pustulosis herpetiformis
Introduction
Introduction to herpes-like impetigo Herpes simpleuritis (impetigoherpetiformis) is a serious skin disease that occurs in pregnant women. The basic damage of the skin is the appearance of aseptic pustules on the basis of erythema, often accompanied by severe systemic symptoms, gradually relieved after childbirth. Pregnancy can recur. basic knowledge The proportion of the disease: the probability of the population is 0.28% Susceptible people: good for pregnant women Mode of infection: non-infectious Complications: miscarriage, premature birth, heart failure, renal failure
Cause
Cause of herpes-like impetigo
(1) Causes of the disease
The etiology has not yet been clarified, and pregnancy may be a predisposing factor. Because of the typical hand, foot and ankle caused by hypocalcemia, it is speculated that the pathogenesis may be related to endocrine disorders such as hypoparathyroidism. It has been reported that thyroid surgery accidentally removes the parathyroid gland. Inducing this disease, the disease is also seen in the long-term use of compound norethisterone tablets (also known as short-acting contraceptive I, the ingredients are ethinyl estradiol and norethisterone) non-pregnant women, it is not a unique lesion of pregnant women.
Chen Xitang (1994) believes that herpes-like impetigo and acrodermatitis continua are identical in histopathology and cannot be distinguished. They are only different in the pathogenesis and lesions, and may be pustules. A variant of pustular psoriasis, which causes psoriasis in potential psoriasis due to metabolic disorders. In 1995, Aronson et al. considered the disease to be an independent gestational skin disease.
(two) pathogenesis
1. The naked eye sees on the basis of erythema, a wide range of pustules appear in the epidermis.
2. Pathological changes of skin tissue In the superficial epidermis, spongy pustules were seen. The pustule fluid contained a lot of neutrophils. The formation of spongy pustules was caused by a large number of neutrophils entering the upper part of the spinous layer and accumulating. In the spongy network formed by degenerated and thinned epidermal cells, as the pustules enlarge, the epidermal cells in the center of the pustules all disintegrate until a single atrial bullous is formed, which is still visible around the bullae. A network formed by degenerated and thinned epidermal cells. When the neutrophils in the cavernous pustule fluid move up to the stratum corneum, nuclear pyknosis forms a Munro microabscess, the oral grooved tongue and the histopathology of the map tongue. Changes are similar to changes in the skin.
Prevention
Herpes-like impetigo prevention
Strengthen the oral care and skin care of pregnant women to prevent complications, although the pus in the pustules is sterile, prophylactic application of broad-spectrum antibiotics.
Complication
Herpes-like impetigo complications Complications, premature birth, heart failure, renal failure
In the course of pregnancy, persistent high fever is extremely unfavorable to the fetus, often leading to miscarriage, premature birth, even stillbirth, stillbirth, and severely pregnant women can also die due to long-term high fever, heart failure, renal failure, and systemic failure.
Symptom
Herpes-like impetigo symptoms Common symptoms Herpes pustules, phlegm, dampness, severe pain, skin wrinkles during pregnancy... diarrhea, high fever, cold war
The disease occurs more than 3 months after pregnancy, and the condition gradually relieves after delivery. The disease can recur after re-pregnancy.
Rapid onset, initially in the skin folds (such as axillary fossa, lower breast, groin, umbilical circumference, limb flexion, external genitalia, etc.), a large number of acute inflammatory erythema suddenly appear in the epidermis, and then not through the nodule or blister stage Direct clustering, shallow small pustules, about the tip of the needle to the size of the miliary, yellow-white, often arranged in a flower ring, semi-circular or map-like, simple lesions can also fuse together to become a large area of pus In the lake, the skin lesions are mildly itchy, and the pustules dry and crusted after a few days. New skin damage occurs around the old lesions. Once the skin is peeled off, it shows moisture, and the red shiny area is wet. Loss, and finally the epithelial repair is cured by deep pigmentation. In severe cases, the skin lesions can spread to the whole body, accompanied by chills, relaxation, high fever, vomiting, diarrhea, phlegm and other systemic symptoms, which can affect the buccal mucosa, tongue, and pharynx. The esophageal mucosa is also often involved, forming pustules or erosions, which are gray plaques, sometimes affecting eating due to swollen pain.
The disease is characterized by chronic menstruation, which lasts for several months and is a periodic acute attack, often accompanied by hand and foot spasm caused by hypocalcemia.
Examine
Herpes-like impetigo examination
Examination of blood sees an increase in the total number of white blood cells, increased neutrophils, hypoalbuminemia and hypocalcemia.
Diagnosis
Diagnosis and diagnosis of herpes-like impetigo
According to the pregnant woman in the third trimester of pregnancy, the skin folds on the basis of erythema, most of the yellow-white clusters are arranged in a flower-shaped pustule, accompanied by more serious systemic symptoms, combined with the characteristics of skin tissue pathology, the diagnosis is more difficult .
Sometimes it is difficult to identify with pustular psoriasis. The latter lesions are characterized by hands and fingers, and have a tendency to desquamation. It should also be differentiated from pemphigus. The latter is the size of peas to walnuts on the surface of normal skin. Blister, easy to identify, in addition to pregnancy herpes (polymorphic rash, mainly vesicles, no systemic symptoms).
