Dermatitis herpetiformis

Introduction to herpes-like dermatitis Herpes simplex dermatitis (dermatitisherpetiformis), also known as Duhring-Brocq disease, is a benign, chronic relapsing, symmetrical, pleomorphic skin disease with severe burning and itching and herpes-like blisters, often accompanied by gluten sensitivity Enteropathy. It can happen suddenly, or it can start slowly, with significant itching and burning pain. Intense itching is the most important clinical symptom of this disease. basic knowledge The proportion of illness: 0.04%-0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: erythema

Cause of herpes-like dermatitis

Genetics (40%):

The etiology is unclear, patients have higher HLA-B8 and HLA-DW3 antigen frequencies, and there is evidence that these antigen genes are closely related to genes that regulate immune responses, and some are involved in the development of herpes-like dermatitis, indicating that the genes are in herpes-like The pathogenesis of dermatitis plays an important role.

Dietary factors (10%):

Gut allergy is 60% to 70% in herpes-like dermatitis. Eating gluten-containing food can aggravate herpes-like dermatitis and gluten allergic bowel disease. Some patients have confirmed jejunal villi atrophy by biopsy and eat iodine-containing food. It can be aggravated in some patients. It is not clear whether IgA skin precipitation plays an important role in the formation of bullae. In almost all patients, IgA and C3 are deposited on the skin of normal skin and lesions in granular form on the top of the dermal papilla, IgA. It is possible to activate complement, neutrophils undergo chemotactic reactions, and the enzymes that release them cause tissue damage.

In general, genetic factors, gluten allergy and autoimmune factors may play a role in the occurrence of this disease.

Herpes-like dermatitis prevention

1, treatment and prevention of herpes-like dermatitis, we must first start from the usual life diet. Reduce salt intake; do not eat drugs containing iodine, bromine (such as Huasu tablets) or food (such as seaweed, kelp); give a gluten-free (gluten) diet, should eat rice or whole grains.

2, pay attention to work and rest, relax emotions, avoid worry, anger and excessive thinking. You should also go to the hospital for a thorough examination to rule out the possibility of visceral malignancies.

Herpes-like dermatitis complications Complications

The whole body has different sizes, and the erythema and blisters that accumulate in groups are recurrent and consciously itchy.

Herpes-like dermatitis symptoms Common symptoms Itching itching Seasonal light erythema herpes Herpes stratum corneum excessive thickening Wind group papules Eczema Limbs Mossy-like tension

Can occur suddenly, but also slowly onset, with significant itching and burning pain, severe itching is the most important clinical symptom of the disease, the damage can occur symmetrically in the scapular region, buttocks and scalp and forearm extension, including elbow and Calf, skin lesions are pleomorphic, with erythema, wheal, papules and blisters, but the most obvious blisters, blisters occur on the erythema base, from mung bean to grape size, can be arranged in groups, the blister wall is tight, not easy to rupture, Negative Nissl's sign, oral mucosa is generally not infringed, some skin lesions can be eczema and lichenification, progressive pigmentation occurs in about 50% of patients with lesions, chronic disease can be repeated and relieved for more than 10 years .

Herpes-like dermatitis

Laboratory inspection

1. Check the eosinophils on the surrounding blood and blister smears.

2. Direct immunofluorescence staining of the living tissue of the skin to examine the presence or absence of IgA deposition in the basement membrane area and the superficial dermal papilla.

3. If necessary, make a X-ray examination of the meal, pay attention to the phenomenon of malabsorption of the small intestine.

Histopathology: There is no acanthosis in the epidermis, and the blisters contain many eosinophils and neutrophils. The basement membrane positive for PAS staining is located on the dermal side of the blisters. The erythema lesions and the vesicular margin of the blister are visible. Cells, eosinophils and neutrophils composed of inflammatory cell infiltration and edema, typical papillary microabscess on the top of the nipple, containing neutral, eosinophils and nuclear dust, after which the dermis and epidermis Small blisters can be fused into a single atrial blister. Indirect immunofluorescence has circulating anti-retinal antibodies in 40% to 60% of patients. Direct immunofluorescence shows that granular IgA is deposited on the top of the nipple. This is important. Diagnostic value.

Diagnosis and diagnosis of herpes-like dermatitis

diagnosis

1. Diagnostic points

Polymorphic lesions, mainly vesicular lesions, clustered in the trunk and extremities, severe itching, histopathological examination for epidermis blister, blister and dermal papilla with neutrophils, direct immunofluorescence Check for granular IgA deposits at the dermal papilla.

2. Chinese medicine pathogenesis and syndrome differentiation

(1) The disease is mostly due to spleen loss and health, spleen and dampness, exogenous wind and evil, rheumatism, and stagnation of heat, which occurs in the skin.

(2) TCM syndrome differentiation:

Main card: There are different sizes of the whole body, erythema clusters, blistering, repeated attacks, conscious itch, low body temperature, poor sleep, less food, heavy limbs, red tongue, white or greasy fur, slippery pulse Micro number.

Dialectical: spleen and dampness, exogenous wind and evil.

Differential diagnosis

1. The disease should be differentiated from pemphigus and pemphigoid diseases.

2. IgA linear bullous skin disease is clinically indistinguishable from herpes-like dermatitis, but direct immunofluorescence shows that IgA is linearly deposited under the basement membrane with a transparent plate or dense plate, but not deposited on the dermal papilla. , gluten-free allergic bowel disease, no allergic reaction to iodine.

3. The erythema of erythema is short, and it recovers in a few weeks. The skin lesions are better than the hands, feet, forearms, calves, face, neck, mucous membranes of the lips, etc., and the iodine test is negative.

4. Under the cornea, pustulosis is more common in women. The primary lesions are mostly loose pimples, which are ring-shaped and limp-like. The damage occurs in the inguinal region, axillary fossa, breast and limb flexion, itching is mild, tissue Pathological examination is pustular pustules. Other skin diseases are sometimes identified according to clinical manifestations such as atopic eczema and simple pruritus.

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