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Classification

Pathogenesis
How there are 6 kinds of infections
1. Radiation directly to the skin of the organ
under the skin that has been subjected to
tuberculosis, for example Scrofuloderma
2. Inoculation directly on the skin around
the orifice of the tool in the subject to
tuberculosis, such as orificial tuberculosis
3. Radiation haematogenously, such as
acute miliary tuberculosis

4. Radiation is limfogen, such as lupus


vulgaris
5. Radiation directly from the mucous
membrane which have been
attacked tuberculosis disease, such
as lupus vulgaris
6. Germs directly into the skin, if there
is damage to the skin and local
resistance has decreased, for
example, tuberculosis verrucosa

Clinical Manifestation
Primary Inoculation Tuberculosis
Afek primer can be shaped papules,
pustules, or indolent ulcer, walled
resonated and surrounding livid
Incubation period of 2-3 weeks,
lymphangitis and lymphadenitis occur
several weeks after the primary affective,
at that time into a positive tuberculin
reaction

Altogether it is a primary complex


In these ulcers can occur induration, as it
is called tuberculous chancre
The younger the patient, the more severe
the symptoms, for example, in infants
In children, the elderly are higher
resistance, so the primary affective
experience involution spontaneously and
leave sicatrix

Tuberculosis Verrucosa Cutis


In contrast to Scrofuloderma, infection of
tuberculosis verrucosa cutis happen
exogenously, so bacteria directly into the
skin, therefore predilection place on the
lower leg and foot, place more often gets
trauma, the most common in the knee

The clinical picture is typical, generally


crescent shaped due to propagation in
serpiginous, which means the disease spreads
to the majors followed healing in other majors
The rash consists of lenticular papule-papule
erythematous skin above
In the concave portion are sicatrix
Besides spreading in serpiginous, also can
spread to the periphery, forming sicatrix in
the middle

Lupus Vulgaris
According to Western literature, where
predilection in advance
In experience, more often located in the
body and extremities
In India, the most common place in the
buttocks
How infection may be endogenous or
exogenous

Clinical features common ones are groups of


nodes erythematous turns yellow in places
emphasis (apple jelly color)
If the nodes are confluence formed plaque,
destructive, often ulceration
At the time of involution formed sicatrix
When the face, nose cartilage can be damaged
Spontaneous healing occurs slowly somewhere,
but it happened on the way elsewhere, which
may be to the peripheral or serpiginous

Scrofuloderma
The emergence Scrofuloderma per continuitatum
due to propagation of the organ under the skin that
has been attacked tuberculosis, the most common
are from limfonode and can also be derived from the
joints and bones
Therefore predilection place in places that many
found superficial limfonode, which is common in the
neck and then followed in the rare armpits and in
the groin

Then the Scrofuloderma chronic disorders


will be found as follows: enlargement
many limfonode
With a soft rubbery consistency and
without signs of acute inflammation, in
addition to the tumor; periadenitis;
multiple abscesses and fistulas; ulcerulcer with distinctive properties; sicatrixsicatrix elongated and irregular, and
bridges skin

Tuberculosis milliary cutis


Occurred due to spread from the skin to
focus on the body
The reaction to the tuberculin usually
negative (anergy)
Circumscribed rash erythema, papules,
vesicles, pustules, scaling, or generalized
purpura
In general, the prognosis is poor

Orificial Tuberculosis
Synonyms is tuberculosis cutis ulserous
As the name implies, it is located around
orifice
In pulmonary tuberculosis can occur
ulcers in the mouth, lips, or in the
vicinity as a result of direct contact with
sputum

In the gastrointestinal tract tuberculosis,


ulcers can be found around anus consequence
from direct contact with feces containing the
tuberculosis germ
In the urinary tract tuberculosis, ulcers can be
found around the urethra orifice externum due
to contact with urine containing the germ
Incidence of tuberculosis is caused by a form
of immunity is very less
Ulcers walled resonated and surrounding Livid

Tuberculous gumma
Tuberculosis cutis are caused by hematogenous
spread, usually of the lungs
Skin disorders such as gumma, namely
subcutaneous infiltrates, circumscribed and
chronic, then softened and destructive
Distinguished from other diseases that gummas
is syphilis, yaws, and deep mycosis, because it
must be performed histopathological
examination.

Sequelae Of BCG Inoculation


In the normal course of BCG vaccination, an
infiltrated papule develops after approximately 2
weeks, attains a size of approximately 10 mm
after 612 weeks, ulcerates, and then slowly
heals, leaving a scar
Vaccination may provoke an accelerated reaction
in a previously infected person
Tuberculin sensitivity appears 56 weeks after
vaccination

Problems include the following:


LV at or near the vaccination site (latency
of months to years)
Koch phenomenon in individuals sensitive
to tuberculin [see Section Tuberculin
Reaction (Koch Phenomenon)]
Regional adenitis, sometimes severe and
with systemic symptoms, more often in
children

After deep injection, local abscesses,


excessive ulceration
Scrofuloderma with suppuration for
612 months
Generalized tuberculid-like reactions
(rare)
Generalized adenitis, osteitis, organ
tuberculosis (e.g., in the joints)
occasionally

Lichen Scrofulosorum
Mainly found in children
Skin disorders consist of some papules billion, color
can be similar to the skin or redness (erythematous)
Initially composed of its own, then clusters composed
sirsinar, sometimes in the vicinity there are smooth
scaling
A predilection for the chest, abdomen, back and
sacrum area. Course of the disease can be months
and residive, if recovered not leave sicatrix

Papulonecrotic Tuberculid
Apart form the papulonecrotica, may also form
papulopustul
A predilection for the face, extensor limbs and torso
At first there were erythematous papules arising,
enlarges slowly, and then into pustules
Then break into crust and forming of necrotic tissue
within 8 weeks, and then healed and abandon sicatrix
Then comes the new lesions. Old disease can be
years

Erythema Nodosum
Skin disorder of nodes indolent mainly on
limb extensor
On it there is erythema
Many diseases that can also be members of
the clinical picture as E.N. often leprosy as
erythema nodosum leprosum, id reaction
due to streptococcus B hemolyticus,
systemic drug allergy, and rheumatic fever

Erythema Induratum Of Bazin


Also skin disorder erythema and nodes indolent
as E.N., but the predilection on extremities the
flexures
Another difference, the E.I. suppuration thus
forming ulcers-ulcers
Sometimes it does not undergo suppuration, but
regression resulting in hipotrophy form of
indentations
Chronic-recurrent course of the disease.