Of Cutaneous T B


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Of Cutaneous T B

  1. 1. Cutaneous TUBERCLOSIS BY M.Yousry M.Abdel-Mawla. Zagazig faculty OF MEDICINE
  2. 2. Cutaneous T B <ul><li>Mycobacterium tuberculosis is the causative agent of tuberculosis (TB). </li></ul><ul><li>Aerobic, nonsporeforming, nonmotile, facultative, intracellular, curved rods measuring 0.2-0.5 by 2.0-4.0 mm. </li></ul><ul><li>Stained with acid-fast stain. </li></ul>
  3. 3. The variants of cutaneous TB <ul><li>Primary-inoculation TB (tuberculous chancre) </li></ul><ul><li>TB verrucosa cutis </li></ul><ul><li>Scrofuloderma </li></ul><ul><li>Lupus vulgaris </li></ul><ul><li>TB cutis orificialis </li></ul><ul><li>Miliary TB of the skin </li></ul><ul><li>Tuberculids </li></ul>
  4. 4. Tuberculous Chancre <ul><li>Results from direct introduction of mycobacteria into the skin or mucosa of an individual who was not previously infected with TB. </li></ul><ul><li>. An inflammatory papule develops in 2-4 weeks at the inoculation site that breaks down into a firm, nonhealing, shallow, nontender, undermined ulcer with a granulomatous base. Painless regional lymphadenopathy is evident at 3-8 weeks. </li></ul>
  5. 5. TB verrucosa cutis <ul><li>Occurs after direct inoculation of TB into the skin in someone who has been previously infected with mycobacteria </li></ul><ul><li>Presents as a purplish or brownish-red warty growth </li></ul><ul><li>Lesions most often occur on the knees, elbows, hands, feet and buttocks </li></ul><ul><li>Lesions may persist for years but can clear up even without treatment </li></ul>
  6. 6. Lupus vulgaris <ul><li>Persistent and progressive form of cutaneous TB </li></ul><ul><li>Small sharply defined reddish-brown lesions with a gelatinous consistency ( called apple-jelly nodules) </li></ul><ul><li>Lesions persist for years, leading to disfigurement and sometimes skin cancer </li></ul>
  7. 10. Scrofuloderma <ul><li>Results from direct extension of underlying TB infection of lymph nodes, bone or joints </li></ul><ul><li>Often associated with TB of the lungs </li></ul><ul><li>Firm, painless lesions that eventually ulcerate with a granular base </li></ul><ul><li>May heal even without treatment but this takes years and leaves unsightly scars </li></ul>
  8. 11. Miliary TB <ul><li>Chronic TB infection that has spread from the primary infection (usually in the lungs) to other organs and tissues via the bloodstream </li></ul><ul><li>Skin lesions are small (millet-sized) red spots that develop into ulcers and abscesses </li></ul><ul><li>In immunocompromised patients, e.g. HIV, AIDS, cancer </li></ul><ul><li>The patient is generally sick </li></ul><ul><li>Prognosis is poor (many patients die even if diagnosed and treated) </li></ul>
  9. 12. TB cutis orificialis <ul><li>Results from autoinoculation of mycobacteria into the periorificial skin and mucous membranes in patients with advanced TB </li></ul><ul><ul><li>Tuberculin sensitivity is strong. The site of the periorificial lesion often is determined by trauma. </li></ul></ul><ul><li>Red papules that evolve into painful, soft, punched-out, shallow ulcers. </li></ul>
  10. 13. Tuberculid <ul><li>Generalised exanthem in patients with moderate or high degree of immunity to TB </li></ul><ul><li>Usually in good health </li></ul><ul><li>Erythema induratum ( Bazin disease ) : recurring lumps on the back of the legs (mostly women) that may ulcerate and scar. </li></ul><ul><li>Papulonecrotic tuberculid :crops of recurrent crusted skin papules on knees, elbows, buttocks or lower trunk that heal with scarring after about 6 weeks. </li></ul><ul><li>Lichen scrofulosorum : an extending eruption of small follicular papules </li></ul>
  11. 14. T B Patient Work Up <ul><ul><li>Medical history Perform a physical examination. </li></ul></ul><ul><li>Tuberculin skin test </li></ul><ul><li>Posteroanterior chest radiograph </li></ul><ul><li>Specimens for bacteriologic examination: 3 sputum specimens on each of 3 consecutive days. </li></ul><ul><li>Skin biopsies </li></ul>
  12. 15. THERAPY of T B <ul><li>Isoniazid : 5 mg/kg/d in adults; 10-20 mg/kg/d in children, not to exceed 300 mg qd </li></ul><ul><li>Rifampin: 10 mg/kg/d in adults; 10-20 mg/kg/d in children, not to exceed 600 mg qd </li></ul><ul><li>Pyrazinamide : 15-30 mg/kg/d in adults and children, not to exceed 2000 mg qd </li></ul><ul><li>Ethambutol: 15-25 mg/kg/d in adults and children or streptomycin: 15 mg/kg/d in adults; 20-40 mg/kg/d in children, not to exceed 1000 mg qd </li></ul>