ACRODERMATITIS (acrodermatitis; Greek akron — an extremity and derma — skin + - itis) — group of the dermatosis affecting extremities. This term combines the following diseases.
An acrodermatitis atrophic chronic [Gerksgeymer, Gartmann (To. Herxheimer, To. Hartmann), 1902]; synonym: an atrophy of skin idiopathic progressing (A. I. Pospelov, 1886), an erythromelia [F. Pick, 1900]. The etiology is not found out; assume that diseases are the cornerstone neurogenic disturbances of a trophicity, allow the infectious nature of a dermatosis. Adults are ill, women are more often.
Histopathology. In an initial stage of an erythema observe hypostasis and inflammatory infiltration of a derma (generally lymphocytes and plasmocytes) around vessels, hair follicles, grease and sweat glands. Walls of vessels of an infiltrirovana, the endothelium which their bulked up separate vessels are obliterated. In stages of an atrophy — sharp thinning of an aculeiform layer of an epithelium, all derma and hypodermic fatty tissue, collagenic fibers are homogenized, painted faintly. Hair follicles, grease and sweat glands are atrophied.
Clinical picture. The initial stagnant and cyanotic erythema appears on the back of feet and brushes, in areas of elbow and knee joints more often, is symmetric or on one extremity, gradually, very slowly extending on all extremity. Subjective feelings either are absent, or are shown by a pricking, more rare neuralgic pains. In many months or even years the atrophy of the affected skin gradually develops; it becomes thinner, becomes wrinkled, reminding the crumpled tissue paper, with the translucent veins and usually plastinchato is shelled. Sometimes along with an atrophy consolidation of skin (pseudo-scleroderma) is observed, is more often on the back of feet and the lower third of a shin or lentoobrazno on a front surface of a shin or on the elbow surface of a forearm. Dense fibrous nodes about knee or elbow joints are sometimes formed. There can be trophic ulcers.
Treatment is ineffective and promotes only delay of progressing of a disease. For this purpose usually appoint 2 — 3 courses of a penicillin therapy on 15000000 PIECES to a course; penicillin is combined with a pyrotherapy, iron preparations, vitamins A, With, E, groups B.
At endocrine disturbances — the corresponding therapy. It is reasonable to appoint a diathermy, D'Arsonval's currents, Ural federal district, hydrosulphuric bathtubs, a resort therapy in Sochi-Matsesta, Pyatigorsk, etc.
An acrodermatitis pustular [Allopo (N. Hallopeau), 1897] — a dermatosis of not clear etiology. Assume that diseases are the cornerstone neurogenic disturbances of a trophicity, the role of an infection is a little probable. Some authors identify this form with the herpetiform dermatitis of Dyuringa, herpetiform impetigo of Gebra, pustular psoriasis localized by an enteropatichesky acrodermatitis.
A histopathology — an acanthosis, a parakeratosis, subhorn pustules with existence of piogenic cocci; hypostasis of a derma and inflammatory infiltrate with abundance of neutrophils and lymphocytes.
Clinical picture. On hyperemic cyanotic-red, intense and brilliant skin of extremities there are small superficial pustules, bubbles, korkocheshuyka (fig.) are more rare. Subjectively note a pricking, pains are more rare (neuralgic). The rashes, quite often symmetric are located on palmar (or bottom) and dorsums of fingers of hands, is more rare than legs, gradually extending. Nails become dim, then are deformed and disappear. There can be dissimination of rashes on all body. Extremely seldom mucous membranes of an oral cavity and a vagina are surprised.
Forecast mostly adverse: pustular And. proceeds chronically (many years) with short remissions.
Treatment, as a rule, unsuccessfully. Elimination of a focal infection, disturbances of neuroendocrinal system and a metabolism is necessary. Appoint iron preparations, redoxons and And, phytin, neurosin, corticosteroids, locally — disinfecting and anti-inflammatory drugs, in especially persistent cases Bukki's beams and a roentgenotherapy.
An acrodermatitis of enteropaticheskiya [Danbolt, Klos (N. Danbolt, To. Gloss, 1949); Danbolt's synonym — Klos a syndrome] — a rare disease, arises at chest and early children's age more often, sometimes in one family several children are ill.
The etiology is unknown. The look expresses proximity of this disease to inborn dystrophies, in particular to an inborn epidermolysis. Existence of yeast-like fungi in Calais, on a mucous membrane of an oral cavity, in the centers damages were caused by the assumption that enteropaticheskiya And. is widespread candidiasis. However the possibility of secondary nature of a drozhzhepodobny infection is not excluded. A part is played went. - kish. frustration.
Histopathology. In epidermis of the phenomenon of a hyperkeratosis, the acanthosis, a granular layer in places is absent, intercellular hypostasis; in a derma swelled, perivascular infiltrates from histiocytes and lymphocytes, an atrophy of hair follicles
Clinical picture. Bubble and violent rashes develop at first around eyes, a mouth, an anus, then in elbows, knees, in inguinofemoral folds, on hips, buttocks. Bubbles are located with groups, symmetrically; during the opening crusts, the plaques reminding psoriasis which further are shelled are formed.
Damage of a mucous membrane of an oral cavity is at the same time observed; nails become fragile, dim.
The hair loss on the head, eyebrows, eyelashes is characteristic; the photophobia therefore the child blinks eyes is expressed and hangs the head. Expressed went. - kish. frustration are followed by exhaustion; the child lags behind in physical development.
Forecast. The disease proceeds for years with short spontaneous remissions. Without treatment a recurrence accepts heavier current, the lethal outcome is possible.
Treatment. Enteroseptolum (iodchloroxyquinoline) is most effective. It is appointed to children aged till 1 year on 0,25 g by 2 times a day; from 1 to 3 years — on 0,25 g 4 times a day; from 4 to 7 years — on 0,5 g 3 times a day; from 8 to 10 years — on 0,5 g 4 times a day (it is long, before permanent remission). After the termination of treatment there can come the recurrence therefore the prolonged supporting treatment is recommended. Also fortifying means, by revenge antiseptic and antiinflammatory drugs are applied. Corticosteroids, antibiotics and streptocides do not render effect. Children shall be under dispensary observation.
See also Dermatosis .
Bibliography: Earth A. G. Atrophic acrodermatitis, Vestie, hir., t. 91, No. 7, page 83, 1963; Meshchersky G. I. To the doctrine about an idiopathic progressive atrophy of skin and about its relation to a scleroderma, M., 1904: Studnitsin A. A., Stoyanov B. G. and Sharapova G. Ya. Skin diseases at children, page 237, M., 1971; Fandeev L. I. Enteropatichesky acrodermatitis, Works Permsk. medical in-that, Nauch. notes kaf. skin. and veins. diseases, century 4, page 7, 1968, bibliogr.; Canguilhem J. Les acrodermatites enteropathiques, Toulouse, 1968; Dermatology in general medicine, ed. by T. Century of Fitzpatrick a. o., p. 737, N. Y. a. o., 1971, bibliogr.; Oppenheim M. Atrophien, Handb. Haut-u. Geschl. - Kr., hrsg. v. J. Jadassohn, Bd 8, T. 2, S. 563, V., 1931; Riecke E. Aerodermatitis continua, ibid., Bd 7, T. 2, S. 654.
S. T. Pavlov, A. A. Studnitsyn.