TUBERCULOSIS OF THE SKIN

Def : chronic infection disease of Mycobacterium tuberculous extra pulmonary skinClasification : - Exogenous inf : Primary inoculation TB (PIT) Tuberculosis verrucosa cutis- Endogenous Spread: Schrofuloderma(SD)Lupus Vulgaris(LV)Acut miliary TB (AMT)

PIT- Def : inoculation M TB percutaneous, occurs at inoculated site in nonimmune host- Clinical feature :- papule2-4w after wound healing enlarges painless ulcer thick crustDD: primary syphilis with chancre, sporotrichosis

Tuberculosis Verrucosa CutisDef : percutaneous inoculation, occurs at inoculated site in individual with prior TB infClinical feature: papule with violaceus halohyperkeratotic, irregular border, verucous plaque, purpelish, red or brown colourLocation: hands, knees, ankle, buttocksDD: Veruca Vulgaris, pyoderma, blastomycosis, squamous cell carcinoma

Acute Miliary TBDef : lesion that appear cause of the spreading of body focus. Reaction of tuberculin test is negativeClinical features :profuse crop of bluish papules, vesicles, pustules or haemoragic lesins small ulcers

Schrofuloderma- Def : results from the involvement and breakdown of the skin overlying a TB fokus, ussually a lymph glands (cervical, axilla, inguinal, retroauricular)- Clinical feature :bluish-red nodule (mobile) overlying the infected gland, tender in palpationundermined ulcers fistulaintercommunicate beneath rigdes scarDD: Hidradenitis suppurativa, sporotrikosis, acne conglobata

Schrofuloderma, merupakan akibat dari kikut terkenanya kulit yang menutupi suatu fokus tuberkulosis biasanya nodus limfe, dimana yang paling sering adalah di leherGambaran klinisberupa fistula multipel dan jaringan parut yang padat

Lupus Vulgaris- Def : a progressive form of cutanedus TB occuring in a person with a moderat or high degree of immunity- Clinical feature :*generaly confluence nodules erytem becomes yellowish and look like apple-jelly with diascopy- plaque form: plaque eritem with scale like psoriasis appearance, edge becomes thickened and hyperkeratoticDD: sarcoidosis, chronic cutaneous lupus erythematosus, leprosy, pyoderma

Lupus vulgaris terdapat di kepala dan leherGambaran khas adalah bercak noduler berwarna coklat kemerahanLupus vulgaris merupakan proses destruktif dan pada tulang rawan hidung dan telinga bisa terjadi kerusakan hebatTes MT (Mantoux Test) positif kuat

Teraphy :- Isoniazid 300mg/d 6 m- Rifampicin 450mg/d 50kg BW, 600mg/d > 50kg BW- Pyrazinamide 1,5 gr/d 50-74 kg BW, 2,5 gr/d >75 kg BW 2 m (I)- Ethambutol 15mg/kg BW/d 2 m (I)