Persistent pustular acrodermatitis Allopo: causes, symptoms, diagnosis, treatment

Acrodermatitis resistant pustular Allopo (synonyms: acropustulosis, Crocker's persistent dermatitis) is a chronic relapsing disease characterized by the defeat of the coccyxes of the fingers and toes, on which there are pustular eruptions prone to spread.

The causes and pathogenesis of persistent pustular acrodermatitis Allopo have not been established. Some scientists believe that the disease is based on an infectious agent. However, the content of the flicken and pustules and the patient's blood are often sheril. Other scientists consider generalized pustular psuniosis Tsumbush, persistent dermatitis Allopo and herpetiform impetigo of Gebra as one disease. Clinical observations of the author allow us to consider persistent acrodermatitis as an independent dermatosis.

Symptoms of persistent pustular acrodermatitis Allopo

The onset of the disease is usually associated with minor trauma or pyoderma. Eruptions are localized on the palms (hands and feet), especially in the area of distal phalanges around the nail plates, in the form of pustular, vesicle or erythematoma-squamous elements. In the beginning, the process is localized, asymmetric and unilateral, more often one, mostly large, finger of the hand is affected, then the other fingers of the hands, less often the legs, are involved in the process. Clinically distinguish pustular, vesicular and erythema-squamous forms of the disease. Over time, lesions can spread to adjacent areas of hands and feet, rarely - the entire skin. Some patients experience secondary atrophic skin changes.

With pustular and vesicular forms, the nail ridges are swollen, red (hyperemic), infiltrated. With pressure on the nail plates pus is secreted. Multiple pustules and vesicles appear on the affected phalange, which are opened, forming erosions, then covered with crusts and scales. The fingers become cylindrical in shape, flexing and unbending them is difficult due to soreness. After the ablation of the inflammatory process, a slight atrophy and tender reddish skin remain at the site of the rashes.

When viscous-squamous, the affected fingers are red, dry, flaky and have superficial cracks. Nail plates with a light current of dermatosis on its surface have furrows, dullness, and with a pustular form there is an onycholysis or nail plates fall away.

The disease can sometimes be malignant. In this case, the spread of the process to the entire skin, the loss of nails, finger mutilation are noted.

Histopathology of acrodermatitis of persistent pustular Allopo. The histological examination is characterized by the presence of spongiosiform pustules of Kagoya, as well as with pustular psundosis of Tsumbush and herpetiform impetigo.

Pathomorphology of acrodermatitis of persistent pustular Allopo. Expressed acanthosis with elongation and expansion of epidermal outgrowths, hyperkeratosis, parakeratosis, and later - thinning of the epidermis. A characteristic histological feature of this disease is the presence of spongioform pustules of Kogoy. Large pustules are sometimes located under each other, their cover is formed by a thin stratum corneum, in the base are small spongioform pustules. Pustules contain neutrophilic granulocytes, single epithelial cells. In the dermis, edema, vasodilation and a significantly burned inflammatory infiltrate from neutrophil granulonites, lymphocytes, histiocytes and a small number of plasma cells are noted.

Histogenesis has been studied little. It is unclear whether Allopo's persistent purulent acrodermatitis is a localized variant of pustular psoriasis or an independent dermatosis.

Differential diagnosis. Differentiate the disease with pustular psoriasis, eczema, pyoderma, Andrew's pustular bacterium, Dühring's herpetiform dermatitis.

Treatment of persistent pustular acrodermatitis Allopo

Treatment depends on the clinical course and intensity of skin changes. For systemic therapy, use etretinate, corticosteroids, PUVA-therapy, cyclosporine or methotrexate. For local treatment, Castellani paint, calcipatriol, ointments containing corticosteroids and antibiotics are recommended.

[1], [2], [3]