Folliculitis (a3100)

FOLLICULITIS (folliclis, tbc cutis papulo-necro-tica, acnitis, papulo-necrotic tbc of the skin, papulo-necrotic tuberculid of Darier), a chronic, often recurring disease of the skin, occurring predominantly in young age, mainly on the extensor surfaces of the limbs, in the form of nodules showing a tendency to central necrosis with the formation of characteristic pit-like scars. The name F. for papulo-necrotic tbc of the skin, given by Barthélemy, who identified it as an independent nosological form, is not quite appropriate. Previously it was assumed that the process originates from the hair follicles and hence the name folliculitis. The morphological elements—pink, dense nodules the size of a hemp seed—are located in the upper layers of the dermis. Over the course of several days their color changes and they acquire a bluish or yellowish-brown color, protruding in the form of flat or hemispherical papular formations, in the center of which what appears to be a pustule appears. However, no purulent discharge is obtained upon puncture, while upon pressure a viscous necrotic mass is found. In their further evolution, the elements dry in the center into dark brownish or dirty-gray crusts, incrusted into the dermis; after their removal, round, sometimes easily bleeding ulcers with vertical edges remain, leaving behind smooth, round, depressed scars surrounded by a pigmented border of bluish-crimson color. Over time, the pigmentation disappears and the scars become completely white. The evolution of the efflorescences takes on average 5-6 weeks, and during this time they go through all stages of development; usually during this period new eruptions occur in separate outbreaks, which undergo similar changes. The favorite localization is the back of the hands, feet, fingers, knee and elbow joints, the back of the thighs and shoulders, buttocks, less often the auricles, nose and cheeks. The elements are arranged without any order, sometimes in groups, in rings, mostly focally, but they can also merge. In addition to these superficial elements, deeper lying tuberculides (nodules) may also occur, originating from the deep layers of the dermis and subcutaneous tissue. Subjective disorders are minimal or absent. The general condition is almost undisturbed. The disease is characterized by a chronic benign course. Eruptions can occur periodically over many years. Exacerbations most often occur in spring or autumn. Histological changes consist of coagulation necrosis, based on which there is damage to the vessels, causing disruption of blood supply to the tissues. According to Philippson and Tereb (Philippson, Tereb), the deep veins of the dermis are primarily affected (endophlebitis with proliferation of the intima and thrombosis). Often there are signs of banal inflammation with a scattered lymphocytic infiltrate. In a number of cases, epithelioid giant-cell nodules can be established in the thickness of the skin. ETIOLOGY. F. and acne (i.e., the large-nodular form of papulo-necrotic tbc), which sometimes appear in patients along with tbc of bones or lymph glands, depend on the presence of Koch's bacilli in the skin, which has been proven by bacterioscopic examinations, positive experimental inoculations to guinea pigs (Gougerot) and biological tests (focal reaction to the introduction of tuberculin). The toxins of the tubercle bacillus are carried to the skin hematogenically from the affected focus in the visceral organs. PROGNOSIS: F. in adults does not directly threaten life, but in small children as a manifestation of tuberculous infection it presents considerable danger. - TREATMENT: general strengthening (arsenic, iron, cod liver oil): rational nutrition, careful irradiation with a mercury-quartz lamp, improvement of general hygienic conditions. Darie recommends injections of calomel or soluble mercury preparations even with negative seroreactions. To accelerate reverse development and prevent new eruptions, many consider the most appropriate means intravenous infusions of neosalvarsan in combination with intracutaneous injections of tuberculin in minimal doses.

m. Per.