Akrodermatit – a little various on an etiopatogeneza of the nozologiya united by the uniform term on the basis of localization of pathological process on skin of disteel departments of extremities. The inflammation terms is the cornerstone of each of diseases. Enteropatichesky akrodermatit arises at children against the background of deficiency of zinc. Atrophic akrodermatit is skin display of borreliosis (an infectious disease after a sting of a tick). Pustulous akrodermatit – result of a trofonevroz which can be considered as violation of work of the autonomic nervous system as a result of failure of exchange processes and food of fabrics. Diagnostics, treatment and the forecast of any of akrodermatit are individual.
Akrodermatit - the uniform name of several rare dermatitis with primary rashes on skin of brushes and feet. Here carry: resistant pustulous akrodermatit Allopo (Crocker's dermatitis, persistiruyushchy dermatitis of Seton), the idiopathic progressing skin atrophy (chronic atrophic Gerksgeymera-Gartmanna akrodermatit, a diffusion idiopathic atrophy of skin of Bukhvald, the Peak eritromeliya), system or enteropatichesky akrodermatit, striking newborns and leading to a lethal outcome at untimely or wrong diagnostics.
Only akrodermatit which etiology is precisely known, – atrophic akrodermatit. Its activator is the bacterium from a sort spirokht - Burgdorfer's borreliya. Because the epidemiological situation in Russia because of activization of the summer attacks of pincers - carriers borreliozny spirokht - worsens from year to year, causing growth of borreliozny infections in a geometrical progression, relevance of knowledge of symptomatology of this disease does not raise doubts. Importance of acquaintance to other dermatitis of this group is caused by weight of possible consequences.
Reasons of akrodermatit
The etiology and pathogenesis of an enteropatichesky and pustulous akrodermatit are up to the end not known. In modern dermatology it is considered that enteropaticheskiya akrodermatit newborns - it is infrequently meeting , inherited by the autosomno-recessive principle. It treats system diseases which cornerstone the enzimopatiya (failure in normal work of enzymes) of digestive tract with further violation of exchange processes is. Against the background of fermental insufficiency there is a deficiency of zinc and an inflammation of all layers of skin. The hereditary theory is confirmed by the fact that there is this pathology mainly at the children born from closely related marriages.
As for a resistant pustulous akrodermatit of Allopo, dermatologists incline to a thought that neurodystrophy – violation nervous traffic is its cornerstone. For some reason (an infection, a trauma) nervous fiber is damaged, and the nervous impulse does not reach a final point. The innervation of fabrics including skin is broken. As result, in a term all stages of an inflammation consistently develop. Elimination of the infectious beginning or a trauma does not change a situation that grants the right to speak about not clear etiology of a disease. Besides, many dermatologists consider akrodermatit a kind of pustulous psoriasis which reason is also not clear.
Atrophic chronic akrodermatit, unlike the sogruppnik, has the well-known cause. Its activator - the borreliozny spirokheta getting into a human body with a sting of a tick. Originally the microbe is localized in lymph nodes, and then, having reached the maximum concentration, comes to the blood course, is carried with blood current on all organism and becomes the reason of development of an inflammation in various bodies and fabrics including in skin.
Classification of an akrodermatit
According to modern representations, distinguish three independent types of an akrodermatit which have various etiopatogenetichesky mechanisms and clinical manifestations:
1. Enteropatichesky akrodermatit - primary element of rashes on skin are the bubbles (vesicles and pustula) different size which are followed by violation of work of digestive tract, development of dystrophy, violation of mentality of the baby.
2. Pustulous akrodermatit Allopo – a form of the local akrodermatit affecting generally nail phalanxes of fingers of brushes and feet. Primary element – the small oval pustula which are pouring out symmetrically. Process generalization is very seldom possible.
3. Atrophic akrodermatit – skin displays of borreliosis (Lyme's disease), his III stages, in the form of a saturated and claret eritema of different size.
A little independently there is atypical akrodermatit – the papular syndrome of Dzhanotti-Krosti which is found at children. Its localization is typical for an akrodermatit, but primary element is the atypical papule.
Symptoms of an akrodermatit
The clinical picture of a disease depends on its version. Enteropatichesky akrodermatit strikes children from the moment of the birth and up to 1,5 years, most often at transfer to artificial feeding. Later terms of developing of a disease – an exception to the rules. It is rare dermatitis with the heavy progressing current. Localization of the grouped puzyrny rash around natural openings is typical: eye, mouth, anus. Over time rash extends in skin folds: on genitals, a groin, hips, popliteal poles, elbow bends, armpits. Primary elements pour out against the background of hyperaemia and hypostasis, evolve in serous and purulent crusts, then in the shelled plaques that forces to differentiate this pathology with psoriasis. An evolution result - the erosive and ulcer, badly beginning to live surface. In parallel there is a damage of nails and mucous. The general health of the child is broken: because of the developing dyspepsia he loses flesh; because of neurotrophic frustration the hair loss, eyelashes begins; because of damage of eyes (conjunctivitis, blefarit) the photophobia joins. The kid lags behind in development, quality of his life sharply worsens.
Pustulous akrodermatit has other clinical picture. It develops at any age, mainly at men. Debuts from rashes on skin of fingers of hands and legs, does not tend to distribution. Usually defeat is limited to disteel departments of extremities, sometimes - only one finger. Process generalization is exclusively seldom possible. As it is clear from the name, primary element is the pustula (a bubble with purulent contents). But there is also a vezikulyozny kind of an akrodermatit (primary element - a bubble with transparent liquid inside), and eritematozno-skvamozny ("dry", spotty and scaly) a form.
At typical clinic process begins with finger-tips, gradually passing to the back of brushes. Nails at the same time are edematous, the okolonogtevy bed is hyperemic, when pressing from under a nail plate pus is emitted. Rashes are followed by sharp morbidity, difficulty to bend or unbend fingers therefore the brush forcedly takes the unnatural halfbent form. Fingers swell, muscles of hands are involved in process, the itch and burning join. Fortunately, this form well gives in to therapy. After permission of pathological process there is only slightly intense skin which recovers over time. The abortive form of an akrodermatit does not tend to aggravation of a disease, is characterized exclusively pustulous ё by rash often on one finger, very quickly regresses without trace. The malignant kind of an akrodermatit of Allopo is the purulent expansion of a disease with capture of all integument which is followed by loss of nails, their lysis, a nekrotizirovaniye of okololezhashchy fabrics and, as a result - shortening of phalanxes. It is treated it is long, with great difficulty. There is a risk of emergence of a recurrence.
Atrophic akrodermatit - it is infectious process which arises as reaction of skin to toxins of the borreliozny spirokheta getting into a human body with saliva of the tick infected with borreliosis. Gender and age do not matter. There are two possible answers of skin on a tick-borne sting: immediate emergence of an eritema on the place of penetration of a tick in a term (sometimes it is the first and only symptom of an onset of the illness) and development of an akrodermatit of the lower extremities in several years against the background of continuous progressing of a disease. Clinically akrodermatit has an appearance of dark-brown spots against the background of thin and atrofichny skin. Over time spots are thickened and condensed, and then atrophy from the outcome in . Eventually perhaps ozlokachestvleny akrodermatita.
Diagnostics of an akrodermatit
Enteropatichesky akrodermatit diagnose on the basis of clinical manifestations, biochemistry of blood, urine (balance of zinc), consultation of the doctor geneticist. Differentiate with secondary deficiency of zinc against the background of inflammatory processes in digestive tract of the patient.
The diagnosis of a pustulous akrodermatit is made on the basis of results of histology: in a bioptata comes to light with inflammatory neytrofilny infiltration of a malpigiyevy layer terms. Clinically differentiate with a banal piodermiya, histologically - with ekssudativny palmar and plantar psoriasis, gerpetiformny dermatitis of Dyuringa, impetigo the Coats of arms, pustulyozy Andrews.
Atrophic akrodermatit is confirmed by allocation of the activator from skin or serological reactions to existence in blood of the patient of antibodies to borreliozny a spirokheta.
Treatment and forecast of an akrodermatit
Timeliness and reliability of the diagnosis is very important for effectiveness of therapy. It is necessary to correct the revealed violations, to remove the cause and to strengthen immunity. At favorable option of succession of events treatment of an akrodermatit yields good results. The radical izlechennost is possible only at the beginning of therapy on the earliest terms of a disease and high quality of a current.
Enteropatichesky akrodermatit is treated by zinc medicines for correction of level of this element in the child's organism (the dietary supplements, vitamins, candles containing zinc) in combination with symptomatic therapy (vitamins C, E, A, a probiotics, gamma or the immunoglobulins, enzymes improving work of a GIT. Cope with a secondary infection purpose of antimikotichesky means, antibiotics inside and aniline paints outwardly. Fight against sepsis – business of extreme importance as it becomes the reason of lethal outcomes.
Pustulous akrodermatit Allopo depending on weight of a current and prevalence of process well gives in to treatment by antibiotics of a broad spectrum of activity () in combination with corticosteroids (Prednisolonum short courses). Aniline dyes, hormonal ointments, gels are locally used (). PUVA-therapy is shown. Treatment of an atrophic akrodermatit pathogenetic – antibiotic treatment ( per kilogram of weight). In parallel treat borreliosis with emphasis on therapy of the struck body (heart, kidneys, joints).
Taking into account achievements of modern dermatology the forecast of akrodermatit favorable, but depends on exact diagnostics and in due time begun treatment. Prevention comes down to the attentive attitude towards the health, regular observation at the dermatologist and to maintaining a healthy lifestyle.