TUBERCULOSIS EFFECTS ON SKIN

Mycobacterium tuberculosis is the organism which causes skin tuberculosis. It is found in the discharges like sputum, faeces, urine or pus from the lesions of the infected cases or animals. The organism is implanted directly on the skin or enters the body either via respiratory system or through the gastro-intestinal tract and reaches the skin through the stream or through contiguous spread. Poverty, overcrowding, lack of hygiene and malnutrition increase the risk of acquiring the infection.

CLINICAL FEATURES:

The clinical picture in an individual depends upon the mode of infection of the skin and state of specific hypersensitivity. Thus tuberculosis of the skin manifests in the following forms:

TUBERCULAR CHANCRE

It occurs when Mycobacterium tuberculosis gets implanted into the skin of an individual who has never been exposed to Mycobacterium tuberculosis before and thus has no hypersensitivity to tuberculin. It is very rare and manifests as a non-descript brownish, painless nodule which breaks down in a week's time to form a ragged ulcer with undermined edges and a haemorrhagic base. It is usually found on the exposed parts of the body. Regional lymph nodes are invariably enlarged. The lesion generally heals spontaneously in a month's time.

LUPUS VULGARIS

This is the commonest form of skin tuberculosis and occurs in a person with moderate to high degree of immunity to Mycobacterium tuberculosis. It manifests as a single, occasionally multiple, erythematous, irregular indurated plaque(s)  which may be ulcerated in some areas and healing with scar formation in other areas. The scars are usually thin, white and smooth but are unstable. The lesion slowly extends irregularly at the periphery. Occasionally the lesion is more verrucous and dry or comprises several large soft nodules arranged in an annular fashion. Such nodules look like apple-jelly nodules on diascopy. The lesion is usually situated on the exposed parts of the body like face, arms and legs. The face is the most favoured site of involvement. Occasionally it may be present on the buttocks, groins, shoulders, trunk and even on the glans penis. When the lesion is present on the face, it may destroy the adjoining area like nose, eyelid and pinna. Carcinoma may develop in a long standing lesion of lupus vulgaris.

TUBERCULOSIS VERRUCOSA CUTIS

This is also known as warty tuberculosis due to the warty nature of its lesion. It is very similar to the lesion of lupus vulgaris except that it is more verrucous and usually situated on the dorsum of the hand or feet. Sometimes it may also be seen on knees, ankles and buttocks. When the lesion is only a warty papule, it is distinguished from common wart by the presence of erythema around it.

SCROFULODERMA

It results from rupture of the skin from the underlying tubercular infection of lymph glands, bones or joints. The lesion consists of single or multiple sinuses with undermined edges which thin yellow pus and are located at the site of lymph nodes, bones or joints. Sometimes the lesions of lupus vulgaris develop around the sinus due to the implantation of Mycobacterium tuberculosis in the adjoining area. Scarring of the lesion produces an irregular mass adherent to underlying structure. Pus discharge from the sinuses contains abundant Mycobacterium tuberculosis.

TUBERCULOSIS CUTIS ORIFICIALIS OR TUBERCULOSIS ORIFICIAL

It is due to direct inoculation of Mycobacterium tuberculosis on the oral, anal or uro-genital mucosae of the patient suffering from tuberculosis of lung, gastro-intestinal tract or kidney respectively. It consists of multiple painful shallow ulcer with undermined edges present in the mouth, around anus and on the genitalia. It occurs usually in patient with advanced tuberculosis and is very rare.

TUBERCULIDES

This term is used to describe a group of lesions which occur in response to tubercular foci present internally and clear with anti-tubercular treatment

PAPULO-NECROTIC TUBERCULIDES

It results from the haematogenous spread of Mycobacterium tuberculosis from a tubercular focus in the body; in an individual with moderate to high degree of hypersensitivity. The primary tubercular focus is usually not clinically active at the time of eruption. The lesion consists of sudden appearance of erythematous papules which become necrotic in the centre within a few days. Subsequently these necrotic papules become crusted and heal leaving behind hyperpigmented and pitted scars in a course 2-3 weeks. New crops of lesions may keep on recurring for a few months to years. of The lesions are more or less symmetrically scattered all over the body more so on the extremities.

LICHEN SCROFULOSORUM

It is also due to haematogenous spread of Mycobacterium tuberculosis from a tubercular focus elsewhere in the body. The lesions are usually found on the trunk of young children in the form of asymptomatic multiple groups of small skin coloured papules. Occasionally mild scales are present. The lesions persist for variable periods and heal slowly over a period of months without scarring.

HOMOEOPATHIC TREATMENT:

The homeopathic medicine for tuberculosis are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition.

The symptoms listed against each medicine may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy. To study any of the following remedies in more detail, please visit our Materia Medica section. None of these homeopathic medicine for tuberculosis should be taken without professional advice.

Sulphur: Is best adapted to the early stages of phthisis when there is an increase of blood to the chest, beginning dullness over the apices of the lungs on percussion and diminished chest motion. The guiding symptoms are hot feeling of the body, desire for air, flushes of heat and pain from the left nipple through to the back. The cough is mostly dry, worse in the evening, excited by talking, with occasional profuse discharges of mucus; there are profuse night sweats and the perspiration is offensive; there is emaciation, weakness and languor and burning of the soles and palms. Dry, scaly, unhealthy; every little injury suppurates.  Itching, burning; worse scratching and washing. Feeling of a band around bones. Skin affections after local medication. Pruritus, especially from warmth, is evening, often recurs in spring-time, in damp weather.

Arsenicum: Is another remedy that must be used cautiously in tuberculosis. The fevers, sweats, diarrhoea, dyspeptic symptoms and debility make it similar in general to phthisis. The symptoms calling for its are these : Utter prostration, emaciation, thirst, hectic, oppressed breathing and sharp pains, darting in character and aggravated by motion. The cough is worse at night on lying down and in the morning on rising; the paroxysms of cough are long and lasting and ushered in with dyspnoea. The expectoration is profuse, greenish and salty, there is throughout much apprehensive anxiety. Itching, burning, swellings; śdema, eruption, papular, dry, rough, scaly; worse cold and scratching. Malignant pustules. Ulcers with offensive discharge

Arsenicum iodide: Is very closely allied to tubercular manifestations. Profound prostrations, rapid irritable pulse, recurring fevers and sweats. Emaciation and tendency to diarrhoea indicate it. Patient is cachectic; hacking cough; cavities; hectic fevers, night sweats; great debility. Dry, scaly, itching. Marked exfoliation of skin in large scales, leaving a raw exuding surface beneath. Ichthyosis. Enlarged scrofulous glands. Debilitating night-sweats.

Silicea: A deep remedy for eradicating the tuberculous tendency when symptoms agree. Worse in wet, cold weather, better in dry, cold weather, but very chilly. Tendency to swellings of glands, which suppurate. The Silica child is timid, lacks confidence. Head sweats in sleep. Sweat of feet, often offensive feet.

Tuberculinum: Patient with T.B. family history, or with T.B. manifestations, glands, etc. A deep-acting, long-acting remedy. Always wanting to go somewhere-to travel. Feeble vitality: tired: debilitated: losing flesh. Emaciation, with hunger. Worse in a close room, in damp weather; better cold wind, open air. Desire for alcohol, bacon, fat ham, smoked meat, cold milk, refreshing things, sweets. Painless swelling of glands. Rose-colored blotches. Scars suddenly become painful. Pus offensive. Promotes expulsion of foreign bodies from tissues. Every little injury suppurates. Eruptions itch only in daytime and evening.

Phosphorus: Phosphorus helps to cure not only bone troubles, but “Scrofulous glands”, but always in the typical slender Phosphorus children, who grow too rapidly: delicate, waxy, anaemic. Bruise easily: easy bleeders: with Thirst for cold water, hunger for salt: love of ices: Are nervous alone-fear the dark, rather apathetic and indifferent.

Iodum: Scrofulous swellings and induration of glands: large, hard, usually painless. “Iodine is torpidity and sluggishness. The very indolence of the disease suggests Iodium” Cross and restless. Impulses. Anxiety: the more he keeps still, the more anxious. Always feels too hot. Eats ravenously yet emaciates. Dark hair and complexion. “Enlargement of all the glands except the mammae: these waste and atrophy.”