Small pustules in skin folds during pregnancy

Introduction Herpes-like impetigo manifestations are small pustules at the skin folds during pregnancy. Herpesigo herpetiformis (impetigo herpetiformis) is a serious skin disease that occurs in pregnant women. The basic damage of the skin is the appearance of aseptic pustules on the basis of erythema, often accompanied by severe systemic symptoms. Gradually relieve after childbirth, re-pregnancy can relapse. Although the disease is rare, it is more serious and can even be life-threatening. In severe cases, there are more obvious systemic symptoms, hypocalcemia and hand and foot convulsions. It is also believed that herpes-like impetigo, pustular psoriasis, and continuous acral dermatitis may be the same aseptic pustular disease.

Cause

(1) Causes of the disease

The etiology has not yet been clarified, and pregnancy may be a predisposing factor. Because of the typical hand, foot and ankle caused by hypocalcemia, it is speculated that the pathogenesis may be related to endocrine disorders such as hypoparathyroidism. It has been reported that thyroid surgery accidentally removes the parathyroid gland. Induced this disease. The disease is also seen in the long-term use of compound norethisterone tablets (also known as short-acting contraceptive I, the composition of ethinyl estradiol and norethisterone) non-pregnant women, it is not a unique disease of pregnant women.

Chen Xitang (1994) believes that herpes-like impetigo and acrodermatitis continua are identical in histopathology and cannot be distinguished. They are only different in the pathogenesis and lesions, and may be pustules. A variant of pustular psoriasis, which causes pustular lesions in potential psoriasis due to metabolic disorders. In 1995, Aronson et al. considered the disease to be an independent skin disease during pregnancy.

(two) pathogenesis

1. Seen by the naked eye: On the basis of erythema, extensive, clustered pustules appear in the epidermis.

2. Histopathological changes in the skin: Sponge-like pustules are seen in the superficial epidermis, and the pustule fluid contains a large number of neutrophils. The formation of spongy pustules is due to the large number of neutrophils entering the upper part of the spinous layer and accumulating in a sponge-like network formed by denatured and thinned epidermal cells. As the pustules enlarge, the epidermal cells in the center of the pustules all disintegrate until a single atrial bullous is formed. A network of denatured and thinned epidermal cells is still visible around the bullae. When the neutrophils in the cavernous pustule fluid moved up to the stratum corneum, nuclear pyknosis occurred to form Munro microabscess. The histopathological changes of the oral groove tongue and the map tongue are similar to the changes in the skin.

an examination

Related inspection

Obstetric B super obstetric examination blood routine

The case was characterized by pustular psoriasis, with increased white blood cells, increased erythrocyte sedimentation rate, hypocalcemia and hypoproteinemia.

The disease occurs more than 3 months after pregnancy, and the condition gradually relieves after delivery. The disease can recur after re-pregnancy.

Rapid onset, initially in the skin folds (such as axillary fossa, lower breast, groin, umbilical circumference, flexor of the extremities, external genitalia, etc.), a large number of acute inflammatory erythema suddenly appear in the epidermis, and then no stage of nodule or blister Directly appear clustered, shallow small pustules, about the tip of the needle to the size of the miliary, yellow-white, often arranged in a flower ring, semi-circular or map-like. Simple lesions can also be fused together to form a large area of pus. The skin lesions are mildly itchy, and the pustules dry and crusted after a few days, and new skin lesions appear around the old lesions. Once the skin is peeled off, it reveals a moist, red shiny area, that is, wet skin lesions, and finally the epithelial repair is cured by deep pigmentation. In severe cases, the skin lesions can be spread to the whole body, accompanied by systemic symptoms such as chills, relaxation, hyperthermia, vomiting, diarrhea, convulsions, etc., which can affect the buccal mucosa, tongue, pharynx, and esophageal mucosa, often forming pustules or erosions. It is gray plaque, sometimes affecting eating due to severe painful swallowing.

The disease is characterized by chronic menstruation, which lasts for several months and is a periodic acute attack, often accompanied by hand and foot spasm caused by hypocalcemia. According to the pregnant woman in the third trimester of pregnancy, the skin folds on the basis of erythema, most of the yellow-white clusters are arranged in a flower-shaped pustule, accompanied by more serious systemic symptoms, combined with the characteristics of skin tissue pathology, the diagnosis is more difficult .

Differential diagnosis

Sometimes it is not easy to identify with pustular psoriasis, the latter is characterized by more hands and fingers, and has a tendency to desquamation. It should also be differentiated from pemphigus, which is a pea-to-walnut blister on the surface of normal skin, which is easy to identify. It should also be differentiated from herpes simplex (polymorphic rash, mainly vesicles, no systemic symptoms). The disease occurs more than 3 months after pregnancy, and the condition gradually relieves after delivery. The disease can recur after re-pregnancy.

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