verrucous skin tuberculosis
Introduction
Introduction to verrucous skin tuberculosis Mycoplasma tuberculosis is a proliferative skin lesion that occurs after direct infection by skin trauma. It has a slow course and is a benign type of skin tuberculosis. It is an exogenous reinfection of Mycobacterium tuberculosis in an immune body that causes localized verrucous skin tuberculosis. Adults are more common, especially men (70.8%), and the incidence of direct contact with tuberculosis patients or tuberculosis animals is higher. Infections are common in exposed areas, with the back of the hand and the back of the finger most. The characteristics of the lesion are: a single papule at the beginning, and the central horn layer is gradually thickened, showing a sickle-like hyperplasia. The course of the disease is extremely slow and often does not heal for many years. basic knowledge The proportion of sickness: 0.003%-0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: common warts
Cause
Symptoms of tuberculous skin tuberculosis
Causes:
Direct contact with tuberculosis-contaminated items, such as tuberculosis sputum, pus, blood, tuberculosis animal milk, lesion secretions, blood, etc.
Pathogenesis:
The patient has been infected with Mycobacterium tuberculosis, and the body has obtained specific immunity, producing specific antibodies and sensitized lymphocytes. When the sensitized T lymphocytes are again contacted with Mycobacterium tuberculosis or phagocytic cells containing Mycobacterium tuberculosis when infected again, It releases a series of immune effectors that attract and activate macrophages, enhance their phagocytosis and bacteriolysis, and transform themselves into macrophages and epithelioid cells to form tuberculous granulomatous changes.
Therefore, in histopathology, tuberculous granuloma consists of multinucleated giant cells and epithelioid cells. There may be varying degrees of caseous necrosis in the center, lymphocytic infiltration in the periphery, tubercle bacilli can be found in tissues, due to allergic reactions, lesions The central layer gradually increases, with thick keratinization or papillary-like changes, showing a sacral bulge.
Prevention
Braided skin tuberculosis prevention
Carry out BCG vaccination, strict work procedures, do a good job in labor protection and sick animal treatment, regular physical examination, early detection and treatment of tuberculosis, take the initiative after the disease, actively do isolation, concentrate on pus dressing, prevent infection to others .
Complication
Verrucous skin tuberculosis complications Complications
1. Can be secondary to lymph node tuberculosis.
2. Deep destructive papilloma and sclerosing types can cause limb deformities.
Symptom
Symptoms of tuberculous skin tuberculosis common symptoms papules contracture scar scaly
Common in exposed parts, with the back of the hand, the back of the finger is most common, followed by the foot, hip, calf, etc., the damage is mostly single, a few can have 2 to 3.
1. Hard purple red pimples: starting from a round or oval-shaped soy-sized purple-red papules, the quality is hard, and the slides are not "apple".
2. Verrucous hyperplasia: The papules gradually enlarge, and the surface is rough and keratinized. It is papillary, with gray scales and scaly, and the boundary is obvious. There are dark red infiltration around it, which merges into plaques, the base is obviously infiltrated, and the central layer is thickened and thickened. The surface is rough and uneven, and slowly develops into a braided or papillary bulge. The surface is covered with gray-white adhesive scales. Most of the lesions have small abscesses (miliary abscess). When pressurized, a little pus can be seen from the nipple groove.
3. "Three-profile phenomenon": the damage spreads to the periphery, and the center forms atrophic scars. The good hair parts are often seen on the back of the hand and the back of the fingers, the forearms, the ankles and the buttocks. After the delay, the nature is stubborn and mostly limited to the local area. There is a local vaccination infection, which is positive for the high-power (1:100,000) dilution of tuberculin, showing a "three-dimensional": central healing leaves irregular atrophic scars, marginal scorpion-like proliferation, and then surrounded by smooth Red infiltration belt.
Examine
Examination of verrucous skin tuberculosis
1. Tuberculin test: It can measure the immunity of the body to tuberculosis. The positive reaction indicates that there is a tuberculosis infection, or the immunity has been established; the strong positive reaction indicates that there is active tuberculosis in the body.
2. Smear microscopy: Take a direct smear of pus or cheese-like necrosis at the lesion to find M. tuberculosis. X-rays or radiographs help to detect tuberculosis in tuberculosis or other organs.
Diagnosis
Diagnosis and diagnosis of verrucous skin tuberculosis
diagnosis
1. History of exposure
The patient is a medical staff member, a breeder and a slaughter who has access to a tuberculosis patient or animal, or has a history of contact with a tuberculosis patient or a tuberculosis contaminant.
2. Typical clinical symptoms
Single-shot, hard-purple purplish papules, or verrucous hyperplasia with empyema and clinical "three-profile" phenomenon.
3. Laboratory inspection
The tuberculosis test was strongly positive; the pus smear microscopic examination showed tuberculosis.
Differential diagnosis
1. Common warts: less damage, dry surface, no inflammatory reaction.
2. Verrucous lupus: The lesions are soft, new nodules often occur on atrophic scars, and the slides are "apple jam".
3. Chronic proliferative pyoderma: suppurative inflammation is more pronounced, less hyperkeratosis, tuberculin reaction is negative.
4. Sporotrichosis: no nodular hyperplasia on the surface of nodules, often arranged in a string, culture can find pathogenic bacteria, tuberculin and spores test can help diagnosis.
5. Coloring germination: The inflammation at the lesion is more obvious, and the pathogen can be found by biopsy or pus smear.
