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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    dependent blebs. There is everywhere a tendency for the lesions to group, and while owing to their great multitude this is not striking in all regions, it is nevertheless very manifest in certain localities, as on the buttocks and thighs. The groups are for the most part small, consisting of from three to live lesions situated within a radius of an inch. In other places a dozen or more lesions occupy an area the size of the palm of the hand. A peculiarity of the lesions is their disposition to coalesce. Inclining to manifest themselves in ill-defined clusters of two, three or more, as they increase in size they run together, forming larger lesions. Around the immediate circumference of these lesions, whether vesicular or pustu¬ lar, smaller, flat pustules or vesicles, the size of pin-heads, are in many instances present. When ruptured the lesions crust over with flat, light, yellowish crusts. Removing these, superficially excoriated, moist, reddish surfaces, having sharply defined irregular vesicular or pustular borders are exposed to view. Everywhere about the older lesions there is noted a disposition on the part of the process to extend itself in a creeping manner while healing in the centre. Itching is present, and is very distressing. Dec. 19. A month has elapsed since the last note. During this period four distinct attacks or crops of eruption have manifested themselves. The lesions in the first three attacks were of the same character as those in the outbreak of November 22d, just described at length, namely, vesicles, blebs and pustules, with but little inclination to intermediate forms, while in the present eruption vesico-pustules predominate. The last two attacks have been milder, with smaller lesions, but accompanied with more itching. The general course of the disease, the disposition of the lesions to clus¬ ter, and the regions invaded, have been the same as on previous occasions. At present the eruption is characterized by many small, and some large, variously shaped, vesicles, vesico-pustules and pustules, occurring in patches or scattered over the surface, in all stages of evolution, together with numerous excoriations, ruptured or torn lesions, crusts and scales seated upon a dark-red, violaceous, mottled, pigmented skin, the remains of former attacks. The patient is able to be about the house ; his general health is good. He has used lately alkaline tarry lotions. Arsenious acid, in doses of one-fortieth of a grain, has also been taken for the last three weeks; also quinia, and a general tonic treatment. In December, 1882 (four years after the last note), I received a note from the patient, stating “ I am still troubled with the disease, and it has not failed to put in an appearance at certain periods since you saw me in 1878, although the blisters and pustules have gradually become less, both in number and in size. At certain times since, within the year, I was so free of eruption that at one time I thought surely I was rid of my pest. I can always tell two or three days before the eruption will appear by the coming on of an itching sensation. During the past six months I have had two attacks.” The history of this case, including the cause of the disease—a violent shock to the nervous system, is both interesting and instructive. The bullous variety predominated, and when I first saw him, it was highly developed; subsequently, however (as in almost every case that I have encountered), other lesions, especially pustules, manifested themselves. The constitutional symptoms accompanying one exacerbation were marked.