Skrofuloderma is a skin disorder caused by

subcutaneous mycrobacterium tuberculosis and a direct

extension of tuberculosis in the tissues under the skin,
for example in lymph nodes, muscles, and bones.
Epidemiology
 Age : usually in children and young adults, but can
occur at any age
 Gender : incidents in men and women are meaningless
Etiology
 Mycrobacterium tuberculosis
Pathogenesis
 The emergence of scrofuloderma from the spread of propagation
perkontinuitatum from organs under the skin that has been attacked
tuberculosis disease, which most often comes from lymph nodes, Also
can come from the joints and bones. Therefore, its predilection in
places where many lymph nodes are found.
 Superficial, the most common is the neck, then followed in the armpit
and the most rarely in the groin.
 Port d'entrée srofuloderma in the neck region is on the tonsils and
lungs.
 If in the armpit the possibility of port d'entrée on the pleural apex.
 If in the thighs the possibility of port d'entrée on the lower extremities.
 Sometimes the three places of predilection are attacked at once in the
neck, armpits and groin, most likely the spread of hematogens.
Pathogenesis
•Enlarged lymph nodes (Limfadenitis TB)
•Adhesion of lymph nodes and surrounding tissues (Peridenitis TB)

Lymph nodes undergo Smooth and soft consistency

softening not all at once (cold abscess)

broken
Ulcers (elongated and irregular shapes, surrounded in a
bluish red (livid), the walls resonate, covered by a extand
Fistel
seropurulent pus)

Drying out
recover scars (elongated and
irregular, Sometimes above
a yellow crust the scars there is a skin
bridge)
Clinical Manifestation
 Enlarged lymph nodes.
 The lymph nodes will undergo softening, resulting in a supple and soft
consistency forming an abscess (cold abscess) that will penetrate the skin and
rupture to form a fistula.
 Fistula extends into ulcers that are long and irregular, and the surrounding
colored bluish red (Livid), the walls resonate, the granulation tissue covered by
a seropurulent pus, if it dries into a yellow crust.
 The ulcers can heal spontaneously into scars that are elongated and irregular.
Sometimes above the scars there is a skin bridge, the shape is like a rope with
both ends attached to the scars, until sonde can be inserted.
 Clinical features of skrofuloderma vary depending on the duration of the
disease. If the disease has been chronic, then the clinical features are complete,
meaning that there are all abnormalities that have been mentioned. If the
disease is not chronic, then scars and skin bridges have not formed
Skrofuloderma disease in the neck

Skrofuloderma disease in the neck is usually a typical clinical

features, so there is no need for differential diagnosis. In the stages of
tuberculosis lymphadenitis difficult to make a clinical diagnosis,
therefore gland biopsy should be done to differentiate it from other
diseases that attack lymph nodes, such as bacterial nontuberculosis
lymphadenitis, lymphosarcoma and malignum lymphoma.
Skrofuloderma disease in the
armpit area

If in the armpit area, it is distinguished by

hidradenitis suppurativa, which is an infection by the
piokokus in apocrine glands.
Skrofuloderma disease in the
thighs area

Skrofuloderma in the thighs area sometimes resembles

lymphogranuloma venerum. The important difference is that LGV has coitus
suspectus, with symptoms of co-transfer (fever, malaise and atralgia) and there
are five signs of acute inflammation. Localization is also different, in the LGV
part of the attack is medial Inguinal lymph nodes, while the attacked
skrofuloderma are lateral and femoral Inguinal lymph nodes.
TUBERCULIN SKIN TEST
Interpretation :
1. Induration ≥ 10 mm :
Positive
2. Induration ≥ 5 mm :
People with conditions
that weaken their
immune system (HIV)
3. Induration 15 mm :
People vaccinated with
BCG
Ziehl-Neelsen examination
Acid fast bacilli stain pink
and the background appears
blue
• Interpretation :
1. > 10 AFB/high power field –
> +++
2. 1-10 AFB/high power field –
> ++
3. 10-100 AFB/100 high power
fields –> +
4. 1-9 AFB/100 high power
fields –> exact number
LOWENSTEIN JENSEN
MEDIA

The interpretation
Lowenstein Jensen
Media is growth of
Mycobacterium species
on this medium.
Histopathology
Epithelioid
histiocytes
Langhans
Lymphocyte giant cells
s

Caseous
necrosis
 DIFFERENTIAL DIAGNOSIS

Sporotrichosis
• Hyphae negative in
scrofuloderma
• Histopathology
sporotrichosis is
suppurative granuloma,
epithelioid granuloma,
tuberculoid granuloma
and foreign body
granuloma.
Hidradenitis SUPPURATIVA

• Microscopy of swabs of
lesions predominantly
has negative results.
• Histopathology
hidradenitis
suppurativa is sinus
lined with stratified
squamous cells and
inflammation of the
apocrine gland
ACTINOMYCOSIS

• Histopathology
actimocycosis is colonies
of actinomycosis species
and actinomycin granule
• Clinical images, pain,
swelling and draining
fistulas
Syphilitic gumma

Histopathology syphilitic
gumma is granulomatous
dermal infiltrate and ulcer
border
Tareatment
 Treatment of tuberculosis kutis (skrofuloderma) in
principle the same as the treatment of pulmonary
tuberculosis, which uses a combination of several
drugs and given within a certain period.
 Tahap Intensif (2 bulan)

 INH adult: 5 mg / kgBW / day, oral, single dose Dose

of child: 10 mg / kgBW/ day, max. 300 mg / day
 Rifampicin: 10 mg / kgBW / day, oral, single dose on
empty stomach (before breakfast)
 Dose of child: 15 mg / kgBW / day, max. 600 mg
 Etambutol: 15-25 mg / kgBW / day, oral, single dose
 Dose of child: 20 mg / kgBW / day
 Pyrazinamide: 20-30 mg / kgBW / day, oral, child: 35
mg / kgBB / day
 Tahap Lanjut (4 bulan berikut)

 INH adult: 5 mg / kgBW / day, oral, single dose

 Dose of child 10 mg / kgBW / day
 Adult Rifampicin: 10 mg / kg / day, oral, single dose
on empty stomach (before breakfast)
 Dose of child: 15 mg / kgBB / day
 The healing criteria in skrofuloderma are all fistula
and the wound has closed, the entire lymph nodes
have shrunk (less than 1 cm and hardness consistency),
and the scar is not red anymore.
 If the lesion is wet, compress with potangan
permanganate 1 / 50.000. If the lesion is dry , give
antibiotic ointment
Complication
 Skrofuloderma lesions initially only the enlargement
of some lymph nodes, then ulcers can become scar if
treatment scrofuloderma is inadequate.
Prevention
 treatment of a suspect source of transmission in the
environment needs to be done. How to live healthy by
maintaining personal hygiene and environment is
highly recommended, both in patients and on family
members.
 Sources of infection in family members should be
treated in order not to give recurrent infections. All
family members have been advised for sputum
examination, chest radiology, and tuberculin test
Prognosis
 The prognosis of skrofuloderma is good because
mortality is very small or almost nonexistent, 7.14 but
needs to be supported by patient compliance and
regularity in following OAT treatment, and improving
environmental hygiene.