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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    however, is variable. The arrangement may be in little groups of two or three or four lesions, or, as in the case of the pustules, they may form in circles or segments of circles around the original lesion. In both the erythematous and pustular varieties there is a marked disposition to spread on the periphery, and in the former variety a disposition to creep, causing at times marginate patches. In the vesicular and bullous varieties there is less tendency to group, and the vesicles and blebs may even be dissemi¬ nated. In the same patient with different attacks I have noted the lesions disseminated and grouped. It frequently happens when the eruption is abundant that grouping will occur here and there, while in between the groups and elsewhere the vesicles and blebs will be disseminated. Another evidence of the herpetic nature of the disease is noted in the irregularity of the lesions, especially in the case of the papules, vesicles, blebs, and pustules. The irregular, angular, or stellate outlines of vesicles and blebs, as a rule without marked areolse, are strongly suggestive of the nature of the process. Pigmentation must also be mentioned as a symptom com¬ mon to all varieties, and in chronic cases is usually pronounced. Con¬ siderable thickening of the skin is also marked in such cases. In almost all instances, at all periods of the eruption, an irritable state of the skin, comprising itching, pricking sensations, heat and burning, is a prominent symptom. In most cases it precedes the outbreak for several days, be¬ coming more pronounced as the eruption reaches its height, then de¬ clining and again asserting itself with a new crop of lesions. Itching is the sensation generally complained of. It is usually severe, causing great distress of mind and body. In most of the cases that I have encountered it has shown itself intense, and to be far more formi¬ dable than in an eczema of like grade. Burning sensations also are fre¬ quently described, especially in connection with the pustular variety; and when the varieties have changed from one to another, as the vesicular to the pustular and back again, itching and burning will exist alternately or be present together, constituting a sensation said to be much the most trying to bear. Sometimes it happens that an attack of the pustular manifestation, especially when the lesions remain small, is unaccompanied by subjective symptoms. I recall one such case in a man where the pus¬ tules were abundant, the patient stating that at the time he suffered but little inconvenience from the eruption ; but in a subsequent attack, of the vesicular and pustular varieties combined, he was greatly distressed with itching and burning. The disease usually runs a chronic course, extending over years, re¬ peated attacks appearing from time to time at intervals of months or years. I have known cases where it has continued, most rebellious to treatment, for five, ten, and fifteen years. During these long periods the patient has suffered more or less continuously, sometimes with periods of