Maloney McKenzie E, Cohen Bernard
Medical College of Georgia, Augusta University, Augusta, Georgia.
Department of Dermatology and Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
JAAD Int. 2023 May 17;12:105-111. doi: 10.1016/j.jdin.2023.05.001. eCollection 2023 Sep.
Tuberculosis (TB) is a significant health concern, affecting over 1.5 million people annually worldwide, with the incidence increasing in the United States from 2020 to 2021. The pediatric population is particularly vulnerable to TB. Extrapulmonary manifestations of TB include cutaneous tuberculosis (CTB).
There are 8 forms of CTB. Lupus vulgaris (LV) is the second most common form of pediatric CTB which presents nontender plaques or nodules with ulceration that progress to well-defined, scaly plaques. Tuberculous chancre results from exogenous inoculation and lesions contain large amounts of acid-fast bacilli (AFB). Clinically, tuberculous chancre presents as erythematous papules which form firm nontender ulcers. Tuberculosis verrucose cutis (TVC) presents as small papules surrounded by inflammation that develops into a wart-like lesion. Periorificial lesions are rare and present as painful ulcers in the oral or perineal regions. Scrofuloderma is the most common form of pediatric CTB and presents as nodules that ulcerate, forming purulent sinus tracts. Tuberculosis miliaris cutis disseminate presents as widespread papules and crusted vesicles. Metastatic abscesses present as multiple nodules that may ulcerate or form draining sinus tracts. Lastly, tuberculid forms include lichen scrofulosorum (LS), which presents as lichenoid papules which may form plaques and scale, and papulonecrotic tuberculid, which presents as necrotic papules. All forms of cutaneous tuberculosis can be treated with the standard 6-month, four-drug anti-tuberculosis treatment (ATT). Some cases of CTB may require debriding and surgical management in addition to ATT.
Determining the type of CTB can be challenging clinically. Histopathology is needed to make the diagnosis. Chest x-ray and a review of systems should be obtained for CTB patients to determine if there are other extrapulmonary manifestations of TB. All types are treated with 6 months of ATT.
结核病是一个重大的健康问题，全球每年有超过150万人受其影响，美国2020年至2021年的发病率呈上升趋势。儿童群体尤其易患结核病。结核病的肺外表现包括皮肤结核病（CTB）。
CTB有8种形式。寻常狼疮（LV）是儿童CTB的第二常见形式，表现为无压痛的斑块或结节伴溃疡，进展为边界清晰的鳞屑性斑块。结核性溃疡由外源性接种引起，病变含有大量抗酸杆菌（AFB）。临床上，结核性溃疡表现为红斑丘疹，形成坚实无压痛的溃疡。疣状皮肤结核（TVC）表现为被炎症包围的小丘疹，发展为疣状病变。口周病变罕见，表现为口腔或会阴区域的疼痛性溃疡。瘰疬性皮肤结核是儿童CTB最常见的形式，表现为结节伴溃疡，形成脓性窦道。播散性粟粒性皮肤结核表现为广泛的丘疹和结痂水疱。转移性脓肿表现为多个结节，可能发生溃疡或形成引流窦道。最后，结核疹形式包括瘰疬性苔藓（LS），表现为苔藓样丘疹，可形成斑块和鳞屑，以及丘疹坏死性结核疹，表现为坏死性丘疹。所有形式的皮肤结核病都可以用标准的6个月四联抗结核治疗（ATT）进行治疗。除ATT外，一些CTB病例可能需要清创和手术处理。
临床上确定CTB的类型可能具有挑战性。需要组织病理学来做出诊断。对于CTB患者，应进行胸部X光检查和系统回顾，以确定是否存在结核病的其他肺外表现。所有类型均采用6个月的ATT治疗。
