Case of dermatitis herpetiformis caused by nervous shock / by Louis A. Duhring.

  • Duhring, Louis A., 1845-1913.
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

Credit: Case of dermatitis herpetiformis caused by nervous shock / by Louis A. Duhring. Source: Wellcome Collection.

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    distinctly pustular in character, the others being vesico-pustular, vesi¬ cular and bullous ; were flat, surrounded with inflammatory areolm, and itchy. They appeared only on the extremities and over the abdomen. They differed in their distribution from the former lesions in being grouped, two, three or more manifesting themselves in close proximity, often coalescing. Present Condition_November 22, 1878. He is now suffering with the remains of the third attack, just described, to which within the week has been added a fourth outbreak. New lesions have been coming out from day to day. He is confined to bed, and is suffering with a profuse multiform eruption occupying the greater portion of the general surface. It consists of vesicles, blebs, vesico-pustules, and pustules of various sizes and shapes, and in all stages of evolution ; erythematous (light and dark red) patches and stains, for the most part the remains of former lesions ; exco¬ riations and scratch-marks, and crusts, though these latter lesions are by no means abundant. The multiformity of the lesions is striking. Vesicles, blebs, and pustules are in about equal proportion, and are so intermingled as to exist side by side. The vesicles and blebs maybe first considered, and I speak of them together for it is impossible to draw a line of distinction between them ; the difference is merely of size. They exist in large numbers, in hundreds. They vary in size from a pin-head to a walnut and larger, the majority averaging between a split pea and a hazel-nut. They are semi-globular or flat in form, and are either tensely distended or flaccid, the former condition existing in all of the smaller lesions. They rise abruptly from the surrounding skin to the height of from one to several lines, have moderately thick walls, similar to the lesions of pem¬ phigus, and show no disposition to rupture spontaneously. There is no sign of umbilication. They are of all shapes, the majority being circular or ovalish ; but some are irregular in outline and show angular, “ puckered” borders, as is often seen in herpes zoster, in which event they are usually surrounded with bright-red, highly inflammatory areolte. Many of the vesicles and blebs rise up without areolte, looking like mag¬ nified sudamina. They have a pearly or pale-yellowish color, and, as in the case of other similar lesions, refract light, which gives them a glistening appearance. The contents are for the most part clear, but some are cloudy and in many instances are more or less tinged with blood, producing a mottled or streaked bluish-red hemorrhagic look. The pustules are likewise in all stages of evolution both as to size and extent of pustulation. Some are distinct pustules no larger than pin¬ heads, flat or semi-globular in form, and circular or irregular in outline ; while others of the same size and larger have evidently been vesicles and blebs, and are passing into pustules. Still others are the size of peas and cherries and are distinctly pustular, like the lesions of true simple impetigo, and contain whitish pale-yellowish puriform contents. Some are in a perfect state of preservation, semi-globular or accuminate in form ; others are more or less collapsed. As stated, inflammatory areolm surround almost all of the larger pustules. As regards distribution, no region is free except the palms of the hands. It is a very general eruption, the lower extremities exhibiting the most lesions. The flexor surfaces are especially invaded. Upon the thighs and legs there is not a square inch that is not the seat of disease. The skin which is not occupied by distinct lesions is dark red and violaceous in color. The ankles are literally encircled with blebs and pustules, many of which have run together forming large, elongate, flaccid, partly bloody,