Thibon, PASK;
- medications with moderate activity in the treatment of skin tuberculosis - streptomycin, ethambutol, florimycin;
- funds with high efficacy - rifampicin, ioniazide.
Surgical intervention in detecting skin tuberculosis is usually not performed.
Although it is not necessary to engage in self-medication when diagnosing this type of dermatological lesion, folk medicine can be used as a supportive and immune-stimulating treatment. For example, a drug based on natural ingredients that stimulate immunity, increase its resistance to disease.
It can be infusions of medicinal herbs, broths vitaminized( dogrose, hawthorn, honey-based preparations and other bee products).
Prevention of the disease
If there is a genetic predisposition to any skin diseases, regular checkups should be carried out at the dermatologist, in case of any negative changes in the patient's condition, immediately take a course of treatment to reduce the characteristic symptoms and eliminate the unpleasant manifestations of the initial stage of the disease.
As a complication of this disease, there may be significant cosmetic defects, and in the absence of the necessary treatment, there can even be a disfiguring of the facial skin, which in some cases requires plastic surgery.
Survival in this skin lesion is 85-93%, only in some particularly neglected cases and with a low body resistance there is a probability of a lethal outcome.
Even more useful information about skin tuberculosis is contained in the video below: