refractory ulcer
Introduction
Introduction There is no obvious effect after regular medical treatment, including persistent nonunion of the ulcer, or recurrence of symptoms during the maintenance treatment period, or complications, called refractory ulcer. Chronic skin ulcer, also known as refractory ulcer, is a common clinical disease, including vascular ulcers, radiation ulcers and infectious ulcers. The common feature is that the surface ulcers are unhealed and the disease is lingering. For such ulcers, there are many at home and abroad.
Cause
Cause
Skin ulcers are generally localized skin tissue defects caused by trauma, microbial infections, tumors, circulatory and neurological dysfunction, immune dysfunction or congenital skin defects. Traumatic ulcers are often caused by physical and chemical factors acting directly on tissues. Microbial infectious diseases are mostly caused by bacteria, fungi, spirochetes, viruses and the like. Nodules or tumor rupture. An vascular inflammatory ulcer caused by an immune abnormality is formed by necrosis of tissue due to arterial or arteritis. Circulatory or neurological dysfunction is a tissue disorder caused by nutritional disorders, such as varicose veins and leprosy ulcers.
(1) Bacterial diseases
Swollen, phlegm, cellulitis, sweat gland inflammation, skin tuberculosis, sore, skin anthrax, nasal discharge, skin diphtheria, necrotizing acne, squat pyoderma, leprosy, tropical ulcer, mycobacterial ulcer, Swimming pool granuloma, oral tuberculous ulcers.
(two) fungal diseases
Griposis, cutaneous cryptococcosis, histoplasmosis, ball basidiomycete, aspergillosis, foot swollen, actinomycosis, nocardiosis, jaundice, purulent, mucormycosis disease.
(3) Viral diseases
Hand, foot and mouth disease, foot and mouth disease.
(4) Parasitic diseases
Skin amebiasis, skin fly plague.
(5) Sexually transmitted diseases
Genital sores, syphilis, soft acne, granuloma, and sexually transmitted lymphogranulomatosis.
(6) Allergic skin diseases
Fixed drug rash.
(7) vasculitis and vascular diseases
Nodular polyarteritis, allergic vasculitis, thromboangiitis obliterans, papular necrotic tuberculosis, hard erythema, gangrenous pyoderma, fatal midline granuloma, wegener granulomatosis, arteriosclerosis obliterans , stasis dermatitis, Raynaud's disease.
(8) Physical diseases
Ray dermatitis, frostbite, hemorrhoids.
(9) Occupational skin diseases
Chromium, nickel, sodium, zinc, cobalt, hydrochloric acid, sulfuric acid, hydrofluoric acid, sodium hydroxide, sodium carbonate can cause skin ulcers.
(10) Autoimmune diseases
Behcet's disease.
(11) Tumor
Eczema-like cancer is eczema-like cancer and basal cell carcinoma. Squamous cell carcinoma, malignant melanoma, sebaceous gland carcinoma, chapter-like granuloma, malignant histiocytosis, kaposi sarcoma, hair sheath cancer, fibrosarcoma, proliferative erythema, squamous cell carcinoma, multiple plasmacytoma.
(12) Others
Continuous acral dermatitis, nodular fat necrosis, fatty granuloma, foot-through ulcer, aphtha stomatitis, gangrenous balanitis, acute female genital ulcer.
Examine
an examination
Related inspection
Drug vagus nerve block test oral endoscope
(1) medical history
To understand the history of ulcer patients should be directed at the cause of ulcers, in general, should include the age and sex of the patient and the history of unclean sexual intercourse, because ulcers are often secondary damage. Therefore, in the current medical history to understand the characteristics of the initial damage of lesions, especially important can often provide diagnostic clues. It should also be aware of the changes in the development of the lesions, the duration of the disease and the past conditions of the medication.
(2) Physical examination
Physical examination should pay attention to the patient's general condition and the distribution of the location of the ulcer. The color edge is clear whether the shape base and surface secretions.
(3) Laboratory inspection
Histopathology is a commonly used diagnostic method for the identification of tumor vasculitis and general inflammatory ulcers. Bacterial culture fungal examinations are helpful for the diagnosis of infectious diseases.
Diagnosis
Differential diagnosis
First, bacterial diseases
1. The skin is swollen and sputum cellulitis: the deep folliculitis caused by staphylococci and the inflammation around the hair follicle are several sputum merging into an inflammatory mass. The cellulitis is caused by Staphylococcus aureus hemolytic streptococcus. A wide range of subcutaneous tissue purulent infections, the above three inflammatory masses can form ulcers after ulceration and ulceration. The growth of pathogenic bacteria has red inflammation and other inflammatory characteristics are generally not difficult to distinguish from ulcers.
2. Sweat gland inflammation: The infection is more common in the apocrine gland. It mainly occurs in the genital groin outside the armpit and the inflammatory induration around the anus.
3. Swelling sores: often caused by streptococcal infection is not clean, trauma, insect bite is the cause, mainly occurs in the beginning of the calf for the development of inflammatory water sores or abscesses to the periphery and deep exudate, more can form The crust-like thickness is a clear round or oval ulcer with a clear boundary, and the steep base around it is hard with grayish green purulent secretions. Usually 2-4 weeks of crusting and more than a few months, several dozens of unequal, long-term treatment can form deep necrotizing ulcers.
4. Lupus vulgaris: the most common type of skin tuberculosis for children and young people, more common in the face of the first small nodular soft apple sauce color, can be self-destructed to form ulcers, the formation of atrophic epilepsy, the week can appear new The skin lesions are not itchy and painful. Chronic pathology shows typical tuberculous nodules.
5. Painful skin tuberculosis: It occurs mostly in children and young women. It is often seen as a lymph node bone and joint tuberculosis lesion under the skin. It spreads to the skin through lymphatics and has multiple lymph node tuberculosis to the neck upper chest. At the beginning of the inguinal region, the skin nodules are hard to increase and adhere, and the synthetic block has a case of necrotic softening and ulceration, and a tuberculous nodule.
6. Leprosy ulcer: nutritional ulcer caused by neurological dysfunction in leprosy patients, generally occurs in the soles of the foot and the joints of the extremities. The nearby ulcers are pierced and painless. The dark red granules are not easy to bleed, and the surface is accompanied by spoiled necrotic tissue. There are peripheral superficial nerves, large dry skin, no sweat, hair loss, sensory disturbances, etc. The chronic disease is extremely difficult to heal. It can be diagnosed by means of the test leprosy test biopsy.
Second, fungal diseases
1. Sporotrichosis: This disease is caused by a history of traumatic injury caused by Mycoplasma serrata; it occurs in the invading part of the limbs and produces subcutaneous nodules that are not red and painless nodules. After expansion, it softens and breaks down to form an ulcer. After the damage spreads along the lymphatic vessels, the number of strips spreads, and more or less lymphatic vessels can be used for microscopic examination or culture. It can help to diagnose pathological changes. Chronic granuloma changes can be seen in macrophages. body.
2. Skin cryptococcosis: the beginning of the cryptococcal bacterium can be soft sputum or acne-like papular nodule abscess shortly central collapse edge, clear boundaries without redness, several lesions can be merged into larger ulcers, new membrane often ulcers The damage is good for the face and the fungus culture of the limbs is helpful for diagnosis.
3, histoplasmosis: caused by histoplasma through the respiratory tract, skin mucosal gastrointestinal membrane infection mainly invade the lung mucosa, liver and spleen lymph nodes and other skin mucosal damage, began to form a solid hard plaque and then suppuration and ulceration, pain Sexual shallow ulcer pathology shows giant, phagocytes and tissue cells, can be found in round and other spore culture can identify the species.
4, actinomycosis foot bacteria such as cardiosis: for chronic suppurative disease nodules rupture after the outflow, there are granules of pus can form ulcer fistula fungal examination can be distinguished and determine the diagnosis.
5, Astragalus purulent: for the head fungal infection can have shallow ulcers, fungal microscopic culture can establish a diagnosis
