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Non-infectious vesiculopustular dermatoses: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Noninfectious vesiculopustular dermatoses characterized by the presence of sterile pustules in the skin include a large group of diseases, including both generalized and restricted forms. Generalized pustules include herpetiform impetigo, subcorneal pustulosis of Sneddon-Wilkinson, to localized - acrodermatitis Allopo, palmar-plantar pustulosis and pustular bacterium Andrews. The common primary morphological element of all these diseases - a pustule with sterile contents - histologically corresponds to exocytosis of neutrophilic granulocytes with the formation of intra-epidermal pustules. The basis of the histogenesis of the pustules is neutrophil granulocyte chemotaxis due to the presence of chemoattractants in the epidermis, which can be metabolites of arachidonic acid (12HEET, leukotrienes), epidermal thymocyte activating factor (ETAF), activated complement fractions C3a, C5a and C567. To a large extent, the intensity of chemotaxis depends on the properties of the neutrophilic granulocytes themselves.
The etiology of the majority of non-infectious pustular skin diseases remains unclear, but in their pathogenesis, infection and drug effects as provoking factors are important. It is assumed that hypersensitivity mechanisms participate, which is confirmed by the presence of immune disorders.
There is no clarity in their classification, which is largely due to the lack of clear differential diagnostic criteria, especially with limited forms of pustules. The relationship between pustules with ordinary and generalized psoriasis is not clear. Morphological commonality of pustules has given rise to the view that they represent different forms of the same disease. It was suggested to combine them under the common name "pustular psoriasis". A number of authors consider all the diseases included in this group to be pustular variants of ordinary psoriasis. At the same time, one can not but admit that pustular skin diseases substantially differ from each other in the clinical picture, the course and the prognosis. Most domestic and some foreign authors consider pustular diseases belonging to this group as independent nosological units.
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