IMPETIGO HERPETIFORM

From Big Medical Encyclopedia

IMPETIGO HERPETIFORM (impetigo herpetiformis; lat. of impetigo pustulous rash, purulent deprive; lat. similar with we deprive of herpetiformis; synonym impetigo gravidarum) — the rare disease of an unknown etiology which is characterized by pustular rash. It is described in 1872 by F. Gebra and in detail studied M. Kaposha (1887). The women, mostly pregnant get sick, it is very rare And. develops at men and children of both sexes.

The etiology and a pathogeny

Is supposed an infectious origin; in most cases the disease is connected with endocrine frustration, especially with dysfunction of epithelial bodies; sometimes And. develops against the background of a postoperative tetany, and also at disturbance of calcic exchange (hypocalcemia); often And. carry to toxicoses of pregnant women.

Patogistologiya

In an upper part of an acanthceous layer is formed a pustule as a result of penetration of neutrophils that causes destruction of cytoplasm and kernels of epithelial cells; the remained cell walls form spongy network with neutrophils in it (a so-called spongioformny pustule of Kogoya); infiltrate, as well as in a pustule, contains many eosinophils in a derma.

Clinical picture

Fig. 5. In the field of a femoral triangle and on a stomach the edematous and erythematic and erozirovanny centers.

The clinical picture is characterized by a sudden feverish state and emergence on skin of an inner surface of hips of the edematous and erythematic centers which are densely covered with pustules at which ssykhaniye impetiginous crusts are formed. On the periphery the erythematic and edematous ring covered with pustules spreads; the separate centers of defeat merge (tsvetn. fig. 5). In axillary hollows, pleated under mammary glands, around a navel and in bends there are new centers; further process extends to other sites of skin (up to an erythrodermic state), sometimes on a mucous membrane of a mouth, a vagina, respiratory tracts, is very rare — a gullet, intestines. The heavy general phenomena — long or intermittent fever of septic type, oznoba, vomiting, a diarrhea, nonsense, spasms are characteristic. The itch, as a rule, is absent. The current is acute, quite often comes to an end letalno in several days or weeks, but can flow is long — up to 10 years and more.

The diagnosis

the Diagnosis is based on a wedge, and gistol, data. Crops of contents of pustules are, as a rule, sterile. And. it is necessary to differentiate with subcorneal pustular dermatosis (see), pustular psoriasis (see), herpetiform dermatitis (see. Dyuringa disease ), and also with herpes of pregnant women (see. Herpes ).

Treatment

Glucocorticosteroids, parathyroidin, Dihydrotachysterolum, drugs of calcium, D2 vitamin; appoint estrogen, injections of blood serum of the healthy pregnant woman, a hemotransfusion; sometimes — abortion. At complications and as prevention of consecutive infection — antibiotics. Locally — heat baths with potassium permanganate, opening of pustules, disinfecting ointments.

The forecast

the Lethality reached 50% earlier; use of modern pharmaceuticals, in particular hormonal drugs, considerably reduced quantity of lethal outcomes. At pregnant women there can come premature birth; sometimes the child is born the dead or perishes soon after the birth.

See also Toxicoses of pregnant women .


Bibliography: Mashkilleyson L. N. Private dermatology, page 289, M., 1905; G e of t 1 e of W. Systematische Dermatologie und Grenzgebiete, Bd 2, S. 821, Lpz., 1972, Bibliogr.

L. H. Mashkilleyson, V. I. Samtsov.

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