Andrews pustular bacteriride: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Pustular disease of Andrews arises in the presence of foci of infection in the body, so in its pathogenesis, great importance is given to hypersensitivity reactions to streptococcal antigens. Clinically, the appearance on the unaltered skin of the palms and soles of the blisters and small pustules. Bubbles quickly turn into pustules, which are characterized by rapid growth; their diameter sometimes reaches 5-10 mm, they are surrounded by a narrow rim of erythema. Eruptions are usually resolved within 2-3 weeks, if the disease-provoking factor is eliminated.
The pathomorphology of the Andrews bacillus pustularis: moderate acanthosis, hyperkeratosis, focal parakeratosis, intraepidermal pustules and blisters surrounded by a zone of indistinctly expressed spiroidosis. Pustules are sometimes located one under the other. The pustule cover consists of several rows of granular and prickly epitheliocytes, covered with horny scales. Pustules contain fibrin, neutrophilic granulocytes, single lymphocytes and the remains of destroyed epithelial cells. In the spinous layer - exocytosis. In the dermis - edema, vasodilation and pronounced perivascular infiltrates, consisting of lymphocytes, histiocytes and neutrophilic granulocytes, sometimes with an admixture of plasma cells.
The nosological affiliation of the bacterium Andrews is debated. A.A. Kalamkaryan et al. (1982) deny the existence of this disease, some consider it a localized form of subcorneal pustules, some as a kind of palm-plantar pustules, and DM Stevens and A.V. Ackemian (1984) - palmar-plantar psoriasis.
Based on several observations, it is believed that clinically and histologically the bacterium of Andrews differs significantly from other localized pustules. Clinically - the presence along with pustules of small vesicles, as well as the rapid dynamics of rashes, histologically - the presence of an eczematous reaction and the absence of spongiform pustules.
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