Pustulous Andrews – a dermatological disease of not clear etiology which is characterized by chronic, quite often recidivous current. Symptoms of this state are the papular rashes arising on feet or palms, a skin eritema, an itch and morbidity on affected areas of skin. Diagnostics of a pustulous bakterid of Andrews is based on results of dermatological survey, histologic studying of a bioptat of tissues of skin in a zone of defeat, a research of the anamnesis of the patient. Treatment of this disease includes both fight against local manifestations, and the all-therapeutic actions directed to elimination of provocative factors.
Pustulous Andrews ( palmar and plantar) – the chronic disease of skin which is characterized by development is frequent with purulent contents, and further with formation of crusts, scales, violations of an orogoveniye. For the first time pathology was described in 1934 by the American dermatologist J. Andrews who at first mistakenly took it for one of psoriasis forms. Now pustulous Andrews it is considered a disease with not clear etiology which development somewhat, perhaps, is caused by the general condition of an organism and type of its reactivity. This pathology approximately with an identical frequency affects both men, and women, practically never occurs at children. Pustulous Andrews it is considered rather rare dermatological state, its frequency in population is authentically not determined now.
Reasons of a pustulous bakterid of Andrews
The etiology and pathogenesis of a pustulous bakterid of Andrews are not established for today, there are some hypotheses in this respect. The version according to which a peculiar type of allergic reaction of the slowed-down type participates in development of this state that partly is confirmed by clinical data is considered popular. Most of patients with a pustulous bakterid of Andrews have episodes of allergic pathologies in the anamnesis (urticaria, angioneurotic hypostasis, bronchial asthma). Besides, according to some researchers, the desensibilizing therapy reduces expressiveness of displays of a disease that also indicates a possibility of its allergic genesis.
Other theory of development of a pustulous bakterid of Andrews, popular in dermatology, is influence of microorganisms from the centers of a chronic infection in an organism – carious teeth, tonsillitis, sinusitis can act as those. Supporters of this hypothesis also point to clinical data at this disease – practically the active center of a bacterial infection is found in all patients at careful inspection. Moreover, at its treatment (sanitation of an oral cavity, application of antibiotics) of manifestation of a pustulous bakterid of Andrews also abate, and sometimes there comes the absolute recovery.
There is an opinion that in development of this dermatological state set of factors plays a role: a bacterial infection, allergic states (hypersensitivity to components of a cellular wall of microorganisms or to their toxins), features of reactivity of an organism. Attempts to prove hereditary predisposition or the genetic nature of a pustulous bakterid of Andrews were not crowned with success. Nevertheless, at hereditary predisposition to allergies and other immunological violations the probability of development of a palmar and plantar pustulez increases a little.
Symptoms of a pustulous bakterid of Andrews
Pustulous Andrews most often strikes aged people from 20 to 50 years, his development is preceded by frequent allergic diseases or long inflammatory processes of bacterial genesis. As a rule, pathology begins with damage of palms, rashes on soles join a bit later, separate cases of the isolated damage of hands or legs are described. Rashes at a pustulous bakterid of Andrews usually symmetric, at first are formed the small papules in the center of palms or feet filled with serous contents which quickly gain purulent character. Pustula do not tower over the surface of healthy skin and after a while turn into lurid crusts.
Around and crusts arises , skin hyperaemia, in some cases is noted local . The formed pathological center at a pustulous bakterid of Andrews always expands, there are new pustula and crusts, the area of damage of skin gradually increases, does not take all sole or a palm yet. Further the disease gains chronic recidivous character – pustula disappear during remissions and appear again at aggravations. Giperkeratoz leads to formation of large scales on skin between which there are pustula and crusts. Duration of a current of a pustulous bakterid of Andrews can make many years, in many cases is full it is not possible to cure this state.
At a pustulous bakterid of Andrews pathological changes of skin can sometimes pass to area of fingers and nail plates. It leads at first to deformation and growing of nails, and then and to full loss. Subjective symptoms of a disease usually include morbidity when pressing on area of defeat including when walking, a skin itch. These manifestations weaken during remission of a pustulous bakterid of Andrews and sharply amplify at an exacerbation of pathology. Any general or system manifestations at this pathology are not defined.
Diagnostics and treatment of a pustulous bakterid of Andrews
Diagnostics of a pustulous bakterid of Andrews is performed on the basis of results of dermatological survey of sick, bacteriological and microscopic studying of contents , researches of the anamnesis of the patient and results of the general medical examination for identification of provocative inflammatory states. In disputable cases the skin biopsy in a zone of defeat and a histologic research can play a supporting role. At survey the peeling, , pustula and crusts of purulent character is defined on the surfaces of palms and feet. At the same time bacteriological researches confirm sterility of contents . Test of the Minor can reveal signs of a local gipergidroz on the sites of integuments struck with a pustulous bakterid of Andrews.
The general medical examination and studying of the anamnesis of the patient at this disease in 90% of cases confirms existence of the chronic inflammatory center. About two thirds of persons with a pustulous bakterid of Andrews have allergic states in the anamnesis, and the beginning of development of this pathology at them coincides with any infectious disease. The histologic structure of a pustula also has characteristics – it represents a single-chamber cavity which is executed by leukocytes (neutrophils and macrophages) with impurity of a small amount of lymphocytes. Destruction of a basal membrane of epidermis at a pustulous bakterid of Andrews does not happen. In a term hypostasis, insignificant perivaskulyarny infiltration is defined by lymphocytes and gistiotsita.
In view of obscurity of an etiology of a pustulous bakterid of Andrews etiotropny treatment of this pathology is not developed. According to most of dermatologists, the greatest efficiency elimination of a provocative factor – the chronic center of a bacterial infection has. Helps to reduce expressiveness of symptoms of a disease at an aggravation purpose of kortikosteroidny means and antibiotics. Locally recommend to impose the calming ointments, bandages for morbidity reduction. Also at a pustulous bakterid of Andrews apply immunoexcitants and antihistaminic medicines, however their efficiency remains undecided. During remission it is possible to use ointment and cream on the basis of tar and other similar means.
Forecast and prevention of a pustulous bakterid of Andrews
The forecast concerning the patient's life at a pustulous bakterid of Andrews unambiguously favorable – it a disease has no general manifestations and does not lead to development of heavy complications. However concerning recovery forecasts of experts much more uncertain – in many cases completely it is not possible to cure this state, especially if to begin therapy at the started stages of its development. Efficiency of treatment and probability of recovery at a pustulous bakterid of Andrews in many respects are defined by character and expressiveness of a chronic bacterial infection, and also features of reactivity of an organism of the patient. For prevention it is necessary not to allow emergence of provocative pathologies – in due time and in full to eliminate bacterial infections, to regularly make sanitation of an oral cavity.