Eritematozny puzyrchatka (seboreyny puzyrchatka, Senira-Asher's syndrome) — the clinical form of a puzyrchatka combining manifestations of a true puzyrchatka, seboreyny dermatitis and eritematozny option of a system red volchanka. Typical symptoms of an eritematozny puzyrchatka are the red sites of damage of face skin covered with dense crusts in combination with the seboreyny centers on a hairy part of the head. The long current with remissions is characteristic. Diagnostics of an eritematozny puzyrchatka is based on a research of dabs prints and biopsiyny material. Treatment is carried out by glucocorticosteroids, methods of extracorporal haemo correction, local introduction of a triamtsinolon and imposing of glucocorticoid ointments.
According to most of the authors researching in the field of dermatology, the eritematozny puzyrchatka represents clinical option of a true puzyrchatka that is confirmed by cases of her transformation in a listovidny or vulgar puzyrchatka. However other researchers consider a disease of a kind of a listovidny puzyrchatka with an easy current. Localization of an eritematozny puzyrchatka and similarity of her manifestations on a hairy part of the head with a picture of seboreyny dermatitis formed the basis for the second name of a disease — a seboreyny puzyrchatka.
Symptoms of an eritematozny puzyrchatka
The eritematozny puzyrchatka begins with emergence of accurately delimited sites of reddening of skin — the eritematozny centers. They are localized mainly in cheeks and a back of a nose. Eritematozny spots are covered with friable and thin grayish-yellow crusts which are formed owing to drying of the liquid which is coming out the opened bubbles. The bubbles arising on a surface of spots, thin and flabby, are so quickly opened that most often remain imperceptible both for the patient, and for the doctor.
The manifestations of an eritematozny puzyrchatka which are localized on a face are combined with defeat of a hairy part of the head in the form of the centers of red color covered with fat scales reminding a picture of seboreyny dermatitis. On affected areas there is a cicatricial atrophy and the hair loss leading to an alopetion.
Long time (on average 5-7 years) manifestations of an eritematozny puzyrchatka affect only head skin. Further there can be a generalization of process about emergence of rashes on skin of interscapular area, a breast and a back. The eritematozny spots located on a trunk are covered with dense crusts which removal hurts the patient. During removal of crusts from a spot surface under them the open mouths of hair follicles having an appearance of pinches are found.
Approximately at 33% of patients with an eritematozny puzyrchatka skin displays of a disease are followed by damage of mucous membranes. The positive symptom of Nikolsky is noted. At some patients typical rashes of an eritematozny puzyrchatka are combined with the papules or the centers covered with crusts with the characteristic of seborrhea fat well removed scales.
Diagnostics of an eritematozny puzyrchatka
Typical clinical manifestations and localization of the centers of defeat allow to assume an eritematozny form of a puzyrchatka to the dermatologist. The positive symptom of Nikolsky, identification in dabs prints of akantolitichesky cages, typical for a puzyrchatka, results of a histologic and immunological research of the material taken by a biopsy confirm the diagnosis. The histologic research reveals existence of bubbles and cracks in the field of horn and granular layers of epidermis, follicular . When carrying out direct immunofluorescence the "lyupusny strip" going along a basal membrane, and a congestion of intercellular antibodies in epidermis is observed. Indirect immunofluorescence also reveals antibodies, but does not give "a lyupusny strip". In blood of patients with an eritematozny puzyrchatka anti-nuclear antibodies, antibodies, characteristic of a system red volchanka, to SS-A and ds DNA often are found.
Differential diagnostics of an eritematozny puzyrchatka is carried out with seboreyny eczema, a system red volchanka, a rozatsea, aktinichesky dermatitis, other forms of a puzyrchatka, mnogoformny ekssudativny eritemy.
Treatment of an eritematozny puzyrchatka
The main therapy of an eritematozny puzyrchatka consists in system reception of glucocorticoids (Prednisolonum, , methylprednisolonum). At presence at the patient of stomach ulcer or stomach ulcer of 12 items of a gut drugs are injected intramuscularly. At a generalized form for clarification of blood of the patient from the immune complexes circulating in it methods of extracorporal haemo correction are shown: plasma exchange, cascade filtration of plasma, immunosorption, haemo sorption, . Local treatment of an eritematozny puzyrchatka consists in imposing of okklyuzionny bandages with glucocorticoid ointments and intra focal introduction of a triamtsinolon.