herpes
Introduction
Introduction Herpes is a skin lesion with a confined cavity containing a high liquid surface and is one of the common skin disease symptoms. The diameter of the blister is generally less than 1 cm, and those over 1 cm are bullae. The blister wall is easily broken and is a loose water ring. The blister wall is called a tension blisters. Cancers that occur within the epidermis are called intraepithelial carcinomas, and cancers that occur in the epidermal basement membrane, basal cells, and below are called epidermal vesicles. Diseases in which vesicles can occur are related to skin diseases and systemic diseases. The causes are complicated. The etiology of some diseases is not well understood. Most diseases are mainly vesicles, while others are in serious stages or special types. Or occasional blisters, this section will be listed in the cause classification.
Cause
Cause
(1) Spinal layer release: Due to the degeneration of epidermal cell bridges (bridge particles and tension filaments, etc.), the cells lose a close relationship and become loose, thus forming fissures, water sores or large hugs in the epidermis. The cause of the acanthosis is autoimmune factors such as herpes. The acanthosis solution caused by genetic factors is found in chronic familial benign day cancer sores and follicular keratosis.
(B) basal cell liquefaction and basement membrane lesions: basal cell liquefaction refers to the vacuolarization or disruption of epidermal basal cells, the basal cell layer disappears, the spine cells directly contact the dermis, immune, genetic and drug allergies often lead to the substrate The cause of cell liquefaction is found in hereditary large cancerous epidermolysis, systemic lupus erythematosus, dermatomyositis, erythema multiforme, drug eruption, and large sore flat moss. Basement membrane lesions refer to autoantibody deposition or congenital pathological defects in the basement membrane. The cause is autoimmunity and heredity. The leech disease caused by the basement membrane lesions has large cancerous herpes zoster, pregnancy herpes, and primitive scars. Herpes, herpes-like dermatitis, linear k-human disease, acquired large cancerous epidermolysis, congenital major epidermal lysis, pigmented incontinence.
(3) Balloon degeneration and reticular degeneration: due to intracellular edema, the epidermal cells increase in volume, form a balloon shape, the cells swell and rupture, and the adjacent residual membranes form a majority of the network septum, and finally form a multi-atrial water sore. More common in viral infectious skin diseases.
(D) Sponge edema: due to the increase of intercellular fluid, the cell gap is widened to form water sores, found in eczema, contact dermatitis, sweat herpes and so on.
(5) Vasculitis: It is caused by allergic reactions of immune complex type, and water sores such as allergic vasculitis are formed due to inflammation and necrosis of tissues. Behcet's disease, acute febrile neutrophilosis, etc.
(6) Granular degeneration of the epidermis: also known as epidermal loosening hyperkeratosis, found in ichthyosis.
(7) Epidermal necrosis: due to drug and Staphylococcus aureus infection, epidermal necrosis, epidermal exfoliation, found in large cancerous epidermis drug-borne drug eruption and Staphylococcus aureus scald-like syndrome.
Examine
an examination
Related inspection
Rabbit infection test fungal histopathology cell membrane surface immunoglobulin determination herpes simplex virus antibody circulating immune complex
Physical examination
1. Distribution of leeches: clusters of small water sores, more common in pityriasis, herpes zoster, eczema, contact dermatitis, hand, foot and ankle. The distribution of small water sores is more common in chickenpox, Kaposi varicella-like rash, papular and other measles, Coxsackie rash, and acne. Diseases in which small blisters can be aggregated or scattered can be found in eczema, cancer-like dermatitis, hand, foot and mouth disease. The limited distribution of diseases of the genus is found in contact dermatitis, insect bites, sputum, bee stings, snake bites, burns, fixed drug eruptions, diabetic cancer, and contact dermatitis. The systemic distribution of large water sores is found in herpes zoster, herpes zoster, large cancerous epidermis-releasing drug eruption, erythema multiforme and polymorphic erythematous rash, Staphylococcus aureus scalded syndrome, congenital large cancerous epidermium Solution.
2. Nie's sign examination: Nie's sign positive refers to the pressure on the water sores with finger pressure, the content of water sores with the epidermal uplift and scattered around, this test positive disease is seen in the blisters, large cancerous epidermis release drug eruption , congenital large cancerous epidermolysis, Staphylococcus aureus scald-like syndrome.
Laboratory inspection
(A) skin pathology examination
Skin pathology is an important means of diagnosing water-borne diseases. It is usually divided into epidermal cancer and subepidermal sores with or without epidermal cells under the light microscope. Combined with other characteristics of the disease to make a diagnosis, such as subepidermal sores and a large number of eosinophilic infiltration to consider herpes zoster, subepidermal sores with epidermal eosinophilic necrosis consider pleomorphic erythema. In addition to epidermis and familial benign herpes, epidermial acne is more common with dermatitis and eczema and viral skin diseases, while viral skin diseases are often accompanied by degeneration of epidermal cells, and eczema dermatitis is mainly caused by sponge edema. The description is as follows:
1. Epidermoid sarcoma: refers to the presence of epidermal cells in the bottom of the sore, epidermal sore disease with sponge edema seen in contact dermatitis, eczema, sweat herpes, dermatophytosis, polymorphic rash, Kaposi varicella-like rash, insect Biting dermatitis, herpes-like herpes. Pigment incontinence, pleomorphic erythema. Epidermal malaria with balloon degeneration is found in herpes simplex, herpes zoster, varicella, hand, foot and mouth disease and some primary irritant contact dermatitis, polymorphous erythema, fixed drug eruption, acute acne-like mossy dermatitis, large Cancerous ichthyosis. Epidermal sores with acanthosis are found in herpes, familial benign herpes, follicular keratosis, temporary acantholytic dermatosis, herpes simplex, herpes zoster and chickenpox. Staphylococcus aureus scalded syndrome.
2. Epidermis: refers to the absence of epidermal cells at the bottom of the blister, and there is no or little inflammatory cell infiltration of the epidermis. It is found in congenital large cancerous epidermolysis, acquired large cancerous epidermolysis, and bone disease. Degree of burns, water sores that occur secondary to hypoxia or local stress. Epithelial inflammatory infiltration of inflammatory cells found in erythema multiforme, large hernia epidermis drug eruption, large hernia fixed drug eruption, large cancerous lichen planus, hardened atrophic moss dance, polymorphic sun rash, large cancer Sexual herpes zoster, pregnancy pityriasis, insect bite dermatitis, herpes-like dermatitis, IgA major disease skin disease, large cancerous systemic lupus erythematosus, leukocyte fragmentation vasculitis, major sore pigment and other measles.
Diagnosis
Differential diagnosis
1. Herpes labialis: Herpes labialis (face herpes) is the most common type of herpes simplex. The cause is infection with herpes simplex virus. It appears that there are hot, itching and flushing in the beginning, and then there are dense integrated groups or groups of needle-sized blisters, which are smaller and more clustered than the original blister, ruptured and eroded, exudate, and gradually dry. Hey, after about 1 to 2 weeks, the local pigmentation can be left behind. The damage occurs at the junction of the skin and mucous membranes, such as the corners of the mouth, the lips and the nostrils, and also occurs in the face and lips. Herpes labialis (face herpes) is the most common type.
2. Varicella-like rash: Varicella-like rash lesions are mainly in epidermal spine cells. Cell degeneration and edema form sac cells, the latter liquefy and tissue fluid infiltrate into vesicles, and there are hyperemia, monocytes and multinucleated giant cells infiltrating around and at the base, and eosinophilic inclusions in the nucleus of multinucleated giant cells. The blister contains a lot of virus. It is transparent at the beginning, and becomes turbid due to epithelial cell shedding and leukocyte invasiveness, and becomes pustule after secondary infection. Skin damage is superficial, leaving no scar after dislocation. Mucosal herpes is easy to form ulcers and is easy to heal.
3. Herpes zoster in the tip or nose of the nose: herpes zoster ophthalmicus may be associated with orbital inflammation, conjunctivitis, keratitis, scleritis, uveitis, retinopathy (acute retinal necrosis), optic neuritis, eye Muscle paralysis and so on. 60% of them can develop herpes zoster keratitis, which causes corneal scars and seriously affects vision. There has been a tendency to increase gradually in recent times and it is worthy of vigilance. The occurrence of keratitis occurs mostly after the appearance of rash, especially the presence of herpes zoster on the tip of the nose or the nose, which is a sign of invasion of the nasal ciliary nerve, followed by keratitis and iritis.
