Comorbid Condition Induced by Lichenoid Tuberculosis of the Skin and Lichen Planus. Significance of a Multidisciplinary Approach to Timely Diagnosis and Treatment

Abstract

In Ukraine, all cases tuberculosis (TB) of the skin are classified as «extrapulmonary TB», which complicates the accurate determination of disease prevalence. Clinical cases of skin TB require a multi­disciplinary approach for diagnosis, particularly for differential diagnosis from chronic dermatoses with similar morphological skin lesions and for treatment. Objective — to conduct a differential diagnosis and determine the presence of comorbid pathology in a patient exhibiting clinical manifestations typical of both lichenoid tuberculosis of the skin and lichen planus. This involves utilising a suite of modern diagnostic procedures, including pathohistological analysis and Doppler laser flowmetry. Materials and methods. We observed a patient, B., born in 2005, who presented with skin lesions characteristic of both lichenoid TB of the skin and lichen planus. According to the patient's history, the duration of the disease was 4 years. Using laser Doppler flowmetry with a Vingmed SD-100 flowmeter (Medata, Sweden), we measured microcirculation and its standard deviation, coefficient of variation and maximum amplitude of slow, fast and pulse oscillations in the affected areas and visually unchanged skin (3—4 cm from the rash elements). Pathohistological examinations were also conducted in the areas of efflorescence. Results and discussion. Considering the clinical examination data, results of comprehensive laboratory and pathohistological research, and indicators of laser Doppler flowmetry in the areas of skin lesions, a comorbid condition caused by lichenoid TB of the skin and lichen planus was diagnosed. The patient was referred to a phthisiologist at his place of residence for comprehensive specific treatment with antitubercu­lar drugs. The patient was also recommended to undergo dermatological monitoring to assess the effectiveness of the pathogenetic therapy prescribed for lichen planus. Conclusions. The variety of clinical forms of skin TB and a number of chronic dermatoses, particularly lichen planus, as well as the similarity in the clinical picture of morphological elements of the skin rash in these diseases, necessitate a multidisciplinary approach and the execution of a complex of clinical, specialised laboratory, pathohistological and modern diagnostic instrumental studies. These enable timely differential diagnosis of skin lesions, including comorbid conditions, and the prescription of rational comprehensive therapy. The use of laser Doppler flowmetry to determine the state of dermal blood circulation in the affected skin areas is an important additional diagnostic test in the differential diagnosis of some chronic dermatoses or in determining a comorbid state.