Case of dermatitis herpetiformis illustrating in particular the pustular variety (impetigo herpetiformis of Hebra) / by Louis A. Duhring.

  • Duhring, Louis A., 1845-1913.
Date:
[1884]
Catalogue details

Licence: Public Domain Mark

Credit: Case of dermatitis herpetiformis illustrating in particular the pustular variety (impetigo herpetiformis of Hebra) / by Louis A. Duhring. Source: Wellcome Collection.

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    at its height four or five days since. It consists of numerous, variously sized, rounded or irregularly shaped pustules in all stages of evolution. They are typical pustules, the smallest of them exhibiting a distinctly pustular state. They vary in size from a pin-head to a large pea, the greater number being of the size of small peas; when two or more have coalesced, however, a small or large finger-nail-sized lesion exists. In shape, when small, they incline to be acuminated, but as they increase in size they become decidedly flat, with an irregularly rounded or angular out¬ line. They incline to crust in the centre and to spread in a creeping man¬ ner on the periphery, a ring of small, flat pustules, isolated or confluent, being frequently present; and where two or more are in close proximity thus almost invariably run together, forming flat, broad lesions as large as a quarter dollar and sometimes even larger, the crusting being more or less complete. A bright or deep red areola of considerable size surrounds all of the lesions. In color, the pustules are whitish and opaque, and con¬ tain a thin puriform pale-yellowish or whitish fluid. The walls of the young lesions are distended, but those of the older ones are more or less flaccid, and in many instances are ruptured, the fluid oozing forth and drying into flat, uneven crusts of a greenish or brownish color. Here and there are patches of disease, made up not only of confluent lesions but of two or more distinct groups of lesions. These areas of disease, several inches in diameter, are striking upon the arms and upon the thighs. The distribution of the lesions is for the most part in the form of more or less distinct groups, but there are also disseminated lesions. The groups are irregularly formed, and are as a rule composed of from two to four pustules. Clusters of two and three lesions situated in close proximity, within an area of an inch in diameter, are not uncommon, while in some places as many as a half-dozen or more of various sizes may be found. On the anterior aspect of the middle of the thigh is a conspicuous group, composed of a central, unbroken, tensely distended, somewhat acu¬ minated, pea-sized, irregularly-shaped pustule, with a vivid, deep-red, “puckered” areola, around which are three similar but smaller lesions, the whole occupying an area the size of a quarter-dollar. The group¬ ing, however, viewing it as a feature of the disease, is much less marked than in herpes zoster. In addition to the pustules, there are numerous excoriations, blood-crusts, scratch-marks, deeply-stained spots, with or without old crusts, and general pigmentation of a dirty-yellowish, brownish hue. The disease is the impetigo herpetiformis of Ilebra. October 12. The patient stated, upon her admission to the Hospital, that the disease had, she thought, passed the height of the attack, and would soon begin to subside; and so the events have proved, but there have been, notwithstanding, sufficient typical new lesions for purposes of study.