Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital (University of Delhi), Delhi, India.
NDMC and Hindu Rao Hospital, Delhi, India.
Int J Dermatol. 2021 Oct;60(10):1278-1284. doi: 10.1111/ijd.15737. Epub 2021 Jun 28.
Lichen scrofulosorum (LS) represents immunologic reaction to the Mycobacterium tuberculosis antigen and presents with subtle, asymptomatic, grouped follicular papules over the trunk and shows good therapeutic response to antitubercular drugs.
To study the clinical and epidemiological characteristics of patients diagnosed with LS.
A single-center retrospective review of patients diagnosed with LS from 1997 to 2018 was conducted. The data pertained to clinico-epidemiological profile, BCG vaccination, Mantoux positivity, laboratory investigations, coexistent focus of tuberculosis, and response to antitubercular treatment (ATT).
LS cases constituted 15.2% (221/1458) of all the patients diagnosed with cutaneous tuberculosis (CTB). Of these, 156 (70.5%) were pediatric patients. All patients presented with multiple follicular and perifollicular grouped papules. The trunk was the most common site involved (98.6%), followed by lower limb (25.33%), upper limb (15.83%), face (5%), and external genitalia (3.6%). Evidence of BCG vaccination and Mantoux test positivity was observed in 52.03 and 83.2%, respectively. Coexistent TB focus was detected in 134 (60.6%) patients in lymph nodes, lungs, abdomen, and unusual sites such as intracranial, endometrium, and eye. Twenty-eight patients (12.66%) had coexistent other clinical forms of CTB. Clinical diagnosis of LS was confirmed on histology that revealed chiefly periappendageal epithelioid cell granuloma. Response to ATT was good with complete resolution of lesion in 8-12 weeks.
LS appears to be an underdiagnosed entity. Subtle and asymptomatic lesions of LS are often missed, thereby necessitating a high index of suspicion and appropriate evaluation of the underlying TB focus.
蕈样肉芽肿（LS）代表对结核分枝杆菌抗原的免疫反应，表现为无症状、多发性、成群的滤泡性丘疹，主要发生于躯干，对抗结核药物治疗反应良好。
研究诊断为 LS 的患者的临床和流行病学特征。
对 1997 年至 2018 年期间在单中心确诊的 LS 患者进行回顾性分析。数据涉及临床流行病学特征、卡介苗接种、曼托试验阳性、实验室检查、并存结核病灶以及对抗结核治疗（ATT）的反应。
LS 病例占所有确诊为皮肤结核（CTB）患者的 15.2%（221/1458）。其中，156 例（70.5%）为儿科患者。所有患者均表现为多发性滤泡性和滤泡周围成群丘疹。最常见的受累部位是躯干（98.6%），其次是下肢（25.33%）、上肢（15.83%）、面部（5%）和外生殖器（3.6%）。观察到卡介苗接种和曼托试验阳性的证据分别为 52.03%和 83.2%。在 134 例（60.6%）患者中检测到共存的 TB 病灶，包括淋巴结、肺部、腹部和颅内、子宫内膜、眼睛等不常见部位。28 例（12.66%）患者共存其他临床类型的 CTB。LS 的临床诊断通过组织学证实，主要表现为围绕附属器的上皮样细胞肉芽肿。ATT 反应良好，病变在 8-12 周内完全消退。
LS 似乎是一种被低估的疾病。LS 的隐匿性和无症状性皮损常被漏诊，因此需要高度怀疑，并对潜在的 TB 病灶进行适当评估。
