Dermatitis herpetiformis : its relation to so-called impetigo herpetiformis / by Louis A. Duhring.

  • Duhring, Louis A., 1845-1913.
Date:
[1884]
Catalogue details

Licence: Public Domain Mark

Credit: Dermatitis herpetiformis : its relation to so-called impetigo herpetiformis / by Louis A. Duhring. Source: Wellcome Collection.

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    to form around this lesion as before, or the process maybe arrested. The number of pustules varies; there may be a half a dozen, scattered about, or hundreds, some the size of a pin-head or of a pea ; others as large as a quarter dollar. When they are in close proximity and have run together large patches may form. I may now direct attention to a peculiarity of the several lesions of the disease, and this is the tendency for two or more kinds to exist simultane¬ ously, as, for example, vesicles, vesico-blebs and blebs, or it may be vesicles, blebs, and pustules—both rare combinations in the list of cutaneous dis¬ eases. The order of manifestation is variable. There is no definite order in the evolution of the lesions during an attack, nor even in relapses or in recurrences of the disease. This irregularity in the evolution of the process is peculiar, and must be regarded as one of the marked features of the dis¬ ease. It has been present in almost all of the cases that have been under my observation. The longer the patient has been under observation the more frequently has this feature asserted itself. An attack beginning as an erythema may pass rapidly into the vesicular or bullous variety, to be in a few weeks succeeded by the pustular variety, this again by the vesicular or bullous variety, followed by perhaps the pustular for the second time, these several changes or varieties of the disease appearing, it may be, in the course of a month ora year. The mixture or commingling of the several lesions, two or more kinds often showing themselves during an attack of any one variety, certain lesions decidedly predominating and giving the type to the eruption, is striking. Thus in the pustular variety it is not uncommon to note vesicles, vesico-blebs, and blebs seated in close proximity to the pustules ; and in the bullous variety to observe pustules almost contiguous to the blebs. Multiformity, therefore, is the rule, and where cases remain under no¬ tice for a period of years, and repeated recurrences are recorded, this feature is in almost all instances one which impresses itself alike on patient and physician. Eczema, as we all well know, is often multiform, but surely this disease far exceeds eczema in the extent to which this character may go. It is not only multiform, but is capriciously so, the various manifes¬ tations often taking place in rapid succession, but especially in the case of new crops of lesions and relapses. At one period it is strictly vesicular, this variety continuing it may be several weeks or months, several attacks of the same kind appearing during this time ; on another occasion it will be vesicular and bullous, or alternately vesicular and pustular. The tendency is to be vesicular and bullous, the erythematous and pustular manifestations being rarer. The general character of the eruption is herpetic, in the sense that the lesions incline to group or to appear in small or large patches, and further that where they form in proximity they tend to coalesce. This feature, f