Herpetiform Impetigo Hebra

Herpetiform impetigo (syna herpetiform impetigo of Gebra) is a disease with severe course and possible fatal outcome. It usually develops in the second half of pregnancy, but occasionally similar changes occur in men.

The disease was first described in 1872 by Hebra. Herpetiform impetigo is very rare. Mostly pregnant women are ill, but sometimes this disease affects non-pregnant women, men and children.

[1], [2], [3], [4], [5], [6], [7]

The causes of herpetiform impetigo Gebra

There is no single point of view about the origin of the disease. In patients with herpetiform dermatitis, the endocrine gland (parathyroid and sexual) function is often noted. This is evidenced by the fact that the disease mostly occurs during pregnancy or in the puerperal period.

There is an infectious theory, as the contents of pustules are sterile in some cases, in others - contains staphylococci or streptococci.

Histopathology of herpetiform impetigo Gebra

In the uppermost parts of the Malpighian network is a pustule, which is formed due to the penetration of neutrophils, which causes the destruction of the protoplasm and nuclei of the epithelial cells. The remaining cell walls form a spongy network with neutrophils in it - the so-called spongioform pustule Kagoi, which is a hypertrophic form of the Munro microassembly. Infiltration in both the dermis and the epidermis contains many eosinophils.

The pathomorphology of the herpetiform impetigo of Gebra is characterized by the presence of spongioform pustules of Kogoya in the upper parts of the epidermis. Large pustules are sometimes located under each other. The contents of pustules are neutrophilic granulocytes sometimes with an admixture of mononuclear cells or eosinophilic granulocytes. In the dermis, pronounced edema, vasodilation and inflammatory perivascular infiltrates of a lymphogistocyte character or with an admixture of neutrophilic and eosinophilic granulocytes, tissue basophils.

Histogenesis of herpetiform impetigo Gebra

With the flow and prognosis, herpetiform impetigo is very close, if not identical to the primary-pustular form of generalized pustular psoriasis. At the same time, some authors consider it a pustular variant of ordinary psoriasis or an independent nosological unit. Great importance in the development of the disease is given to hormonal disorders (sex hormones, parathyroid hormones), hypocalcemia, hemolytic streptococcus, immunity disorders. It points to the role of incompatibility of the mother and fetus in the HLA system. According to the immunomorphological characteristics of the herpetiform impetigo close to the bullous pemphigoid, deposits of the IgG, IgA and C3 complement components in the basal membrane of the epidermis, circulating antibodies against the epidermal basement membrane, are found.

Symptoms of herpetiform impetigo Gebra

Small grouped pustular eruptions are localized mainly on the trunk and in the folds of the skin on the hyperemic edematous background. Due to the spread of the periphery, foci can occupy large areas of the skin. When the pustules dry out, peeling appears in the form of a collar facing the center of the element. After resolving the process, hyperpigmentation of the skin often remains in place of the elements. Eruptions are accompanied by a marked violation of the general condition of the patient (loss of appetite, headache, fever with chills, arthralgia, etc.).

On the inflammatory, edematic background appear herpetiformly located miliary or small pustules that partially merge with each other. Elements, spreading centrifugally, form annular lesions. In this case, figures of the iris type can be formed, i.e. Rings in the rings. Pustules contain greenish-yellow pus, after the outflow of which the lesions are covered with dirty brownish crusts. Itching is absent. The process does not leave persistent traces, as well as pronounced pigmentation. The pathological process is often localized in the groin, in the navel, on the inner surfaces of the thighs, in the armpits, in the mammary glands, and then can gradually capture all or almost the entire surface of the skin. Often the mucous membranes of the oral cavity are involved, sometimes the mucous larynx, esophagus, conjunctiva. The disease is accompanied by severe common phenomena: prolonged or intermittent septic fever, headache, chills, vomiting, diarrhea, joint pain, etc. The disease often recurs. In the blood of eosinophilia is not observed, there is an increase in ESR.

Differential diagnosis

The disease must be distinguished from herpes simplex, pustular psoriasis, subcorneal dermatitis, Gallopo acrodermatitis.

Treatment of herpetiform impetigo Gebra

Recommended glucocorticosteroids in combination with antibiotics, calcium preparations, vitamin D. Locally used aniline dyes, steroid ointments. Often patients need intensive care.