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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    tom set in violently. On the second day of the attack scattered lesions of the same character appeared here and there over the trunk, legs, and thighs, and were especially numerous on the posterior surfaces of the thighs, over the shins, and about the ankles, and were quite symmetrically distributed. On the trunk they were on the back, chiefly between the scapulas, and on the abdomen about the umbilicus and pubes. On the chest they were few in number and disseminated. By the fifth or six day they had attained the size of large peas—in short became blebs; were tensely distended with clear, serous contents; showed no disposition to rupture; and were accompanied with slight areolae. The itching now became annoying and was constant, the desire to scratch being uncontrollable. The general health remained good ; no chilliness or fever. About this date he was rubbed with olive oil, which aggravated his condition, the skin by the next day becoming hot and more irritable. New lesions continued to appear, especially on the back, and the older ones increased in size without showing any sign of rupturing, and where two or more were in close proximity they often coalesced. From the sixth to the thirteenth day he had no rest, the itching being of the most harassing character. About the eleventh day the lesions became darker, the contents showing a distinct orange-yellow color, and instead of being serous in character were thicker and of a “jelly-like” consistence, so that when the blebs opened with a knife the mass could be removed as a semi-solid gelatinous substance. On the fourteenth day the skin generally and the lesions assumed a dark-reddish, bluish-red color, while the latter contracted and in a few days became crusted and hard, so that with his finger he could “ knock them off,” a dark-reddish stain remaining. The eruption at this date was at its height. The blebs were very numerous, the whole surface being literally covered. The scalp, face, ears, penis and scrotum, and even the verge of the anus, were attacked, the, palms and soles being the only regions that escaped. The mouth was like¬ wise unaffected. The lesions varied in size from a pea to a walnut, the average size being that of a silver dime ; the larger ones were generally formed by the coalition of two or more lesions. They were semi-globular in shape, tensely distended, and in no instance flattened or umbilicated. None burst spontaneously, but many were ruptured by violence ; they invariably burst with “ a crack” or “ explosion.” As already stated, crust¬ ing took place in the course of a few days, the crust being of a yellowish- brown or dark-brown color, and not bulky. After these became detached, he observed about the bases of the original lesions a few small pin-head sized “ whitish points” or pustules, which multiplied and grew rapidly, itched, and burned; were raised; ran together in many instances ; and in four or five days developed into large yellowish pustules, some of them being as large as cherries. Nearly all of these lesions, hundreds in number, were punctured, the walls collapsing and the contents flowing freely but being somewhat turbid. This outbreak constitutes what he terms the second attack. The lesions were as abundant as in the first attack, and while showing a disposition to appear on the sites of the old lesions yet came out also on sound skin. Poultices were applied, and later crusts formed as before, which in the course of a few days became detached, leaving dark-reddish spots and stains. He now rapidly recovered and remained nearly well for a week, when the third attack set in. This was ushered in by malaise, chills, heat, nervousness, and a general itching of the surface, the eruption developing much more rapidly than before. The lesions were for the most part