Dermatitis of Dyuringa (Herpetiform)

Description:

The disease represents the chronic recurrent process of damage of skin demonstrating the polymorphic, often symmetric efflorestsention which are followed by an intensive itch, burning sensation or paresthesias.
The etiology is definitely not established. Hypersensitivity to gluten (protein of cereals) formed in intestines in the course of digestion of food and haloids matters. Developing of geriyetiformny dermatitis against the background of endocrine changes (pregnancy, a menopause), a lymphogranulomatosis, a toxaemia, vaccination, nervous and physical reexhaustions is possible. Considering hypersensitivity of patients with dermatitis of Dyuringa to iodine, express opinion that the disease arises as allergic reaction to various endogenous irritants; also the virus etiology is supposed

Dermatita Dyuringa symptoms (Herpetiform):

The dermatosis arises preferential aged from 25 up to 55 years. Extremely seldom the disease can begin both in the first months of life, and in an extreme old age. Women are ill less than men.
The disease is characterized by polymorphism of skin elements, at the same time or with a small interval there are bubbles, bubbles, papules, pustules, earlier - the blisters located on limited erythematic sites. Then there are secondary elements - erosion, scales, crusts. Rashes differ in the grouped (herpetiform), symmetric arrangement, quite often chronic and recurrent current expressed by subjective symptoms (an itch, burning and morbidity).
The general condition of patients rather good, despite periodic temperature increase.
On skin of a trunk and extensor surfaces of extremities and buttocks there are erythematic, spotty and papular and urtikarny elements showing bent to transformation into vesicles and pustules. Also large pemfigusopodobny bubbles can be formed. The pale yellow, translucent vesicles with a diameter of 5-10 mm are typical. They can merge in larger bubbles which, being opened and shrinking, form crusts. Contents of vesicles, pustules and bubbles sometimes have hemorrhagic character. Rashes are followed by a severe itch or burning sensation and morbidities. On site deep having combed the excoriations which are formed owing to an itch, and also erosion, crusts, scales, superficial hems, pigmentation strengthen the polymorphism phenomena. Mucous membranes of an oral cavity are surprised much less often (10% of cases), than at a vulgar pemphigus, and never serve as initial displays of a disease. However at children mucous membranes are surprised quite often and the dermatosis is characterized by dominance of vesical elements, smaller bent to group, polymorphism and formation of pigmentation on site of the former rashes which is noted also at adults.
Nikolsky's symptom at dermatitis of Dyuringa negative. In blood the eosinophilia is noted. A significant amount of eosinophils is found also in contents of bubbles. By statement of the direct immunofluorescent test in a zone of a basal membrane reveal granular deposits of immunoglobulin (IgA).
Distinguish a kruinopuzyrny kind of a dermatosis at which the intense transparent bubbles the size from cherry to walnut located on edematous hyperemic skin, and a melkopuzyrny version when the bubbles and papulovezikulezny elements grouped on sharply hyperemic skin have the sizes from prosyany grain to a pea are formed. In the first case the most frequent localization of a dermatosis - a trunk, extensor surfaces of extremities, in the second - preferential face skin, extremities, inguinal and axillary folds. Frustration of a water salt metabolism, reduction of amount of protein (albumine) in blood serum with simultaneous increase in globulinovy fraction, acidosis, reduction of excretion of 17 ketosteroids and 11 oxycorticosteroids (cortisone metabolites) in urine take place.
As at patients with a herpetiform dermatosis hypersensitivity to iodine is noted, it is determined by intake 3-5% of solution of potassium or Natrii iodidum or drawing on skin of 50% of ointment from potassium by iodide (test by Yadasson). When giving drug inside note a process aggravation; at external use of ointment on site its imposings in 24-48 h arise new rashes. However iodide tests should not be carried out to the period of an aggravation of process or in the progressing stage.
Children, despite the expressed clinical symptomatology of dermatitis of Dyuringa, quite often have no eosinophilia and hypersensitivity to iodine drugs that gave a reason to a number of dermatologists to consider these signs not unconditional, but probable symptoms of a disease.
Children get sick in rare instances, but process can be shown in the first months of life. Separate cases of herpetiform dermatitis at newborns and babies are known. At most of children the disease of Dyuringa develops after the postponed infectious diseases, is characterized by dominance of the large erythematic and edematous centers with existence of the vesicular and violent elements which are followed by a sharp itch. At children are noted smaller bent to group and dominance of the generalized disseminated efflorestsention of urtikarny, spotty and papular character which are quickly turning into vesicles, bubbles and pustules. It is necessary to consider frequent localization of rashes in genitals, large folds and accession of a consecutive piokokkovy infection. Mucous membranes of a mouth at children are surprised vesicular and violent elements more often.

Dermatita Dyuringa reasons (Herpetiform):

The disease represents the chronic recurrent process of damage of skin demonstrating the polymorphic, often symmetric efflorestsention which are followed by an intensive itch, burning sensation or paresthesias.
The etiology is definitely not established. Hypersensitivity to gluten (protein of cereals) formed in intestines in the course of digestion of food and haloids matters. Developing of geriyetiformny dermatitis against the background of endocrine changes (pregnancy, a menopause), a lymphogranulomatosis, a toxaemia, vaccination, nervous and physical reexhaustions is possible. Considering hypersensitivity of patients with dermatitis of Dyuringa to iodine, express opinion that the disease arises as allergic reaction to various endogenous irritants; also the virus etiology is supposed.

Dermatita Dyuringa treatment (Herpetiform):

    *  Before an initiation of treatment of patients with dermatitis of Dyuringa it is necessary to inspect for detection of diseases of digestive tract and malignant new growths
    * The diet with an exception of wheat, oats, millet, barley and other cereals, and also products containing iodine (sea fish) is shown.
    * Dapsone — on 100 mg 2 times a day 5 days with 1 — 2-day breaks (3 — 5 cycles and more). After disappearance of displays of a disease appoint in a maintenance dose (5 mg every other day or 1 — 2 time a week). Side effects of dapsone: nausea, vomiting, anemia, damage of a liver, psychosis, allergic reactions; dapsone is incompatible with pyramidon and barbiturates
    * In addition to dapsone применяютмя also димеракоптопропансульфонат sodium, methionine, lipoic acid, Etebenecidum, vitamins (ascorbic acid, rutoside, group B vitamins), antihistaminic drugs.