SUBCORNEAL PUSTULAR DERMATOSIS (synonym: syndrome Sneddona — Wilkinson, a subhorn pustular dermatosis) — the chronic dermatosis which is characterized by formation of subcorneal small pustules, koltsevidno or linearly located on skin of a trunk, in axillary poles and inguinal folds. Page of the item of — rather rare disease; it is described in 1956 by Sneddonom and Wilkinson (I. Century of Sneddon, D. S. Wilkinson); more often women are ill.
Etiology and pathogeny are not found out. In some cases S. the item of represents reaction to focal infection. In contents of pustules there are no bacteria; in blood the number of IgA is rather often increased. Pustulation arises as a result of penetration of leukocytes and their accumulation under a corneous layer of epidermis.
Histologically the subhorn pustules filled with neutrophils and single eosinophils are defined. The acantolysis (see) is absent, but in the old centers there can be single akantolitichesky cells resulting from effect of proteolytic enzymes of pustules. Under a pustule in epidermis there is a small exocytosis and spongiosas (see). In a derma — perivascular infiltration from neutrophils, single mononuklear and eosinophils. Near rashes in epidermis the cytolysis of keratinotsit reaching a granular layer is defined.
Wedge, picture it is characterized by emergence of primary element — small to 5 mm in the diameter sluggish pustules (see) or the bubble which is quickly turning into a pustule, edge it is not connected with a hair follicle. Rashes usually develop groups on externally healthy or hyperemic skin. At the beginning of a pustule are located separately, and in the subsequent merge in the tsirtsinarny serpiginiruyushchy centers having various outlines. Several days of a pustule later the thin crusts reminding dry up and are formed impetigo (see). On site the resolved rashes there are erythematic sites having polycyclic outlines. On them in process of disappearance of old pustules new appear. The atrophy and hems is not observed, but on site rashes sometimes there is a brownish hyperpegmentation. Rashes usually arise symmetrically, more often on a trunk near large folds, the flexion surface of extremities; palms and soles are surprised extremely seldom; face skin, mucous membranes are not involved in process. Sometimes there is an itch and burning. General condition of patients satisfactory.
Page of the item of — the chronic disease lasting for years; the aggravations proceeding for months alternate with spontaneous remissions by duration from several days to several months.
Diagnosis establish on the basis a wedge, pictures and results gistol. researches. The page of the item of should be differentiated with impetigo, herpetiform impetigo (see. Impetigo herpetiform ), a disease of Dyuringa (see. Dyuringa disease ), a leaflike pemphigus (see) and to generalized pustular psoriasis (see). At impetigo in a pustule it is possible to find cocci, besides, the positive effect from topical and general administration of antibiotics is characteristic. The immunofluorescent research (forward reaction of an immunofluorescence) allows to otdifferentsirovat S. of the item from a disease of Dyuringa and a leaflike pemphigus. Generalized pustular psoriasis differs in the general symptomatology, elevated temperature, a leukocytosis, existence of spongioformny pustules in epidermis, lack of effect of use of sulphones (see. Sulphones aromatic ).
Treatment carry out by sulphones or corticosteroids and antibiotics of a broad spectrum of activity. Radical treatment of the centers of an infection is necessary.
Forecast favorable; course of a disease high-quality.
See also Dermatosis .
Bibliography: Honigsmann H. and. Wolff K. Subcorneal pustular dermatosis (Sneddon-Wilkinson disease), in book: Derm, in general med., ed. by T. B. Fitzpatrick a. o., p. 347, N. Y., a. o., 1979; Sneddon I. B. a. Wilkinson D. S. Subcorneal pustular dermatosis, Brit. J. Derm., v. 68, p. 385, 1956.
A. L. Mashkilleyson.