OVERVIEW
OVERVIEW
Tuberculous ulcers are a cutaneous manifestation of visceral tuberculosis. Mostly occurs in the viscera have active tuberculosis foci, at the same time the patient to tuberculosis bacillus resistance weak active pulmonary tuberculosis or throat tuberculosis patients, sputum tuberculosis bacilli can cause oral mucosal ulcers. If the bacteria-containing sputum is swallowed or intestinal tuberculosis is excreted, tubercle bacilli in the feces can cause perianal ulcers. In tuberculosis of the kidneys or bladder, Mycobacterium tuberculosis can be inoculated with urine in the urethra or vulva. Mycobacterium tuberculosis can be detected.
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Department
Dermatology, Infectious Diseases
Synonyms
Ulcerative skin tuberculosis, Oral skin tuberculosis
Clinical symptoms
Painful, ulcerated skin and mucous membranes, subcutaneous nodules, etc.
Harms
It affects the appearance of the skin, and oral mucous membrane tuberculosis may also affect eating.
Examination
Blood routine, tuberculin test, polymerase chain reaction test, pus picture microscopy, antacid staining, histopathological examination, X-ray film, etc.
Diagnosis
Diagnosis is made on the basis of medical history, ulcer manifestations and tuberculin test, tuberculosis culture, antacid staining and PCR.
Treatment principle
Systemic and local anti-tuberculosis treatment. Not only treating the skin damage, but also eradicating the internal tuberculosis must be done at the same time. Surgical treatment if necessary.
Curability
Depends on the cure of active tuberculosis foci in the viscera.
Dietary recommendations
High-calorie, high-protein, high-fat, high-vitamin foods are recommended.
Etiology
Etiology
Caused by infection with Mycobacterium tuberculosis.
Transmission
When Mycobacterium tuberculosis is present in the body’s excreta, it can inoculate the mucous membrane of the cavity and mouth to form ulcers.
Symptoms and diagnosis
Typical symptoms
Early manifestation is localized skin and mucous membrane, including gums, cheeks, lips, tongue, and palate, etc. Nodules or small abscesses, which are hard nodules at the beginning of the disease, and gradually break down to form ulcers, accompanied by pain. Generally, the margins of the ulcers are irregular and appear inverted, and the surface of the ulcers are small, granular, granulomatous wounds with small, corn-like nodules. It occurs at the natural openings of the skin, mostly in the mouth, anus or vulva. It may extend to the cutaneous-mucosal junction. Patients often have active visceral tuberculosis. Mycobacterium tuberculosis is easily detected in secretions. Animal inoculation and culture are readily successful.
Diagnostic basis
1. history of extra-oral tuberculosis or contact with tuberculosis patients.2. shallow concave margins of the ulcers, with a softer granulomatous base and dark red color.3. Mycobacterium tuberculosis can be seen on antacid staining of the lesion surface smears, with a positive tuberculosis PCR test, and tuberculous granulomatous manifestations can be seen on histopathologic examination.
Treatment
Treatment guidelines
Anti-tuberculosis drug therapy or surgery to improve symptoms.
Drug treatment
1. The standard treatment regimen for adults is oral rifampicin, isoniazid, pyrazinamide, and ethambutol for the first 2 months, followed by oral rifampicin and isoniazid for the next 4 months of continuous treatment. Ethambutol may not be added if the patient has not developed resistance to isoniazid.2. Topical treatment may be given in conjunction with antituberculosis therapy, including isoniazid ointment as a topical dressing on the wound.
Surgical treatment
Early, small tuberculous ulcers can be surgically resected, but in the operation must pay attention to make the outermost layer of wrapped fibrous tissue intact, do not make it break and lead to incision contamination (can be together with a part of the skin and excision), otherwise the incision healing is slow. Early incision and drainage of cold abscesses is recommended, as well as removal of surrounding necrotic tissue.
Prognosis
Scarring is common and the prognosis depends on the eradication of active tuberculosis in the viscera.
Nursing care
Daily care
1. Strengthen the care of skin and mucous membrane of the affected area, keep clean and dry, avoid secondary infection.2. Oral tuberculosis patients should pay attention to oral hygiene, keep the mouth clean.3. Appropriate isolation, daily necessities are used separately from other people.4. Regular life, ensure sufficient sleep.5. Follow the doctor’s instructions, do not stop or increase or decrease the dose without authorization, and review regularly.
Dietary management
Give high-calorie, high-protein, high-fat, high-vitamin diet, avoid smoking and alcohol, eat less stimulating food.