Fenniche S, Ben Jennet S, Marrak H, Khayat O, Zghal M, Ben Ayed M, Mokhtar I
Service de Dermatologie, Hôpital Habib Thameur, 8, rue Ali Ben Ayed, Montfleury, Tunis, Tunisie.
Ann Dermatol Venereol. 2003 Nov;130(11):1021-4.
Despite prevention programs, tuberculosis is still progressing endemically in developing countries. The prevalence of cutaneous tuberculosis is estimated as 2.1 p. 100 and represents a rare localization among the extra-pulmonary forms. In order to study the epidemiology, the most frequent anatomoclinical forms and the progressive features of cutaneous tuberculosis, we conducted a study in the area of Tunis over a 20-year period.
All cases of cutaneous tuberculosis observed between 1981 and 2000 in the dermatology department of the Habib Thameur hospital were included in a retrospective study. Diagnosis of cutaneous tuberculosis was challenging and required the correlation of clinical, biological and progressive features.
Twenty-six patients were observed in the study. There were 12 men and 14 women with a mean age of 30.4 years (range: 6-74) and 20 p. 100 of infantile cases. Of the various patterns of cutaneous tuberculosis seen, 11 (42 p. 100) had lupus tuberculosis, 10 (38 p. 100) had scrofuloderma, 4 (15 p. 100) had tuberculosis verrucosa cutis and 1 child had a perianal tubercular ulcer. The Mantoux test was positive in 20/24 patients. Histological tuberculoid granuloma was seen in 25 cases (96 p. 100) associated with caseating necrosis in 10 cases (38 p. 100). All patients were treated successfully with triple or quadruple anti-tubercular drugs for 6 to 10 months. One patient exhibited a squamous cell carcinoma on a lupus tuberculosis scar four years later.
The progression of cutaneous tuberculosis remains stable, ranging from 1.4 cases/year between 1981 and 1990 to 1.2 cases/year between 1991 and 2000. In our study, females were slightly more affected than men with a M/F sex ration of 0.86. Before 1984, scrofuloderma was the most frequent form among the cutaneous tuberculoses. Now the frequency of lupus tuberculosis has reached that of scrofuloderma, demonstrating the increase in the incidence of clinical pattern of cutaneous tuberculosis with strong immunity probably related to the improvement in health conditions and generalization of vaccination programs.
尽管有预防项目，但结核病在发展中国家仍呈地方性流行态势。皮肤结核的患病率估计为2.1/100，在肺外结核形式中是一种罕见的发病部位。为了研究皮肤结核的流行病学、最常见的解剖临床形式及进展特征，我们在突尼斯地区进行了一项为期20年的研究。
纳入哈比卜·塔默尔医院皮肤科1981年至2000年间观察到的所有皮肤结核病例进行回顾性研究。皮肤结核的诊断具有挑战性，需要临床、生物学及进展特征之间的相互关联。
本研究共观察到26例患者。其中男性12例，女性14例，平均年龄30.4岁（范围：6 - 74岁），婴儿病例占20/100。在所见的各种皮肤结核类型中，11例（42/100）为狼疮样结核，10例（38/100）为瘰疬性皮肤结核，4例（15/100）为疣状皮肤结核，1例儿童患有肛周结核性溃疡。24例患者中20例结核菌素试验呈阳性。25例（96/100）可见组织学上的结核样肉芽肿，其中10例（38/100）伴有干酪样坏死。所有患者均用三联或四联抗结核药物成功治疗6至10个月。4年后，1例患者在狼疮样结核瘢痕处出现鳞状细胞癌。
皮肤结核的发病情况保持稳定，从1981年至1990年的1.4例/年降至1991年至2000年的1.2例/年。在我们的研究中，女性受影响略多于男性，男女比例为0.86。1984年前，瘰疬性皮肤结核是皮肤结核中最常见的类型。如今狼疮样结核的发病率已达到瘰疬性皮肤结核的发病率，这表明可能与健康状况改善和疫苗接种计划普及相关的、具有较强免疫力的皮肤结核临床类型发病率有所增加。
