Erythematous pemphigus is a clinical form of pemphigus that combines the characteristic properties of pathologies such as true pemphigus, seborrheic dermatitis and erythematous manifestation of systemic lupus erythematosus. Characteristic manifestations of erythematous pemphigus are considered to be red, with dense crusts of redness localized on the face together with seborrheic foci in the area of hair growth on the head. This disease is characterized by a long course, associated with frequent periods of remission. Erythematous pemphigus is diagnosed based on the examination of a biopsy and smear prints. Therapy is carried out medicamentally with glucocorticosteroids, as well as methods of extracorporeal hemocorrection, the introduction of triamcinolone and the use of glucocorticoid ointments.
The content of the article:
Symptoms of erythematous pemphigus
Diagnosis of erythematous pemphigus
Treatment of erythematous pemphigus
Erythematous pemphigus
Most dermatological researchers call erythematous pemphigus one of the clinical manifestations of true pemphigus. This is proved by frequent episodes of its transformation into a vulgar or even leaf-shaped pemphigus. On the contrary, other scientists consider this disease to be just a kind of leaf-shaped pemphigus with a mild course. Since erythematous pemphigus is located on the head and is clinically manifested on the scalp as seborrheic dermatitis, it was given another name — seborrheic pemphigus.
Symptoms of erythematous pemphigus
Erythematous pemphigus begins with erythematous foci, which look like clearly limited areas of redness of the skin, localized mainly in the area of the cheeks and nose. Erythematous spots are covered with loose grayish or yellowish crusts, which are obtained due to the drying of the liquid released from the opened bubbles. In turn, the bubbles themselves that appear on the surface of the spots are so thin that they are quickly opened and are almost invisible to both the patient and the attending physician.
Erythematous pemphigus, which is localized in the face area, can also affect the scalp. This phenomenon has the appearance of red areas covered with oily scales, which resemble the clinical picture of seborrheic dermatitis. In areas affected by erythematous pemphigus, scar atrophy of the skin takes place, which leads to hair loss and alopecia.
For quite a long time, erythematous pemphigus manifests itself and spreads only to the scalp. But in the future, generalization of the process is possible, which leads to rashes on the skin in the chest, back, and also between the shoulder blades. Erythematous spots that are localized on the trunk are covered with dense crusts, when removed, the patient is caused severe pain. Under the crusts, when they are removed from the erythematous spot, you can notice the open mouths of hair follicles, which have the appearance of spikes.
About a third of all patients with erythematous pemphigus, in addition to skin manifestations of the disease, also suffer from damage to the mucous membranes. In some patients, characteristic eruptions of erythematous pemphigus are often combined with papules covered with a crust or areas with oily scales characteristic of seborrhea, which are easily removed.
Diagnosis of erythematous pemphigus
The erythematous form of pemphigus is diagnosed by a dermatologist on the basis of typical clinical manifestations of the disease, as well as based on the localization of lesions. The diagnosis of this disease is finally confirmed by the positive symptom of Nikolsky, as well as the detection of acantholytic cells in smears-prints characteristic of pemphigus. Also important for the diagnosis will be the results of immunological and histological examination of the biopsy from the affected areas of the skin. Histological examination reveals cracks and blisters in the area of the granular and horny ball of the epidermis, as well as follicular hyperkeratosis. When direct immunofluorescence is performed, you can notice a “lupus stripe” that runs along the basement membrane, intercellular antibodies are visible in the thickness of the epidermis. The method of indirect immunofluorescence also determines antibodies, but it in turn does not give a “lupus band”. In the blood of people with erythematous pemphigus, antinuclear antibodies, antibodies to SS-A and ds DNA, which are characteristic of systemic lupus erythematosus, are often found.
Differential diagnosis of erythematous pemphigus is carried out in conjunction with studies on seborrheic eczema, lupus, rosacea, multiform exudative erythema, actinic dermatitis and other forms of pemphigus.
Treatment of erythematous pemphigus
Basically, the treatment of erythematous pemphigus is medicamental and consists in taking drugs of a number of glucocorticoids: prednisolone, methylprednisolone, triamcinolone. If the patient has a stomach ulcer, as well as duodenal ulcer, then these drugs are administered intramuscularly. When the disease passes into a generalized form, extracorporeal hemocorrection methods such as plasmapheresis, immunosorption, cascade plasma filtration, hemosorption are used to purify the blood. Local therapy of erythematous pemphigus is carried out using occlusive dressings impregnated with glucocorticoid ointments, as well as with the introduction of triamcinolone intraocularly.
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