Mycobacteriosis cutie is largely classified to localized forms and examthematous
forms and it is subdivided 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 faciae, 3)
papulonecrotic tuberculid, 4) lichen scrofulosorum and 5) erythema indurarum in
Rich (1944) insisted on that, the pathogenesis of cutaneous tuberculosis was
essentially the same as that for tuberculosis on general. He said that all forms of
cutaneous tuberculosis were produced by th local action of the bacillus of
tuberculosis. In th formerly termed true tuberculosis such as lulus, 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 tissues
and this fact explained the failure to find the microorganisms in this 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 mycobateriosis cutis, especially
the type in the category of tuberculids are caused by the hematogenous
dissemination of tubercle bacilli from a focus, often extrapul-in location, into
the skin , where they are rapidly destroyed. and Roeckle (1960) agreed with above
mentioned plausible theories with the background of their hypothesis that was; the
skin was hyperagic. And Miescher (1951) also insisted that, skin had a decreased
But according to Flegel (1957), if the skin was in a state of hyperegic reaction,
the focus from which the dissemination was taking place was also should be in a
hyperegic state and vice versa should be right. And moreover, Sulzverger (1940)
declared that whenever microorganisms or their products were being overcome or
neotralized by local reactions, tubercles or tuberculoid structures had a tendency
appear. So the theories of differemt immunologic state between the skin and focus
were discarded. After that many authors proposed three factors against a tuberculos
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 respond to the
administration of corticosteroids.
According to Eberhartinger(1963), Schneider and Undeutsch(1965), in erythma
induratum the primary event is a vasculitis of subcutaneous and veins. And any fat
necrosis following vascular damage develop 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 tuberculids, could be originated from
mycobacteria tuberculosis in fact or not.
Eleven patients, whose clinical diagnosis were skin tuberculosis or very similar
to those disease 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 3500 r.p.m. for 30 minutes, 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 tuberculous media in incubator at 37℃.
Finally the acid-fast tubercle bacilli have been grown on the Owaga's media three
months after its first inoculation. The inoculation material was biopsied from the
patient of eighteen year-old girl, whose and histopathological diagnosis was
erythema induratum. from the result of this study, we got the strong confidence
that in spite of its culture, the erythema induratum can be or in evidently caused
from mycobacterium tuberculosis.
It may be early 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 tjos study.