Bladderwort

  • Treatment of water
  • Bladderwort (pemphigus) is a chronic severe disease of the skin and mucous membranes, characterized by eruption of blisters on unchanged in appearance to the skin or mucous membranes.
    There are bladderwort true, or cantalamessa, and negastriinae.
    To acantholytic the disease include the following her clinical varieties: vulgar vegetating, leaf and seborrheic, or erythematous.
    For all clinical varieties true bladderworts presence of acantholysis (one form of degenerative changes in the cells of the epidermis, which is the melting of intercellular bridges, degenerative changes of the nuclei and the loss of part of protoplasm; the result is a violation of communication not only between cells maleyevka layer, but also between the layers of the epidermis. These so-called cantalamessa, the cells are easily found in smear-print, taken from the bottom of the bubble or surface erosion. Each clinical stage corresponds to a certain cytological picture. Bubbles are formed due acantholyda inside of the epidermis. Acantholytic hand, foot ill more often than people aged 40 to 60 years. In childhood, the disease is observed very rarely.
    To negastriinae the bladderwort referring negastriinae the bladderwort (bullous pemphigoid), Muco-sieheandy atrofidagi bullous dermatitis (a disease of the eye, rubcowskii pemphigoid) and benign negastriinae a disease of the mucous membrane only the mouth. When negastriinae the bladderwort bubbles are formed as a result of inflammatory process.
    Etiology water is not clear.
    vulgar bladderwortVulgar disease. More than half of the patients the disease begins with a defeat mucous membrane of the mouth or lips. Bubbles on the mucous membrane is detected seldom as their tires easily destroyed, leaving erosion, which normally resides on an unmodified mucosa. Blisters on the skin first, stressed and have transparent (sero) content; formed erosion pale pink or bright red, and exudate shrinking in loose or dense cover. In the initial phase of water, which can last from several weeks to several months, lesions of the mucous membranes or skin subjective feelings do not cause or they are minimal. In the phase of deterioration eruptions increases, often formed the great, very painful erosive the surface, appear insomnia, irritability, depression of mind, and the failure of the diffuse nature of the mucous membrane of the mouth and lips difficulty eating. Some patients increased body temperature.
    Vegetative disease occurs much less frequently than the vulgar. Bubbles, smaller than when vulgar hand, foot, located on the mucous membranes of the mouth, lips, around the natural orifices of the body and skin folds. Abundant separated from the surface lesions publishes an unpleasant smell. On the surface erosion formed papillomatosis growths resembling a wide condylomas inherent secondary recurrent syphilis. Patients complain of pain in the centers.
    Leaf disease is characterized by a very superficial position the flat bubbles with thin tires. The surface of the resulting erosion covered with a thin leaf crusts. The process quickly spreading to the entire skin, but the phenomenon cachexia grow slowly, the disease lasts for years.
    Seborrheic (erythematous) disease begins with lesions of the skin of the face, scalp, back and chest. At first appear erythematous-squamous lesions resembling seborrheic eczema , or lupus erythematosus. Later defeat takes widespread lesions covered with a greasy yellowish scales, surface appear poorly tense bubbles, erosion, soft cover.
    When all varieties true water in the phase of deterioration found cantalamessa cells and, as a rule, well-identifies a symptom of St. Nicholas (stretching for scrap tires bubble seemingly unchanged upper layers of the epidermis rejected like a tape).
    For all clinical forms of the true bladderworts disease gradually progresses, develops cachexia; the lethal outcome.
    Actually negastriinae bladderwort (bullous pemphigoid) has several clinical variants: generic, polymorphic and monomorphic and actually negastriinae disease mucous membranes. Bubbles tense, are formed under epidermis (the epithelium). This form of water often reminds dermatitis herpetiformis of during (see during illness); unlike the latter, subjective feelings expressed less, samples with potassium iodide is negative.
    Forecast when actually negastriinae the hand, foot, unlike the true water, relatively favorable. Actually negastriinae disease usually occurs in elderly and senile age.
    Muco-sieheandy atrofidagi bullous dermatitis (eye disease, disease of the conjunctiva, rubcowskii pemphigoid) occurs mainly in older people. Bubbles with the subsequent scarring, adhesions and atrophic areas occur on the skin and mucous membranes of the eyes, mouth, nose, throat, esophagus and genital organs. The disease is many years, can lead to blindness, a narrowing of the esophagus.
    Bubbles are the subepidermal (acantholyda not).
    Benign negastriinae disease of the mucous membrane only the mouth characterized by the appearance of subepithelial (without the effects of acantholyda) bubbles only on the mucous membrane of the oral cavity. Are mostly women older than 40 years. The disease tends to own emerging remissions.
    In all forms negastriinae water symptom of St. Nicholas is missing, however, may be a detachment of the entire epidermis on distance of 3-5 mm from the fire.


    Bladderwort (pemphigus; from the Greek. pemphix, pemphigos bubble) is a severe disease of the skin and often mucous membranes; characterized by a rash of blisters on unchanged in appearance to the skin or mucous membranes. With application in the treatment of corticosteroid outcome of the disease for most patients now is not fatal.
    To the group of the true, or acantholytic, bladderworts include the following types of water: vulgar (p. vulgaris), the vegetative (p. vegetans), leaf (p. foliaceus) and seborrheic, or erythematous (p. seborrhoicus, s. lupus). Some authors refer to this group and the Brazilian bladderwort (fogo selvagem, considering it to be a variant of the leaf. The disease occurs more often at the age of 40-60 years, mostly in women.
    To the group of so-called negastriinae bladderworts are actually negastriinae disease, or bullous pemphigoid, Muco-sieheandy atrofidagi bullous dermatitis (disease of the eye) and benign negastriinae disease of the mucous membrane only the mouth. These diseases are characterized, in addition to the clinical features, mostly satisfactory forecast for the life of the patient.
    The term "disease" is also used to refer to other diseases characterized by rash bubbles: disease of newborns, congenital disease, syphilitic disease and other
    Etiology true bladderworts not clear. There are several theories of its origin: viral, neurogenic, metabolic disorders (especially water-salt), endocrine, enzyme, toxic and, finally, inheritance, having the least number of supporters.
    Vulgar disease. More than 60% of patients with the disease begins with a defeat mucous membrane of the mouth or lips, but the bubbles in such localization is possible to observe rare, because of their thin tires, easily broken. The resulting erosion are apparently unaltered on the mucous membrane. Blisters on the skin, usually more or less stressed and initially filled with clear serous content. Erosion have pale pink or bright red color, the surface can be covered with thick serous or even a purulent exudate, which often shrinking in peel. On the defeat of pigmentation different degrees of intensity.
    In the initial stage, which can last from several weeks to several months, on the skin or mucous membranes appear isolated bubbles, erosion quickly epiteliziruyutsya. General condition of the patient satisfactory, subjective feelings are absent or minimal.
    In the acute stage (generalization) precipitation bubbles increases, erosion often merge, forming extensive erosive surface. On the mucous membrane of the mouth and a red border of the lips erosion also merge with each other, very painful, eating is often extremely difficult. Significantly worsens the General condition of patients: increased temperature, appear insomnia, irritability, depression. At the further progression of the disease and the growing phenomena of intoxication develops cachexia. If there is no improvement spontaneous (rarely) or under the influence of corticosteroid therapy, the stage of generalization ends with the destruction of the patient.
    In the treatment of corticosteroid drugs, usually comes epithelization; new bubbles appear less and less. The General condition of the patient improves, reduced work capacity. In the future when getting sick "supportive" of daily doses of corticosteroids on the skin or mucous membranes may appear a few small bubbles, but the resulting erosion quickly epiteliziruyutsya and General condition of the patient is not violated if the disease again passes in a stage of exacerbation.
    Some authors [Brock (L. Brocq), S. I. Pavlov and others] distinguish particularly malignant form vulgar water - p. subacutus malignus.
    Vegetative bladderwort allocated by Neumann (I. Neumann). The disease often starts with lesions of the oral mucosa, but quickly bubbles appear around the natural orifices of the body and in great folds of the skin. At the opening of bubbles on the surface erosion formed papillomatosis expansion. Abundant separated from the surface lesions easily decomposed, making a very bad smell. Apply pockets at the expense serpiginous growth, the lesions are very similar in the wide condylomas inherent secondary recurrent period of syphilis. Patients complain of pain in the centers, burning and sometimes itchy. With the progression of the process, the disease also ends lethally.
    Leaf disease described by Casanova (P. L. Cazenave); characterized superficially located flat bubbles with thin tires, which are easily destroyed. Pale pink surface erosion is usually covered with a thin plate crusts. Sometimes large areas of skin are continuous wet (dry places) erosive surface. The process quickly spreading to the entire skin, often falling hair and have severe nail dystrophy. Periodically the process fades out. Some patients with long-term existence of the foci on their surface there are papillomatosis and verrucose expansion. Phenomena cachexia grow slowly, and the process can continue for many years. Initial manifestations of leaf water on the mucous membrane of the mouth is not, in General, the mucous membrane of the oral cavity is affected very rarely.
    Seborrheic disease [synonym: erythematous bladderwort (p. lupus), the syndrome of Senir-usher] described by stirom and usher (F. Senear, Century Usher). The disease begins with a defeat in the face, chest, back and scalp. At first appear erythematous-squamous lesions that look just like seborrheic eczema, or lupus erythematosus. After removing the scales on the surface of the lesion becomes slightly moist, often with point recesses. Later defeat takes widespread. Lesions covered with a greasy yellowish scales, loose crusts. Appear surface, slightly strained bubbles. The mucous membrane of the oral cavity are often involved in the process proceeds very slowly and relatively benign. For some patients seborrheic disease can be transformed into leaf or vulgar form with the appropriate period.
    Brazilian disease is observed pandemicheskim mainly in region R. the Amazon. The disease begins with the appearance of a flat bubbles and reminds of the clinical picture of a leaf disease. The chronic course there are ankylosis of large joints, muscular atrophy and Breasts in women. The mucous membrane of the oral cavity is not affected. Unlike leaf water, forecast at it a little better. The disease is observed at the age of 10-30 years.
    For all clinical varieties true water in the acute stage, you can find symptom P. C. Nicholas (1896), which is expressed in the detachment of the epidermis (the epithelium) during a finger under slight pressure on apparently unaltered skin or in the stretching for scrap tires bubble.
    Histopathology true water. Acanthosis is an integral pathogenetic link for all clinical varieties true water. As a result of acantholyda, which is melting protoplasmatic cellular processes (bridges), the loss of supporting apparatus (monofiber) cells and degenerative changes of nuclei, is a violation of communication not only between individual cells maleyeva layer, but also between the individual layers of the epidermis. Such altered cells (cantalamessa cells bladderworts) can be easily found at the bottom of blisters or surface erosion (Fig. 1). To detect these cells Tank (A. Tzank) proposed to explore scraping the bottom blistering, or erosion. In our country this purpose applied research is not the scraping and smear-prints. Each clinical stage of water corresponds to a certain cytological picture. Cantalamessa cells have all patients in the acute stage (generalization) process, whereas in the initial stage and during epithelization they are not always (various degree of severity of acantholyda).
    Treatment true bladderworts spend corticosteroid drugs (cortisone, prednisone, prednisolone, triamcinolone, dexamethasone and other). First (for 12-15 days) appoint a "shock" doses of the hormone, for example 40-60-80 mg prednisolone, resulting tend to stop new lesions. Then (every 3-5 days) gradually reduce the daily dose of 2.5 - 5 mg to establish a minimum, support, equal to an average of 20-5 mg or less. Treatment of "supporting" daily doses of corticosteroids carried out for many months and years.
    Therapy corticosteroid drugs, especially if it lasts for a long time, causes a number of side effects: increased blood pressure; blood, exacerbation of ulcers stomach and duodenal ulcer, disorder of carbohydrate metabolism ("steroidnyi diabetes, syndrome Itsenko - Kushinga, osteoporosis and Many other side effects can be prevented or reduced by assigning appropriate symptomatic therapy. The diet of patients, the true water should be rich in proteins, vitamins, at the same time it is necessary" to limit the consumption of carbohydrates and salt.
    The beginning of the treatment of corticosteroid drugs, especially in the appointment of high doses, should be in hospital. In outpatient conditions can be treated with a "maintenance" doses of corticosteroids. Thus it is necessary to regularly examine the urine and blood sugar, and periodically examine the blood protrombina. Some value in therapy true water (in particular, seborrheic) is Germany, which is injected 0.3-0.5 - 1 g at intervals of 3-5 days before General: dose at 6-8, Antibiotics prescribed for: the emergence of intercurrent diseases.
    Benign family chronic disease of Guiera - Hailey-Hailey (Gougerot, Hailey-Hailey) is characterized by the appearance mainly on the skin of the neck, shoulders, axillary, inguinal femoral: folds small bubbles, erosions, peel, and little vegetation. The symptom Nikolsky positive in close proximity to the lesions. In smears-fingerprints from the surface erosion also found cantalamessa cells, but unlike cells: when vulgar disease, they are smaller and monominee. The disease can begin at any age, family-his character is marked not always. The forecast is favorable.
    Treatment: in the periods of exacerbation used corticosteroids, antibiotics, large doses of vitamin a, lesions are treated alcohol solutions of aniline dyes and liquid Castellani. Actually negastriinae disease, or bullous pemphigoid has the following clinical varieties: universal, when affects the skin and mucous membranes, monomorphic polymorphic and varieties (affected only the skin) and the actual negastriinae the disease mucous membranes (with the defeat mucous membrane of the mouth, nose, throat, genital organs). Bubbles are formed under epidermis, the phenomena of acantholyda not observed; blisters on the skin often hemispherical shape tense. In some patients, along with blisters on the skin there are spots, articipatory elements (polymorphic variant), which is very reminiscent of the clinic dermatitis herpetiformis of during. Unlike the latter, subjective sensations (itching, burning) is expressed less, samples with potassium iodide is negative, diamino-divinylsulfide (DDS) do not have a therapeutic effect. When negastriinae the disease symptom Nikolsky missing.
    Treatment: prednisolone in moderate daily doses (40-30 mg), with readings - antibiotics; treatment of lesions alcohol solutions of aniline dyes; treatment is usually effective, but the recurrence of the disease are observed. The forecast is favorable, if the disease does not burden the accession of intercurrent diseases.
    Disease of the eye, kongyunctiv [pemphigus ocular (pemphigus ocularis, s. conjunctivae); synonym: Muco-sieheandy atrofidagi bullous dermatitis, rubcowskii pemphigoid, benign pemphigoid mucous membranes] may occur at any age, but most often in the elderly. Affected the mucous membrane of the eye that leads to the fusion of the conjunctiva of the eyelid conjunctiva of the eyeball (symblepharon) and a narrowing of the palpebral fissure (Fig. 2). Developing ophthalmolabus sometimes leads to complete blindness. Rash in the form of bubbles and subsequent scarring, adhesions and areas of atrophy may occur initially or after the defeat eye on the mucous membranes of the mouth, nose, throat, esophagus and genital organs. Smooth skin and scalp are in the process considerably less. The disease is flowing many years and has almost no influence on the General condition. The danger lies in the formation of growths between involved in the process of mucous membranes, eventual blindness and, finally, the development of the strictures of the esophagus until it perforation. Bubbles are anatomically subepidermal, phenomena of acantholyda missing. For some patients, there is a spontaneous cure. The purpose of prednisone in daily doses from 40 to 20-15 mg in combination with delagil (chloroquine, rethinam) 0.25 g twice a day during the month of repeated courses are usually significantly improves the disease.
    Benign negastriinae disease of the mucous membrane only oral described B. M. and N. Pashkov. D. Shellakovym. In this disease the subepithelial bubbles without the effects of acantholyda arise only on the mucous membrane of the oral cavity (Fig. 3). They are located on unmodified or slightly damaged mucous membrane of the sky, cheeks, lips, gums, and tongue. Sometimes bubbles are formed in several minutes after an energetic potiranie mucous membranes, for example cheeks with a spatula. The disease is marked mainly in women older than 40 years who are prone to spontaneous remissions and quite resistence to therapy cortical steroids in moderate therapeutic doses and antimalarial drugs number (delagil, chloroquine, Raskin). Scars, atrophy, adhesions on the location of the rash is not observed.

    Fig. 1. Cantalamessa cells bladderworts (X 750).
    Fig. 2. Rough spike conjunctiva age when disease of the eye.
    Fig. 3. Negastriinae bladderwort (bullous pemphigoid): the defeat of the red border of the lips and tongue.