Acrodermatitis

Acrodermatitis is a chronic disease with a primary lesion of the skin of the extremities. The etiology is unknown. There are the following forms of acrodermatitis.
1. Acrodermatitis enteropathic. Develops in early childhood age, characterized by vesico-bullous rash on the skin around the mouth, on the legs and around the anus, baldness, blepharitis, diarrhea, delay Rota, depletion. The disease is severe. Possible death. Treatment: drugs hydroxyquinoline solution - dyadkin, anteroseptal 1 - 1,5 g a day, etc. for a long time (years) under the supervision of a physician.
chronic atrophic acrodermatitis2. Acrodermatitis chronica chronic. Occurs more often in women after 40 years. Characterized by erythema and swelling on the rear feet and hands, in the field of knee and elbow joints, consistently extends to the entire limb. Gradually affected skin atrophy (Fig. 1). Treatment: penicillinate (course 10 000-15 000 000 000 IU), vitamin E 1/2 chain. L. 3 times a day.
pustular acrodermatitis of Gallop3. Acrodermatitis pustular Gallop. Starts with paronychia (inflammation of the soft tissues surrounding the nail), gradually moving to the skin of hands, forearms (Fig. 2)sometimes the feet and lower legs, where erythematous background, there are multiple pustules; nail plate fade, thicken. Treatment: corticosteroids (by prescription), multivitamin, bath with potassium permanganate (red solution); pustules open, grease aniline dyes (methylene blue, brilliant green and others). Forecast when acrodermatitis against life favorable, with the exception of severe forms enteropathic acrodermatitis of infants.

Atrophicans (acrodermatitis; from the Greek. akron limb and derma, dermatos - skin) - a group of diseases characterized by lesions of the skin of the extremities. There are the following forms of acrodermatitis.
Acrodermatitis chronica chronic [acrodermatitis chronica atrophicans (candidate of Herxheimer reaction, E. Hartmann); synonym: skin atrophy idiopathic progressive (atrophia cutis idiopatica progressiva; A. I. Pospelov), eritropenia (erithromelia; J. Pick)] it is indicated in adults, mostly women. The etiology is not installed, there is an assumption about the infectious nature of the disease spirochete, viral infections). Histologically under erythema - swelling and inflammatory infiltration of the dermis. Infiltrate composed mostly of lymphocytes and histiocytes. The walls of blood vessels infiltrated, endothelium swollen. In the stage of atrophy sharp thinning maleyeva layer of the epidermis, dermis and fatty tissue. Collagen fibers homogenized, pale colour. Hair follicles and sebaceous glands atrophied, the sweat glands are partially preserved.
Chronica atrophicans begins with erythema congestive-bluish color, more often localized on the skin rear feet and hands, as well as in the elbow and knee joints. In most cases, affected skin of one limb, rarely occur symmetric changes and on the other limb. Very slowly erythema cover all the skin of the affected limb. Subjective feelings are absent or are manifested a sense of tingling, less neuralgic pains. After many months and even years gradually comes skin atrophy of the affected limb. Skin becomes thin, becomes wrinkled and reminds creased tissue paper (A. I. Pospelov). Through thinning the skin Shine wide Vienna, on its surface it is often stated plate desquamation. In some cases, along with atrophy was observed seal skin (pseudosclerotia), usually at the rear of the feet and lower third of the leg or in the form of a tape on the front surface of the tibia or ulnar surface of the forearm. Sometimes produce dense or soft nodes (pseudohistory, lipoma) around the knee or elbow. As a complication may arise trophic ulcers.
Treatment: injections of penicillin. Just spend 1-2 courses on 8-10 million IU per course.
Acrodermatitis pustular Gallop [acrodermatitis continue suppurativa (N. Hallopeau)] is a chronic disease that has lasted for many years with short breaks. The etiology is unclear. Histologically are found in the epidermis parakeratosis, moderate acanthosis extension epidermal processes and the so-called spongiforme pustules Cogoa. Pustules are formed in the highest ranks of the styloid layer as a result of migration of neutrophils in edematous awl-shaped cells that causes the destruction of their cytoplasm and nuclei. The membrane of the cell remains. The result is a spongy network, in which continue to accumulate neutrophils. Gradually in the center of the lesion shell subulate cells are destroyed, the formed cavity. On the periphery of hearth mesh structure lasts longer. In the dermis - inflammatory infiltrate, mainly from neutrophils. Clinically pustular acrodermatitis is characterized vsapaniem on hyperemic the basis of superficial small pustules, less bubbles, consistently podsypaya with the formation of conococheague. First, the process is localized on the Palmar and dorsal surfaces nail phalanxes of one or more of the fingers (sometimes symmetrically), rarely on the bottom and the rear surfaces of the nail phalanx of the toes. Consistently a rash spreading proximally on the surface of the skin of the fingers of the hand and foot. The affected skin becomes cyanotic-red, as if stretched and shiny; its surface is marked peeling and the formation of new pustular elements. Nails beginning to fade, then deformed and finally fall away. Subjective sensation, less neuralgic pain. In some cases, there may be dissemination rash on the entire skin surface. Rarely affects the mucous membranes of the mouth, vagina. The prognosis is poor. Treatment: corticosteroids, arsenic, radiotherapy, rays Bucky tray; local - warm bath with kaliem, mitigating and disinfecting materials.


Acrodermatitis enteropathic (acrodermatitis enteropatliica) first described Brandt (So Brandt) and consistently by Dbbolton and Kloss (N. Danbolt, K. Closs). Relatively rare chronic relapsing disease; expressed lesions of the skin and gastrointestinal tract. Often a family nature. The etiology is unknown. Microscopic and culture of the affected skin, mucous membranes, and urine and feces, almost as a rule, are found yeast-like fungi of the genus Candida. However, most researchers do not gives them value etiological factor, and is regarded as secondary infection, complicating the course of atrophicans (the absence of the effect of treatment with nystatin and external use of antifungal drugs).
Enteropathic acrodermatitis begins in the first months (sometimes weeks) of a child's life simultaneous damage of the skin and intestines. The intestinal damage reveals persistent diarrhea and loss of appetite. Skin changes are localized on the face around the mouth, nose, eyes (blepharitis), in the armpits, buttocks, perineum, genitals, century inguinal-femoral folds, and on the hands and feet, in the area of knee and elbow joints, usually symmetrical. They are expressed in the eruption of vesicles, flat blisters and pustules, often grouped together and fusing. Consistently formed massive cover, limited eroded surface and flaky psoriazopodobne plaques with sharp edges, wrong scalloped shape. Often there are paronychia and onykii, the defeat mucous membrane of the oral cavity (erosion, stomatitis, glossitis). Very typical hair loss to complete baldness. During remission in the hair can grow back, but at relapse again fall. As a rule, abruptly delayed the growth of sick children and weight gain. During remission growth resumes and weight arrives. The blood marked acceleration ROHE, leukocytosis, hypochromic anemia. Sick children lethargic, apathetic, sometimes restless, irritable, several mental disabilities. Characteristic is the fact that the child holds his head drooping (because photophobia) and slightly tilted to the side.
For enteropathic of acrodermatitis undulating, with the change of relapses and spontaneous remissions. Over time, the recurrences are taking an increasingly heavy and continuous nature, and in a few years, the disease leads to death. In some cases there an easier course with a duration of up to 18 or even to 46 years.
Also described spontaneous healing in puberty.
Treatment: for best results, use inside dyadkin and its analogues (anteroseptal and others); average daily dose of 650-1000 mg Consistently dose to reduce support (250 - 500 mg). At the same time appoint vitamin b complex, ascorbic acid, 10% solution of calcium chloride, injections of gamma globulin, transfusions of plasma.