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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    and thighs, there are distinct patches of pin-head-sized, mostly flat vesi¬ cles. They are small and are ill-defined, so much so that at a distance they would scarcely he detected. Some of the patches contain as many as a dozen or more, other groups not more than three or four. Smaller and disseminated lesions of the same kind exist on the forehead and neck. There are no pustules; none have formed since last October. She states that the eruption comes out and disappears every few days, the itching being most severe in the interim. She is kept awake the greater part of the night, and is exhausted from the long-continued itching. May 16. She recovered from the attack in January in February, and remained comparatively well about ten days, when a new outbreak was announced, which appeared very gradually in the same form as before, namely, as small, flat, grouped, abortive papules and vesico-papules. She has suffered two like attacks since, from the last of which she is just recovering. Under date of August 18, 1879, Dr. Stubbs writes that the patient is again suffering greatly from an outbreak, and that no relief is afforded by any of the remedies used. He further adds, “I do not know what to call the disease; sometimes it is pustular, at other times it is vesicular or papular, while sometimes wheals and boil-like lesions form. It is now vesicular.” Two months later (October 16, 1879) the doctor writes, “Her condition now is the same as when I first sent her to you one year ago; the lesions are pustular. We have not had this condition from that time until now. On the fifth of this month three pustules came on her knees, others rapidly followed on other parts. She can get scarcely any sleep. She has had no appetite for two or three weeks.” I subsequently saw the patient again during an attack, her condition being about the same as the last note. Early in 1883 (Jan. 17) I received a communication from Dr. Stubbs, stating that the patient was still afflicted, although she now suffered less severely than formerly. “ She has since been married, and has had one child. During pregnancy the disease of the slcin gave her no trouble, and most of that period she was quite clear.* Last summer the mu¬ cous membrane of the mouth, throat, and eyes became inflamed, dry, and hot, and finally an eruption', which was the same as that on the skin, appeared. The labia and vagina have never been affected. She has not been under treatment of late for the cutaneous disease. The eruption, as before, is still confined chief!v to the back and flexor surfaces of the . * extremities.” I would add that no treatment used in this case seemed to exert any beneficial effect, the internal remedies prescribed including arsenic in 1 The italics are mine.