Sharp likhenoidny parapsoriasis
Sharp likhenoidny parapsoriasis (a disease Mucha-Gaberman) – a sharp good-quality papuloskvamozny kind of tear-shaped parapsoriasis. Clinical difference of pathology is true polymorphism of rashes, papules, pustula, bulls, gemorragiya, heterogeneous crusts and varitsellepodobny (hemorrhagic) elements which are combined with pink tear-shaped papules, habitual for tear-shaped psoriasis. Primary elements are disseminated, are symmetrized. The disease debuts sharply and generalizutsya very quickly. The phenomena of a prodrom are possible. It is capable to independent spontaneous permission. The only reliable method of diagnostics is the biopsy. If necessary appoint local and system steroids and antibiotics.
Sharp likhenoidny parapsoriasis
Sharp likhenoidny parapsoriasis – a polymorphic dermatosis of not clear etiology which is a kind of parapsoriasis is characterized by a sharp debut and spontaneous permission of process. Also rare severe febrilny ulcer and necrotic form of a disease demanding treatment in a hospital is known. Usually on the place of primary varioliformny elements there are ospopodobny scars, papules are resolved with the hyperpegmentation phenomena that clinically reminds tear-shaped psoriasis. This fact gave to some dermatologists the grounds to consider sharp likhenoidny parapsoriasis a kind of tear-shaped. Pathology arises at men of teenage and young age more often, has no racial features, the vnesezonna meets in all ethnic groups and geographical regions. Relevance of a problem at the present stage is connected with a possibility of spontaneous transformation of sharp likhenoidny parapsoriasis in malignant fungoid mycosis.
Reasons of sharp likhenoidny parapsoriasis
The etiology of pathological process is not clear. In modern dermatology consider three possible reasons of development of sharp likhenoidny parapsoriasis. The infectious theory is considered the leader. From this point of view sharp likhenoidny parapsoriasis is provoked by introduction in skin of the infectious anti-gene activator starting protective reaction an anti-gene antibody. Anti-gene penetration breaks integrity of cages of immune system of local and general level, development of mediators of an inflammation which result are reactions of skin in the form of a rash of primary elements begins.
The theory of developing of sharp likhenoidny parapsoriasis owing to high-quality violation of T-cellular fabric is close to the infectious theory. In this case the inflammation of skin is considered as the process provoked by response (it is possible on a virus) with participation of a complex of T-lymphocytes + by C04, suppressing tsitokina and producing interleykina which participate in proliferation of lymphoid fabric. Rashes on skin of limfoproliferativny character, capable to be transformed at any time to fungoid mycosis become result. Process disseminirut with jet involvement of lymph nodes.
The third theory assumes emergence of an allergic vaskulit as a result of formation of immune complexes. At such option as the factor injuring skin consider the allergic beginning which at introduction causes a sensitization terms. Allergizirovanny skin becomes hyper sensitive and in response to any negative impact begins to produce actively antibodies, autoimmune process with defeat of vessels as a result develops.
Symptoms of sharp likhenoidny parapsoriasis
Clinical displays of a disease come down to sudden emergence of symmetric rashes on the sgibatelny surfaces of extremities, a stomach and a forward part of a thorax. Primary elements are presented by brown eritema, small (from 1 mm to 7 mm) pink convex papules and bulls with the central hemorrhagic necrosis. Rashes develop against the background of quickly taking place subjective deterioration in the general health. Originally hairy part of head skin, palm and sole are not surprised, then process can extend also to these sites of an integument. In several months of a rash are independently resolved. Defeat mucous oral cavities, language is possible.
Emergence of elements is preceded in some cases by high temperature, an adynamy, feeling of weakness, weakness, mialgiya. Then there is polymorphic rash which elements merge in the large centers with raised edges, an ulceration and the central necrosis. In 70% of cases regionarny lymph nodes increase. At emergence of the listed symptoms speak about a heavy current of a febrilny ulcer and necrotic form of a disease. Such version is capable to hronizirovatsya and persistirovat within several months or years. The course of sharp likhenoidny parapsoriasis depends on the general state of health of the patient and his immunity.
Diagnosis of sharp likhenoidny parapsoriasis
The clinical diagnosis is made by the dermatologist on the basis of symptoms of a disease and results of a biopsy. From the center of defeat find in the studied skin fragment expressed , a necrosis of epidermalny cages and lymphocytic infiltrate. In a term infiltrate consists of T-cellular cytotoxic lymphocytes. Differentiate sharp likhenoidny parapsoriasis with chicken pox, chronic likhenoidny and tear-shaped parapsoriasis, a limfomatoidny papulyoz, a pustulous sifilid, Dzhanotti-Krosti's disease, mnogoformny eritemy, an allergic vaskulit, papulonekrotichesky tuberculosis of skin and a toksikodermiya.
Treatment of sharp likhenoidny parapsoriasis
Tactics of treatment of a disease depends on weight of pathological process and its prevalence. In therapy of pathological process dermatologists allocate three lines. The first line – reception of antibiotics of a tetracycline row or macroleads inside according to individual schemes, use in treatment of corticosteroids and local immunomodulators. The second line – application of physical therapy: PUVA-therapy, UFB-therapy. The third line – purpose of tsitostatik. In hard cases the mixed therapy of pathological process is possible. In the absence of effect of out-patient treatment or distribution of process of the patient hospitalize. Outwardly appoint emolenta (the substance on a fatty basis which are evenly distributed on skin), hormonal ointments, medicines with alklometazony, reducing pain, an itch and expressiveness of an inflammation in skin. Prevention methods do not exist yet. The forecast is uncertain, at the same time the sharp form will respond to treatment better than other kinds of a disease and is less often transformed to fungoid mycosis.