. . . lymph nodes reflect like a mirror the pathology of the parenchyma . . .—Parrot, 1876.
INFECTIOUS granulomatous diseases follow a certain pattern which permits differentiation of primary from secondary involvement, and the skin is an organ where this behavior can be very well studied. At the point of entrance of many organisms a primary sore is formed (cutaneous American leishmaniasis, tularemia, scrub typhus, tsutsugamushi, Rickettsial pox, yaws, syphilis, tuberculosis, blastomycosis, coccidioidomycosis, sporotrichosis) and the course of the disease is fairly constant. A short time later lymphangitis and regional lymphadenitis appear, and generally the disease is self-limited and comes to a standstill at the level of the regional lymph nodes.
While these facts should speak for themselves, it has become a custom to confuse these clear-cut issues, and several of the fungus diseases are erroneously classified as "primary" cutaneous lesions. In the following pages
SCHWARZ J, BAUM GL. PRIMARY CUTANEOUS MYCOSES. AMA Arch Derm. 1955;71(2):143–149. doi:10.1001/archderm.1955.01540260001001
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