雷公藤多甙片在颜面粟粒性狼疮治疗中的应用

颜面粟粒性狼疮(LMDF)以面部淡红或褐红色的结节性损害为特征,皮损多侵犯眼睑、颊部、前额以及口周区域;其组织病理与结核相似,故曾认为本病系一种皮肤结核,但抗结核治疗多无效.     

抗结核药物口服和局部注射治疗寻常狼疮80例疗效观察

目的探讨口服抗结核药物联合局部注射异烟肼加地塞米松治疗寻常狼疮的临床疗效。方法 80例皮肤结核患者随机分成注药组(n=40)及对照组(n=40),注药组给予异烟肼注射液0.1 g(2 mL)、地塞米松针2 mg及适量2%利多卡因注射液(约1 mL)配成溶液,多点注射于寻常狼疮处,每周注射1次,同时给予利福平胶囊0.45 g/d、乙胺丁醇片0.75 g/d、比嗪酰胺1.5 g/d口服。对照组只给口服药物。结果 1个疗程结束后,注药组25例痊愈,治愈率为62.5%,有效率为87.5%;对照组10例痊愈,治愈率为25.0%,有效率为57.5%。2组治愈率比较差异有统计学意义(χ~2=5.71,P0.05);2组有效率比较差异有统计学意义(χ~2=4.51,P0.05)。结论口服抗结核药物联合局部注射治疗寻常狼疮所需时间短,治愈率高,避免了长期联合用药对肝肾功能的影响。是一种安全、有效、经济、简单易行的治疗措施,值得临床推广。     

12例寻常狼疮临床分析

【摘要】 目的 探讨12例寻常狼疮患者临床特点及治疗。 方法 对12例确诊为寻常狼疮患者的临床特点、组织病理、误诊原因、治疗及转归情况等进行分析。 结果 12例中83.3%发病前有局部外伤史。所有患者发病早,病程长,多数无明显自觉症状,皮损形态多样,首诊均被误诊,经组织病理、结核菌素纯蛋白衍化物试验、抗酸染色、结核杆菌培养、DNA测序等检查明确诊断。经规范抗结核治疗后预后均良好。 结论 临床医生应加强对寻常狼疮的认识,通过组织病理、培养等检查可确诊。     

寻常狼疮2例

寻常狼疮是皮肤结核中最常见的类型,约占所有皮肤结核患者的半数。本病易侵犯儿童和青少年,好发于面部,影响容貌。我们用异烟肼、乙胺丁醇和利福平联合治愈寻常狼疮2例,报告如下。     

寻常狼疮误诊1例

报告1例寻常狼疮误诊患者,具有典型苹果酱样的狼疮结节和组织病理改变,结核菌素试验(PPD)强阳性,临床上给予抗结核短程三联疗法治疗,1个月后治疗效果满意,目前仍在治疗随访中。     

扁平寻常狼疮1例

报告1例扁平寻常狼疮。患者男,82岁。因"左下颌暗红斑片1年余"就诊。皮肤科检查:左下颌见一大小约8 cm×5 cm暗红色斑片,表面平滑,上覆少许细薄鳞屑,无破溃,边界尚清,触之有轻度浸润感。皮损组织病理:表皮变薄,真皮内见大量由上皮样细胞组成的结核样结节,其中见较多朗格汉斯巨细胞,外周较多淋巴细胞浸润。特殊染色:抗酸染色阳性。分支杆菌培养:见抗酸杆菌生长。PPD皮试强阳性,结核干扰素释放实验(T-SPOT)阳性。结合临床表现、实验室检查结果及组织病理,诊断:扁平寻常狼疮。患者予异烟肼和利福平二联抗结核治疗6个月,临床治愈,随访4个月无复发。     

右上肢带状寻常狼疮一例

患者，男，18岁。右手背至前臂伸侧带状分布暗红斑、丘疹9个月。皮损组织病理示真皮上部可见较多上皮样细胞、淋巴细胞和多核巨细胞浸润形成结核样肉芽肿。诊断：寻常狼疮。治疗：给予标准四联抗结核 (异烟肼0.3 g/d，利福平0.45 g/d，吡嗪酰胺1.25 g/d，乙胺丁醇0.75 g/d)，6个月后皮损大部分变平、消退。     

银屑病样结核性狼疮

结核性狼疮在本世纪初是最常见的皮肤结核病,自有效的抗结核药物问世以来,不但严重的残毁型消失,且已成为少见病。其在皮肤结核中的比例在革命以前占75%,到1971～1976年占27.5%,减少了3倍。20世纪初俄国仅结核性狼疮就有15～20万人,到1972年在俄罗斯联邦共和国所有各型皮肤结核仅5千人。因近年来本病少见,故临床常误诊。据俄国结核研究所的资料,49.8%的结核性狼疮在发病5年后确诊,24%病例经20年才确诊。据列宁格勒狼疮病院的资料1975～1982年期间,在第一年确诊为皮肤结核的仅占4.8%～31.8%。     

右上肢寻常狼疮1例

寻常狼疮是皮肤结核中最常见的类型,约占皮肤结核的50％-75％.目前本病虽然少见,但应加以重视,现我科诊治1例报道如下。     

PCR技术在皮肤结核诊断中的作用

采用ＰＣＲ技术对６８例皮肤结核及相关疾病进行结核杆菌基因扩增，结果寻常狼疮１９／２１例为阳性，疣状皮肤结核５／５例阳性，颜面粟粒性狼疮１／２３例阳性，而硬红斑均为阴性，结显示ＰＣＲ是皮肤结核一种快速、简便及敏感性高的诊断方法。     

Cutaneous tuberculosis in Blackburn district (U.K.): a 15-year prospective series, 1981–95

Data collected prospectively on all 1065 cases of tuberculosis occurring in the Blackburn district, U.K. (population 265.000), over a 15-year period have been analysed, and from these 47 cases of cutaneous tuberculosis have been identified. The most common form was scrofuloderma, skin involvement with adjacent structural disease, of which there were 2b cases (55. 3%). There was no ethnic bias in this group. The eight white patients with scrofuloderma were of average age 66 years, and are thought to represent reactivation disease.Six palients (12.8%) had lupus vulgaris, four (8.5%) had metastatic tuberculosis and 10 (21.3%) were diagnosed as having one of the tuberculides, of which Bazin's disease (erythema induratum) was the most common. In addition, one patient (2.2%) had orificial tuberculosis. In contrast to scrofuloderma. all other forms of cutaneous tuberculosis occurred almost exclusively in patients from the Indian Subcontinent (ISC).The high incidence of tuberculosis in Blackburn is mainly linked to its significant proportion of residents of ISC ethnic origin. There were no cases of HIV infection coexisting with either cutaneous or other forms of tuberculosis. Recommendations for the treatment of cutaneous tuberculosis are made.     

Epidemiology of cutaneous tuberculosis in Japan: a retrospective study from 1906 to 2002

BACKGROUND: Interest in tuberculosis has recently been revived, especially in association with the onset of acquired immunodeficiency syndrome (AIDS). In Japan, the incidence of tuberculosis has declined since the 1950s, but has shown a tendency to increase in the past 10 years. METHODS: To determine the patterns of prevalence of cutaneous tuberculosis in Japan, data for cutaneous tuberculosis cases recorded between 1906 and 2002 were obtained from the dermatologic clinic of Kyushu University Hospital. The population of tuberculosis-infected patients was stratified into groups encompassing 10-year periods. Each patient group was then classified as having true tuberculosis or tuberculid, as well as being classified by gender. The total number of patients with cutaneous tuberculosis analyzed was 1324. RESULTS: The incidence of cutaneous tuberculosis, both true tuberculosis and tuberculid, decreased between 1906 and 1935, increased between 1936 and 1955, and decreased again from 1955. The incidence of true tuberculosis was higher than that of tuberculid between 1906 and 1925. The incidence rates of true tuberculosis and tuberculid were equal from 1926 to 1945, and since 1946 the incidence of tuberculid has been higher than that of true tuberculosis. The incidence of tuberculid decreased between 1986 and 1995, but showed a dramatic increase between 1996 and 2000. The frequency of cutaneous tuberculosis was highest in the 10-49 year age group before 1980, but since 1981 has been highest in groups over 40 years of age. CONCLUSIONS: The incidence of cutaneous tuberculosis in Japan is decreasing and shows a shift towards older generations. However, there is an increase in the incidence of tuberculid, especially in elderly female patients.     

Skin tuberculosis in children: learning from India

Cutaneous tuberculosis in children is a major health problem in India. It accounts for about 1.5% of all the cases of extrapulmonary tuberculosis. Scrofuloderma and lupus vulgaris are the two most common forms of tuberculosis. However, the trend in the pattern of cutaneous tuberculosis is changing, as the tuberculid, lichen scrofulosorum, has become more common in recent years. Overall, the clinical patterns are comparable with adults. However, children can have widespread and severe involvement because many unusual and uncommon patterns are known to occur in children. Underlying systemic involvement is more common in children, compared with adults.     

Panniculitis in tuberculosis: a clinicopathologic study of nodular panniculitis associated with tuberculosis

Background Certain types of panniculitis, erythema induratum of Bazin and erythema nodosum, have been well documented as tuberculids. Many histopathologic diagnoses of panniculitis have been reported in tuberculosis patients. This study investigates the correlation between underlying tuberculosis and clinicopathologic findings of panniculitis.
Methods We retrospectively reviewed the clinical files of histologic-proven panniculitis cases at the Dermatologic Clinic, Siriraj Hospital from January 1992 to December 1995; only cases with active tuberculous foci were analyzed.
Results The incidence of panniculitis caused by tuberculosis was 8.2%. The ratio of men to women was 1 : 1. The mean age of onset was 35.3 years. The average duration of the nodules was 35.5 days. There was a history of contact tuberculosis in 16.6%. Constitutional symptoms and a strongly positive purified protein derivative (PPD) reaction were found in 66.6%. Chest roentgenograms were abnormal in 83.3%. The erythrocyte sedimentation rate was elevated in all tested cases. The histopathologic diagnoses were nodular vasculitis (33.3%), erythema nodosum (50%), and cutaneous periarteritis nodosa (16.4%). The panniculitis lesion responded to standard antituberculous regimens in 4.6 weeks, on average, with residual hyperpigmentation.
Conclusions In panniculitis patients, clues for the investigation of tuberculosis included constitutional symptoms, elevated erythrocyte sedimentation rate, and abnormal chest roentgenograms. Histopathologic changes of panniculitis did not seem to correlate with underlying tuberculosis. The clinician should be aware of the tuberculosis, however, and should carefully search for active foci in all panniculitis patients.     

疣状皮肤结核患者皮损中结核杆菌DNA的检测

本文采用PCR技术，对10例病史2年以上的疣状皮肤结核患者皮损进行了结核杆菌DNA检测，结果显示10例患者1例阳性，而作为阳性对照的4例淋巴结结核组织3例阳性，2例正常组织均为阴性。从而说明疣状皮肤结核后期组织结核菌极少或无有。     

Chronic macrocheilia: a clinico-pathological study of 28 patients

Chronic macrocheilia has a multifactorial aetiology and is often a diagnostic and therapeutic challenge. Epidemiological information on this condition is scarce, most of the data reported relating only to granulomatous cheilitis. We have performed a detailed clinico-pathological analysis of all patients with chronic macrocheilia presenting to us during the last 6.5 years. Of the 28 patients identified, 13 (46.4%) had granulomatous cheilitis (GC), six (21.4%) had tuberculosis of the lip, three (10.7%) had leprous macrocheilia, two (7.1%) had multiple endocrine neoplasia type IIb, and one each had Ascher's syndrome and non-Hodgkin's lymphoma. Two patients were diagnosed as 'nonspecific cheilitis'. Histopathological differentiation between tuberculosis and GC was often not possible; but PCR for Mycobacterium tuberculosis was positive in all patients with tuberculosis and negative in four patients with GC in whom M. tuberculosis was sought. In spite of detailed clinical examination and investigations, a therapeutic trial was required to confirm the diagnosis in five (17.9%) patients. We have reviewed the available literature on this subject, and to our knowledge this study is the first of its kind. More such studies from other centres will help physicians to make an accurate aetiological diagnosis and treat this uncommon but disfiguring condition with confidence.     

Incidence of cutaneous tuberculosis in patients with organ tuberculosis

BACKGROUND: Tuberculosis continues to be a health problem in some countries. The development of resistance to antituberculitic drugs and the increase in diseases and conditions associated with immunodeficiency such as AIDS and chemotherapy have caused tuberculosis to increase recently. As a result, the incidence of cutaneous tuberculosis has been increasing as well. AIM: To detect cutaneous tuberculosis in patients with organ tuberculosis and to establish some characteristics of the relation between organ and cutaneous TB. MATERIAL AND METHODS: A total of 370 patients (145 females and 225 males), aged 2-76 years (mean age 27.5), enrolled for this screening study. These patients were hospitalized patients who already had pulmonary or extrapulmonary tuberculosis diagnosed before admission. All patients underwent a general skin examination, and, if needed, cutaneous biopsies were taken from involved skin areas. RESULTS: Three hundred and forty-seven (93.78%) out of 370 patients had pulmonary tuberculosis only or in association with one of other organ tuberculoses. Twenty-three patients had extrapulmonary TB: nine were TB adenitis, six were TB peritonitis, three were bone tuberculosis, and five were TB meningitides. Of 370 patients, only 13 (3.51%) had cutaneous TB: seven scrofuloderma (SCD; 2.16%), four lupus vulgaris (LV; 1.35%), one LV and SCD, and one Bacille Calmette-Guerin (BCG) adenitis (0.027%). Cutaneous tuberculosis was observed in seven out of 260 patients with parenchymal tuberculosis (2.96%). Four out of nine patients with TB adenitis (44.4%), one out of 12 pulmopleuretic (8.3%), and one out of 67 pleuresic patients (1.40%) had cutaneous TB as well. Mean age of the 13 patients was 32.46 years: mean age of SCD and LV was 24.8 and 48 years, respectively. The one patient with BCG adenitis was 7 months old. Five (62.5%) out of eight patients with SCD, and only one (20%) out of five patients with LV were new cases. Four patients with SCD had a positive family history, while LV patients did not. CONCLUSIONS: Organ tuberculosis is rarely associated with cutaneous tuberculosis. Scrofuloderma and LV are the most frequent forms of skin TB associated with organ TB in this population. Tuberculosis adenitis is the organ TB that causes cutaneous TB most often among other organ tuberculoses. More than one form of cutaneous TB affected only one patient with pulmonary TB; therefore, it is very rare. Tuberculids were not observed in any of the patients.     

Mycobacterium tuberculosis infection in psoriatic patients treated with biologics: Real-world data from 18 Japanese facilities

Although rare, tuberculosis has been reported with biologic treatment against psoriasis in Japan, a tuberculosis medium-burden country. Mycobacterial infection often develops after a long incubation period and might not have been adequately identified in clinical trials or post-marketing surveillance. To determine the real-world incidence of tuberculosis in psoriatic patients treated with biologics, we conducted a retrospective, multicenter, observational study in 18 facilities in Western Japan. Psoriatic patients who visited a participating facility between 2010 and March 2017 and received biologic reagents were enrolled. Information on sex, age at first biologic treatment, results of interferon-γ release assay (IGRA) for Mycobacterium tuberculosis, treatment history with isoniazid, and onset of active and/or latent tuberculosis was collected. A total of 1117 patients (830 men and 287 women) were enrolled. The mean duration of biologic treatment was 3.54 years. Sixty-five patients (5.8%) showed positive IGRA results at screening. Active tuberculosis developed in two patients after the administration of tumor necrosis factor inhibitors (both involved miliary tuberculosis). Latent tuberculosis was observed in two patients treated with anti-interleukin-12/23p40 antibody. The incidence rate of tuberculosis, including latent tuberculosis, in this survey was 0.36%. Although the incidence rate of tuberculosis was low considering the observation period of biologic treatment, active tuberculosis was found in both the screening-negative group and a screening-positive subject after isoniazid prophylaxis (both miliary tuberculosis), concluding that negative screening or isoniazid treatment does not always assure that an individual has no tuberculosis. Hence, dermatologists still need to pay careful attention to tuberculosis at every patient visit.     

Lupus vulgaris: report of two cases

Although there has been a steady decline in the incidence of tuberculosis in recent years, it persists in some regions, and where AIDS is especially prevalent, the number of new cases has been increasing. Thus, cutaneous tuberculosis has re-emerged in areas with a high incidence of HIV infection and multidrug-resistant pulmonary tuberculosis. Lupus vulgaris has been and remains the most common form of cutaneous tuberculosis. Cutaneous manifestations of disseminated tuberculosis are unusual, being seen in less than 0.5% of cases. Scrofuloderma, tuberculosis verrucosa cutis and lupus vulgaris comprise most cutaneous tuberculosis cases. Bacillus Calmette-Guerin (BCG) is derived from an attenuated strain of Mycobacterium bovis and is employed beneficially as a relatively safe vaccination in Poland and other countries in which the prevalence of tuberculosis is high. However, BCG vaccination may produce complications, including disseminated BCG and lupus vulgaris, the latter seen in one of our two patients in whom lupus vulgaris at the inoculation site followed a second vaccination with BCG 12 years after the initial one. A similar phenomenon has been described after immunotherapy with BCG vaccination. Re-infection (secondary) inoculation cutaneous tuberculosis may also occur as a result of BCG vaccination, producing either lupus vulgaris or tuberculosis verrucosa cutis, probably depending upon the patient's degree of cell-mediated immunity. However, most lupus vulgaris cases are not associated with vaccination with BCG, as occurred in our first patient. For those who do develop lupus vulgaris, it can be persistent for a long period, in some cases for many decades. In the second patient we describe a lengthy duration and cutaneous reactivation at distant sites after more than 40 years.     

Polymerase chain reaction based detection of Mycobacterium tuberculosis in tissues showing granulomatous inflammation without demonstrable acid-fast bacilli

BACKGROUND: Cutaneous tuberculosis is especially difficult to distinguish from other granulomatous dermatoses. We used polymerase chain reaction (PCR) to evaluate the incidence of cutaneous tuberculosis and atypical mycobacterial infection in formalin-fixed, paraffin-embedded tissues with unspecified granulomatous inflammation and negative results for acid-fast bacilli (AFB), and analyzed the pattern of cutaneous tuberculosis in this group of patients. METHODS: A total of 38 specimens which had been collected from 36 patients and fulfilled the criteria for tissues described above were used in this study. Two different primer pairs targeting the gene encoding for 16S ribosomal RNA (common to all mycobacteria) and the insertion sequence IS6110 (specific for M. tuberculosis complex) were used in the PCR assays. The clinical characteristics, histopathologic findings, and culture results of the patients were also analyzed. RESULTS: Four specimens were excluded from the analysis due to the lack of internal control testing. Of the remaining 34 specimens, 22 were PCR positive for the 16S rRNA gene. Among them, 18 specimens were PCR positive for both the 16S rRNA gene and IS6110. Cutaneous tuberculosis could be diagnosed in these 18 cases (56.2%). Out of the 18 cases, there were 8 women and 10 men. The age range was 15-77 years (mean: 44.2 years). After reviewing their clinical presentation, 11 cases were considered as tuberculosis verrucosa cutis, 6 cases as lupus vulgaris, and 1 case as erythema induratum. The remaining 4 cases (12.5%) positive only for 16S rRNA gene were considered as possible atypical mycobacteria infection. CONCLUSIONS: These results show that in paucibacillary form of cutaneous tuberculosis with unclassical clinical and histological presentation, this PCR system provides rapid and sensitive detection of M. tuberculosis DNA in formalin-fixed, paraffin-embedded specimens. Cutaneous tuberculosis represents a significant proportion in specimens showing granulomatous inflammation. In areas like Taiwan, where prevalence of pulmonary tuberculosis is still high, tuberculosis verrucosa cutis and lupus vulgaris are common forms of cutaneous tuberculosis and are seen more frequently than atypical mycobacterial infection.