lupus vulgaris
Introduction
Introduction to Lupus vulgaris Lupus vulgaris is a chronic inflammation of hair follicles and sebaceous glands. It occurs in the face, chest and back, and can form blackheads, papules, pustules, nodules, cysts and other damage. It is equivalent to the "pulmonary acne" of Chinese medicine. Lupus vulgaris is a chronic progressive skin infection caused by Mycobacterium tuberculosis. It occurs mostly in children and young people. The course of the disease is slow. At the beginning of the eyelid skin, there are nodules from rice to soybeans. The circumference is surrounded by a blush, translucent, brownish red or brown, and soft. The nodules can absorb or rupture to form ulcers, sometimes papillary. basic knowledge The proportion of illness: 0.005% Susceptible people: mostly in children and young people Mode of infection: contact spread Complications: valgus valgus
Cause
Cause of lupus vulgaris
Cause of disease
Lupus vulgaris is a secondary skin tuberculosis that has been previously tainted and has been sensitized to people with high sensitivity to tuberculin pure protein derivatives. Mycobacterium tuberculosis can invade the skin through skin lesions. Lupus vulgaris can also spread from the ruptured lymph nodes, bone and joint tuberculosis lesions directly or through the lymphatic vessels to the skin, or from the visceral tuberculosis lesions to the skin through the bloodstream. A very small number of cases can occur in the BCG vaccination site. Therefore, it is considered that after the vaccination of BCG, if granulation tissue occurs at the vaccination site, it will not be regressed for a long time.
In addition, the patient's nutrition, living conditions, health status, personal resistance, etc. have a great relationship with the occurrence and development of lupus vulgaris.
Pathophysiology
The pathological changes of lupus vulgaris mainly occur in the superficial layer of the dermis, but also spread to the deep dermis and even the subcutaneous tissue, and can cause damage to the skin appendage.
Pathological infiltration is mainly tuberculous nodules, and nodules with caseous necrosis are rare, even if they are mild. The infiltrating cells are mainly lymphocytes, epithelioid cells and giant cells. Although the giant cells are usually in the shape of marginal Langerhans giant cells, some are multinucleated giant cells with irregularly arranged nuclei. The earlier the damage, the more lymphocytes infiltrate around the infiltrating foci. Epithelioid cells and Langerhans giant cells predominate when the damage is long, and epithelial cells are mostly concentric circular clusters or irregularly arranged. There is no blood vessel in the infiltrating foci, in which the collagen fibers are denatured, and finally the elastic fibers can be degenerated and destroyed. When the lesion heals, the reticular fibers at the margin are dense and collagenized, and a wide variety of fibrous tissue is proliferated. Elastic fibers cannot be recovered.
Epidermal changes are secondary, in some cases there may be atrophic hypertrophy, hyperkeratosis or nipple
Tumor-like hyperplasia, even pseudoepithelial neoplasia, occasionally or squamous cell carcinoma. However, in some cases, the epidermis can be atrophied and thinned due to infiltration in the dermis, and even ulceration can be formed, and purulent can be caused by secondary infection, so that many neutrophils, eosinophils and other suppurations are found in the infiltration. Sexual bacteria.
In the pathological tissues of lupus erythematosus, although there may be the presence of Mycobacterium tuberculosis, it is not easy to be found, and even culture and animal vaccination cannot be often successful.
Prevention
Lupus prevention
Precautionary principle: It is mainly to mobilize the masses, vigorously publicize the prevention and treatment knowledge of tuberculosis, conduct regular health checkups, early diagnosis, early treatment, eliminate infection sources, eliminate infection routes, carry out BCG vaccination, and enhance the body's resistance.
Complication
Lupus complication Complications
Often due to scar contraction to form a variety of deformities, such as mouth slanting, eyelid valgus, nose such as knife cutting, small mouth, small eyes or joint stiffness, knuckles broken.
Symptom
Common lupus symptoms Common symptoms Weak knots contracture scar nodules valgus joint stiffness
The basic damage is the lupus nodules from miliary to pea, reddish brown to tan, translucent, soft to the touch, slightly raised on the leather surface, the surface of the nodule is thin and tender, and when probed, a little force can be used. Piercing, easy penetration and bleeding (probe penetration phenomenon). If you use a glass slide to reduce the local congestion, the nodules are more obvious, pale yellow or yellowish brown, such as apple paste color, so it is also known as "apple sauce nodule", sometimes many nodules merge with each other to form a large reddish brown infiltration Sexual damage, diameter up to 10 ~ 20cm, the surface is uneven, soft to touch, covered with large leafy scales.
In the long-term process, some damages form self-healing scars, and some nodules often ulcerate and form ulcers. When the ulcer starts, it is only seen in a part of the damage, and the whole damage can be ulcerated in the future. The ulcer has many superficial appearances, which are round or non-plastic. The surface of the ulcer is reddish brown granulation tissue, and there is a small amount of thin pus. After the pus is dried, it is thick and thick. The edge of the ulcer is not neat, the color is soft, the color is dark red, and the edge is sneak. In the process of development, the central or one side of the ulcer is cured, but the edge or the other side is continuously expanding outward, which can form a large piece of damage, and can also form a special shape such as a ring, an arc or a serpentine. The tissue is destructive, and the later it forms a high and low strip-like scar. In severe cases, the scar shrinks and deformity or dysfunction occurs. Another feature of lupus vulgaris is that the newly scarred tissue can regenerate new lupus nodules, and then ulceration, so the disease often prolonged for decades.
In addition to the above typical damage, due to the different reactivity of patients, there are several clinical types:
(1) Flat lupus erythematosus: damage to the surface is smooth, there may be a little scaly, a patchy infiltrating patch, composed of lupus nodules, and a flattened atrophic scar.
(2) proliferative lupus erythematosus: including nodular lupus, tumor-like lupus, sputum lupus, papillary lupus and the like. Such lupus are densely intertwined with lupus nodules, and there are obvious infiltrative masses or papillary proliferations of varying sizes.
(3) Ulcerative lupus: ulcers of a large area are often formed, which can be caused by the collapse of lupus nodules, and can also be caused by tuberculosis of lymph nodes, bones or other tissues under the skin.
(4) disseminated lupus: the onset of tuberculosis in the body's internal tuberculosis by the blood to the skin. The disease can be seen in children with acute infectious diseases such as measles or scarlet fever. The skin suddenly has scattered small patches of lupus nodules. The number of lesions is large and does not fuse with each other.
The most common part of lupus vulgaris is the face, which accounts for more than 50%, followed by limbs, buttocks and neck. Lupus vulgaris often causes tissue damage and damages the face, such as nasal cartilage and nasal wing destruction, the nostrils are exposed to the beak-like nose; sometimes the entire nose is destroyed, only the back of the nasal septum and the turbinate; the auricle is only damaged by the ear; the cheek and Eyelid skin is destroyed, scar contraction and eyelid valgus, rabbit eyes, etc., can lead to conjunctivitis, corneal ulcer and even blindness. Limb and neck damage can be contracted due to scar contraction, sometimes muscles, tendons or bones can be destroyed, or even (toe) falling off and deformed.
Lupus vulgaris often invades the mucosa, and mucosal damage can be primary or extended by facial lupus. Nasal mucosa and lips are more common. Nasal mucosal damage can invade the lacrimal sac and even the conjunctiva along the nasolacrimal duct. It can also extend back to the nasopharynx and can pass through the anterior sacral hole to the front of the hard palate. Pharyngeal damage can spread through the eustachian tube to the middle ear. Mucosal lupus occurs in the entire oral mucosa and lips, but due to mucous membrane moisture and other bacterial contamination, mucosal lupus can show a slightly high granulation patch, grayish white, uneven surface granular, sometimes accompanied by tiny ulcers, surface scarring . The gums can be swollen and ulcerated, and the teeth can also fall off, occasionally invading the tongue with nipple hypertrophy or painful cracks. Due to oral mucosal damage, eating disorders, resulting in malnutrition in patients.
Lupus vulgaris has no obvious symptoms, and there may be pain in the case of secondary infection. If it is not accompanied by other tuberculosis, the systemic symptoms are mild. Such re-infectious tuberculosis generally does not involve local lymph nodes.
Examine
Examination of lupus vulgaris
Pathological changes mainly occur in the dermis and can also spread to the subcutaneous tissue, which is characterized by tuberculous granuloma (tuberculous nodules), which is a granuloma composed of epithelioid cells, lymphocytes and multinucleated giant cells. It is a caseous necrosis.
Diagnosis
Diagnosis and diagnosis of lupus vulgaris
diagnosis
1. According to the characteristics of lupus vulgaris, as usual from childhood, the basic damage is apple butter-like lupus nodules, healing and scar formation after rupture, renewed new nodules on the scar, side damage, healing, etc. Combined with histopathological examination, tuberculous or tuberculous infiltration, etc., general diagnosis is not difficult.
2. Chinese medicine pathogenesis and syndrome differentiation
(1) Pathogenesis: Chinese medicine believes that the disease is mostly due to physical weakness, lack of blood, or anger and anger, and exogenous poisonous evils, dampness and stagnation of blood vessels.
(2) syndrome differentiation: skin lesions can be applied to the face, limbs, etc., local skin lesions are dark red or purple, the surface has knots, the slides do not fade after pressing, mostly in adolescents, with thin body, fatigue, anorexia, pale tongue Moss white, veins are gentle.
Differential diagnosis
1. Sarcoidosis: Nodules of sarcoidosis are more solid than lupus nodules, with infiltration, generally do not collapse, tuberculin test is negative.
2. Nodular syphilis: syphilitic nodules develop faster, can be arranged in a row, hard as cartilage, copper red, often ruptured, ulcers are pierced, after the scar, syphilis seropositive, its Pathological changes are mainly plasma cell infiltration and vascular changes.
3. Discoid lupus erythematosus: the color is bright red, the surface is attached with sticky scaly scaly, the hair follicle mouth is dilated, the inner horn is embedded, no lupus nodules and ulcers.
4. Deep mycosis: nodules often rupture, scarring, positive fungal culture, histopathology can be found in histopathology.
5. Tuberculosis-like leprosy: The nodules are slightly harder than the lupus nodules, and the sensory disturbances in the affected area are characterized by large peripheral nerves and numbness of the limbs, which may cause nutritional ulcers.
