Mycobacteriosis cutis is largely classified to localized forms and exanthematous forms and it is subdivded into five diseases in detail, each. They are 1) primary tuberculous complex, 2) lupus vulgaris, 3) tuberculous verrucosa cutis, 4) scrofuloderma, and 5) tuberculosis cutis orificialis in localized forms and 1)´ tuberculous miliaris disseminata, 2) lupus miliaris disseminata faciei, 3) papulonecrotic tuberculid, 4) lichen scrofulosorum and 5) erythema induratum in exanthematous forms.
Rich(1944) insisted on that, the pathogesis of cutaneous tuberculosis was essentially the same as that for tuberculosis in general. He said that all forms of -cutaneous tuberculosis were produced by the local action of the bacillus of tiiberculosis. In the formerly termed true tuberculosis such as lupus vulgaris, the microorganisms were found in oaring numbers in the lesions; and animal inoculations of tissue were successful. In other forms represented by the tuberculids, the bacillus of tuberculosis was found only in the earliest stages before the true clinical and histological picture had developed. Its short lived existenc. in this forms was -explained by the allergic state of the tissues and this fact explained the failure to find the microorganisms in the lesions, or reproduced the affection by inoculations in animals, in cases sufficiently developed to be recognizable clinically and histologically.
The other generally accepted view is that the mycobacteriosis cutis, especially the types in the category of tuberculids are caused by the hematogenous dissemination of tubercle bacilli from a focus, often extrapulmonary in location, into the skin, where they are rapidly destroyed. Spier and Roeckle (1960) agreed with above mentioned plausible theories with the background of their hypothesis, that vas; the skin was hyperegic. And Miescher(1951) also insisted that, skin had a decreased immunologic resistance.
But according to Flegel(1957), if the skin was in a state of hyperegic reaction, the focus from which the dissemination vas taking place was also should be in ahyperegic state d vice,versa c uAd I)q > ht And moreover, Sulzberger(1940) declared that-whenever microorganwm orfir-products ,wsere ibe1W overcome or-neutralized by local immunologic reactions, tubercles or tuberculoid structures had a-tendency to appear. So the theories of different immunologic s-Late between the skin and focus were discarded. After that many authors proposed three against a tuberculous etiology of tuberculids.
First, inoculation of tissue from lesion into guinea pigs and culturing of such_ tissue have given no-evidence for tuberculosis.
Second, active tuberculosis occurs no greater frequency in patients with tuberculids, than in the general population.
Third, tuberculids does not respond to antituberculous treatment but responds to the administration of corticosteroids.
According to Eberhartinger(1963), Schneider and Undeutsch(1965), in erythemainduratum the primary event is a vasculitis of subcutaneous arteries and veins. And any fat necrosis following vascular damage can develop a tuberculoid appearance. Lever(1967) declared with self confidence that it was a relic of the times when a tuberculoid histology was tantamount to tuberculosis.
In this condition we decided to clarify that whether the mycobacteriosis cutis,. especially the disease in the category of tubercullis, could be originated from mycobacteria tuberculosis in fact or not.
Eleven patients, whose clinical diagnosis were skin tuberculosis or very similar to those diseases such as erythema nodosum, were biopsied by 5mm puncher after 2% procaine injection on their two of skin lesions, the early one for the culture of tubercle bacilli and the old one for histopathological study, on the O.P.D. of dermatologic department in Severance Hospital.
Those biopsied material of early lesion was digested with ;proper amount of 4% NaOH and fragmented in tissue grinder about 10 minutes. After that, it ,was. centrifuged in rotating speed of 3,500 r.p.m.,for 30minutes, and neutralized by 8% HCl after adding phenol red drop.by drop. Again it was centrifuged by . same as previous method and it´s supernatant was discarded. The remnants of precipitin was. inoculated on Ogawa´s nutrient tuberculous media in incubator at 37´C.
Finally the acid-fast tubercle bacilli have been grown on the Ogawa´.s .media,threemonths after its first inoculation. The inoculation material was biopsied from . the patient of eighteen year old .girl, whose clinical and histopathological. diagnosis .was erythema induratum. From the result of this study, :we .got the strong confidence that in spite of-many author´s powerful. countertheories and the extremely poor-harvesting of its culture, the erythema induratum can be. or in evidently caused-from .mycobacterium tuberculosis.
It may be early days yet to say that erythema induratum is originated from tubercle bacilli but it is considered to be a truth in Korea, with the result of this study
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