The erythematous variety occurs in patches or diffused over the surface. There is usually slight elevation of the affected skin. The red color of the erup tion may be varied by a yellowish or brownish tint, and is usually followed by more or less pigmentation.
The vesicular variety is the most com mon. The vesicles are irregular in size and shape, usually tense, and rising abruptly from an apparently normal base. They may be disseminated or a2,, gregated in groups or clusters. They sometimes coalesce to form small blebs. The itching is usually more intense than in other fornis of eruption. After the vesicles rupture there is often some relief from this symptom. Excoriation is usu ally not very marked.
In the bullons variety the bulhe are usually tense. standing out from the level of the skin. They are usually ir regular in outline, differing from the bulhe of pemphigus. They are also more likely to appear in groups or clusters. Vesicles and pustules may accompany the blebs.
The pustular form appears pustular from the beginning. The lesions are either acuminate, discrete, up to a pea in size, or flat, not elevated above the skin, aggregated in small groups, and miliary in size. The larger pustules often have a puckered appearance.
The multiform variety is made up of all the various types of eruption in com bination, and has suggested one of the names by which the disease is known, viz.: dermatitis multiforme. The lesions are macules, papules, vesicles, pustules, and bullo of all shapes and sizes. There are excoriations and pigmentations of a brownish color. The character of the lesions is constantly changing.
Dermatitis Herpetiformis. — The course of the disease is a chronic one, and it may last, appearing and disappear ing at intervals for many years. Treat ment has usually little effect upon its progress.
Two cases of symptomatic dermatitis occurring in puerperal women. In the first case the eruption appeared as a popular erythema on the fifth day post partum, while in the second it was a bright-red flush on the eighth day after labor. Wilson (Annals of Gynec. and Ped., INIay. '91).
lierpetiform dermatitis in pregnancy is a rare disease, little known even to obstetricians. It is distinguished by five principal characteristics: 1. A poly morphous eruption. with a predominance of billions vesicles; simple vesicies, bullm, pustules, erosions, crusts, and spots were met with at the. same time. 2. An accompanying pruriginous disease.
really painful. 3. Good general health. 4. Successive attacks of the disease. 5. A chronic character, aggravated by each attack of the disease, which may last for some years. Fournier (Jour. de -MM. et de Chir. Prat., Oct. 10, '92).
Four cases of Duhring's disease in which glycosuria was a symptom. Win field (Jour. of Cut. and Genito-Urin. Dis., Nov., '93).
Two eases in two sisters living apart, interesting as showing family tendency, liability to onset in a predisposed person on change of climate, and general in tractability of the complaint. J. J. Mooney (Med. Age, Aug. 10, '95).
Case of typical recurrent dermatitis herpetiformis, the lesions consisting of a central bulla surrounded by an areola of spreading centrifugal erythema. Be tween this areola and the collapsed original bulla a ring of vesicles fre quent12; made their appearance. It is uncommon to have the lesions of derma titis herpetiformis so closely simulating erythema multiforme. John Liddell (Brit. Jour. of Derm., p. 385, '96).
Etiology. — It sometimes begins in childhood, but most frequently between 30 and 40 years of age. There seems to be some connection between the disease and instability of the nervous system, but nothing is definitely known upon this point. There seems to be a frequent relation between the eruption and preg nancy, the puerperal state, or menstrual disturbances. The disease described by Bulkley and others as "herpes gesta tionis" is probably a vesicular or vesic ulo-bullous form of D. herpetiformis occurring during pregnancy. There seems, also, some connection between renal defect and D. herpetiformis. It has been observed after septic infection.
Case of dermatitis herpetiformis in a woman of 42 with a rheumatic history. She suffered in 1895 from a stuffed-up feeling in the eyes, nose, and throat, and soon after blisters came out on the tongue; a little later on the chin; a hot bath was followed by a copious eruption of vesicles on the face and arms, which swelled greatly, and also 011 the chest and thighs. Fresh eruptions consecutively, with sorerfis in the mouth, eyes, and nose, and vio lent paroxysmal itching and burning of the affected areas. The attacks con tinued, and in November, 1896, the vesicles were both discrete and confluent, and also multilocular. Considerable eosinophilia of the compound-nuclear, coarsely-granular type were found in the blood, the eosinophiles reaching 4.9 per cent. of all leucocytes present.