juvenile dermatitis herpetiformis
Introduction
Introduction to juvenile herpes-like dermatitis Juvenile herpes-like dermatitis is a juvenile chronic benign recurrent bullous skin disease. Most of the sick children may have gluten allergic bowel disease, but there is no obvious clinical symptoms. basic knowledge The proportion of sickness: 0.01% Susceptible people: children Mode of infection: non-infectious Complications: acute nephritis
Cause
The cause of juvenile herpes-like dermatitis
(1) Causes of the disease
The cause is still unclear and may be an autoimmune disease. There are two possibilities. First, it may be due to gluten-sensitive enteropathy, which causes the body to produce anti-glutamate antibody IgA. This antibody passes through blood circulation and skin tissue antigen. Cross-reaction occurs, causing damage to the basement membrane and blistering. The second possibility is that the circulating immune complex deposits the basement membrane to activate complement to cause damage to the basement membrane.
(two) pathogenesis
Epidermis, a microabscess composed of most neutrophils and nuclear dust at the top of the dermal papilla, fissure between the microabscess and its upper epidermis, edema of the dermal papilla, basophilic degeneration of collagen in the papilla, lymphatic periplasm of the superficial vascular Tissue cells and neutrophils infiltrate, with eosinophilic infiltration in the dermal papilla that is damaged later, and in the subepidermal layer of the blister, occasionally single or clusters of acantholytic cells, common necrotic basal cells.
Prevention
Juvenile herpes-like dermatitis prevention
Avoid predisposing factors, such as the use of drugs containing iodine, bromine; edible seaweed, kelp and gluten foods, etc., actively prevent skin infections.
Complication
Juvenile herpetic dermatitis complications Complications acute nephritis
A small number of cases of repeated diarrhea, can be complicated by skin infections, leading to allergic diseases such as acute nephritis.
Symptom
Juvenile herpes-like dermatitis symptoms Common symptoms Herpes rash rash diarrhea
The age of children with good development is 6 to 11 years old. The chronic course of disease is repeated or gradually relieved. It can last for a long time after puberty.
The basic skin lesions are blister arranged in a circular arrangement or cluster on the basis of erythema. The bullae are 0.3-1.0 cm in diameter, the wall of the blister is thick and tense, the blister fluid is clear, the lesion is negative for Nie's sign, and it occurs on the extremities of the extremities. , shoulder and back and lumbosacral, mucosa is rarely affected, can also show erythema papules, urticaria wheal, children generally good condition, no systemic symptoms and fever, the difference with adults is: skin lesions lack polymorphism, Self-conscious itch feels different, some even have no symptoms, no secondary infection after the skin lesions only leave pale brown pigmentation spots.
Most children have good growth and development, a few have a history of repeated diarrhea, a long course of disease, repeated attacks, and puberty is expected to heal itself.
Patients taking this disease take drugs containing iodine, bromine, fluoride, chlorine, etc., which can lead to aggravation of the condition.
Examine
Examination of juvenile herpes-like dermatitis
1. Direct immunofluorescence: The top of the dermal papilla and/or the basement membrane with IgA and C3 are deposited in a granular form, and occasionally IgM and IgG are deposited simultaneously.
2. Indirect immunofluorescence: anti-retinal antibodies and anti-gluten antibodies can be detected in serum of 20% of patients, and anti-muscle sheath antibodies can be detected in 70% of patients, and there is no anti-basement membrane antibody.
3. Immunoelectron microscopy: It was found that IgA was deposited under the substrate plate and combined with anchor fibrils and microfibrils, and part of IgA was deposited in the transparent plate under the basement membrane.
4. Electron microscopy: It was found that the basement membrane of the epidermis was blurred, broken or completely disappeared, and the cytoplasmic membrane of the basal cells was destroyed.
Pathological changes in the small intestine are atrophy of varying degrees of villus, flattened or flattened, submucosal, and lymphocytes infiltrated between epithelial cells.
Generally no special inspection is required.
Diagnosis
Diagnosis and identification of juvenile herpes-like dermatitis
Based on typical characteristic lesions, combined with laboratory tests (histopathology and immunopathology), the diagnosis can be established.
According to direct immunofluorescence and pemphigoid, linear IgA blister skin disease can be identified.
