Gruźlica właściwa skóry to rzadka odmiana gruźlicy o bardzo zróżnicowanym obrazie klinicznym. W zależności od objawów wyróżnia się gruźlicę skórną toczniową, brodawkującą, rozpływną i wrzodziejącą. Jak objawia się gruźlica skórna?
Zmiany skórne w przebiegu gruźlicy właściwej skóry występują na skutek bezpośredniego zajęcia skóry przez proces gruźliczy. Prątki gruźlicy przedostają się do skóry poprzez naczynia limfatyczne lub krwionośne, w rzadszych przypadkach także przez ciągłość z tkanek głębszych. W niektórych odmianach możliwe jest również zakażenie zewnątrzpochodne.
Różnorodność postaci klinicznych tej choroby jest związana z wieloma czynnikami, takimi jak rodzaj i zjadliwość prątków, ilość materiału zakażającego, wrota wejścia patogenów, umiejscowienie patogenów, stan układu immunologicznego czy odczynowość ustroju.
Gruźlica skóry ma przewlekły charakter i zazwyczaj przebiega łagodniej niż narządowa odmiana choroby.
Gruźlica toczniowa
Gruźlica toczniowa to najczęstsza odmiana gruźlicy skórnej. Charakterystycznym objawem jest guzek toczniowy, czyli żółtobrunatna lub czerwonobrunatna miękka zmiana wyniesiona ponad powierzchnię skóry. Guzki toczniowe mają tendencję do przerostu, rozpadu i zlewania się w większe ogniska. Najczęściej występują w obrębie twarzy, na kończynach, bocznych powierzchniach pośladków oraz na piersiach. Guzki goją się najczęściej z pozostawieniem blizn, które mają charakter nieostateczny (w ich obrębie tworzą się nowe zmiany) i mogą następnie ulegać transformacji nowotworowej.
Gruźlica toczniowa może występować w różnych postaciach: płaskiej, przerosłej, wrzodziejącej i brodawkującej.
Gruźlica brodawkująca
Gruźlica brodawkująca objawia się w postaci hiperkeratotycznych brodawkowatych zmian o nacieczonej podstawie, przypominających brodawki wirusowe. Zmiany występują najczęściej w obrębie rąk oraz stóp. Do zakażenia gruźlicą brodawkującą dochodzi drogą zewnętrzną. Choroba dotyka osób o wysokiej odporności na gruźlicę i silnej alergii na tuberkulinę.
Gruźlica rozpływna
W przebiegu gruźlicy rozpływnej w tkance podskórnej tworzą się guzy, które następnie ulegają rozmiękaniu przebijają się ku wierzchnim warstwom skóry, tworząc przetoki i owrzodzenia. Zmiany goją się nierównomiernie, z pozostawieniem mostkowatych, rozciągniętych blizn. Najczęściej występują pod żuchwą, w okolicy nad obojczykiem i w obrębie mostka.
Ta odmiana gruźlicy skóry występuje u osób z wysoką odpornością przeciwgruźliczą. Gruźlicę rozpływną stwierdza się u chorych na gruźlicę węzłową oraz kostno-stawową.
Gruźlica wrzodziejąca
W przebiegu gruźlicy wrzodziejącej zmiany występują w obrębie błon śluzowych. Mają postać owrzodzeń o miękkiej podstawie bez nacieków. Dno owrzodzeń jest pokryte guzkami. Ta odmiana gruźlicy skóry jest często powiązana z gruźlicą płuc. Najczęściej dotyczy pacjentów w immunosupresji.
Źródło:
- M. Malek, D. Kozicka, I. Michajłowski, J. Roszkiewicz, „Gruźlica skóry — trudna diagnoza w praktyce dermatologicznej”, „Forum Medycyny Rodzinnej” 2012, 6(1): 43-49.
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