Benign viral pemphigus. Causes of the disease

Pemphigus - dermatological disease, manifested by a blistering rash on the skin. In severe cases, a secondary infection may occur. What causes this disease in an adult, what types are there and what is used for treatment?

What kind of disease is this

The term “pemphigus” combines a number of skin diseases with similar symptoms. They can be called for various reasons. The main symptom for which this group was collected is a blistering rash on the skin. In some cases, the rash also affects the mucous membranes.

Varieties

The group of blistering dermatoses includes the following diseases:

pemphigus classic or pemphigus;

pemphigus ocular or cicatricial pemphigoid;

bullous pemphigoid;

Dühring's dermatitis herpetiformis.

The classification is based on the mechanism of formation of pemphigus vesicles. True pemphigus- this is pemphigus. Rashes with it are formed as a result of acantholysis - destruction of the spinous layer of the epidermis. The disease is serious and can be fatal.

All other types are pemphigoid, or non-acantholytic pemphigus in adults. It is less severe and usually ends favorably.

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Reasons for appearance

It is more convenient to consider the causes of pemphigus by specific diseases. In some cases the reasons are similar, in others they are different.

Classic pemphigus has been proven to be an autoimmune disease.
Pemphigus of the eyes is also of autoimmune origin.
Bullous pemphigoid is a disease of autoimmune origin. It may occur as a manifestation of paraneoplastic syndrome in tumor diseases.
Dermatitis herpetiformis or Dühring's disease is a disease of unknown etiology.

Note. It is believed that there is hereditary predisposition To Dühring's disease, gluten intolerance plays a role. There is also a theory that this viral pemphigus in adults.

Symptoms

Despite the common symptom of a blistering rash, various diseases are characterized by their own, characteristic only for them, manifestations.

Pemphigus

This classic version pemphigus. The essence of the disease is the appearance of blisters from exfoliated epidermis on the inflamed skin. Mostly people over 35 years of age get sick; children get sick very rarely.

The first rash appears on the mucous membrane oral cavity, in the throat. Gradually the rash spreads to the entire body. Pemphigus vesicles on the mucous membrane are very thin and burst easily. In their place, erosive changes form. As a result, eating and even talking are very difficult due to pain.

Pemphigus vesicles on the skin are more durable, but they also open with the formation of erosions. They occupy vast areas. Then the erosions are covered with dense crusts, after the removal of which foci of pigmentation remain.

Note. The disease can have a benign course, in which the patient’s condition practically does not worsen. There is also a malignant course with severe intoxication, exhaustion and dehydration.

According to the characteristics of symptoms, four forms are distinguished:

pemphigus vulgaris;

pemphigus foliaceus;

seborrheic pemphigus, or erythematous;

vegetative.

With pemphigus vegetans, the rash tends to be located in skin folds, around the natural openings of the body and the navel. After the blisters open, instead of erosions, skin growths appear - vegetations. They have a grayish color. Papillomas can merge and form extensive lesions. The growths produce abundant fluid. Patients experience severe painful sensations and skin itching.

The leaf-shaped form of pemphigus is often found in children. Bubbles with this option consist of several layers of the epidermis. After opening them, scaly crusts form on the skin.

Important. This disease lasts for many years, gradually spreading to the entire skin, including the scalp. The larger the lesions, the worse the patient's condition.

A type of pemphigus foliaceus is Brazilian or epidemic pemphigus. It often affects all members of the same family. The disease is common in South America. There is a high probability that this pemphigus is infectious, but its causative agent has not yet been identified.

Seborrheic pemphigus is called Senir-Usher syndrome. By its origin, this is true pemphigus - it can develop into other variants of pemphigus. The main part of the rashes is localized on the skin. If bubbles appear on the mucous membrane, this is an unfavorable sign. The blisters are practically invisible; they immediately become covered with yellow crusts, as with seborrhea.

Pemphigus eye

The disease is typical for women over 50 years of age. First, conjunctivitis develops - unilateral or bilateral. Then, against the background of the inflamed conjunctiva, thin blisters form. After opening them, adhesions are formed, which lead to the fusion of the eyelids with each other. Eyeball becomes immobile and blindness develops.

Note. In addition to the conjunctiva, pemphigus vesicles appear on the oral mucosa. There they are dense and tense. After opening them, deep painful erosions form.

Bullous pemphigoid

Bubbles appear on symmetrical areas of the body - on the sides of the torso, inner thighs. The background may be unchanged or hyperemic skin. Some blisters contain hemorrhagic contents. The rash is accompanied by itching.

The blisters can merge and reach several centimeters in diameter, forming bullae.

Dühring's dermatitis

Occurs at puberty, more often in men. Unlike other types of pemphigus in adults, the rash here is polymorphic. First, hyperemia of the skin appears, on which blisters, papules and blisters form. After some time, erosions and crusts form in their place. The rashes resemble those of herpes - they are located in separate groups, on symmetrical areas of the body. Accompanied by severe skin itching.

Diagnostics

Diagnosis is based on characteristic clinical picture. Confirmation is a histological examination of the epidermis. If acantholysis is detected, the diagnosis of pemphigus is considered reliable.

Pemphigoids - bullous and cicatricial - are diagnosed based on the characteristic clinical picture. At histological examination In the epidermis, acantholysis of the stratum spinosum is not detected.

Dühring's dermatitis is diagnosed based on the typical clinical picture. From specific methods the Jadasson test is used - when applying an iodine solution to the skin, the number of rashes increases.

Treatment

True pemphigus, which is an autoimmune disease, is subject to treatment with hormonal drugs.

Important. Since the disease is fatal without proper therapy, there are no contraindications to the use of corticosteroids in this case. The benefits of their use far outweigh the risk of side effects.

The main drugs used in the treatment of pemphigus are Prednisolone and Dexamethasone. Their reception begins with high doses, then happens gradual decline to a maintenance dose - one at which the appearance of fresh rashes will not be observed.

Cytostatic agents are prescribed simultaneously with corticosteroids. Usually this is Methotrexate or Cyclosporine. A long-acting corticosteroid is also used - Diprospan injection.

Local treatment of pemphigus in adults is of secondary importance. Bubbles and erosions are treated with antiseptics - brilliant green solution, fucorcin. For extensive rashes, baths with potassium permanganate are used.

Solcoseryl, a paste with a regenerating effect, is applied to the mucous membranes. Apply rinses with antiseptics. Thorough sanitation of the oral cavity must be ensured.

Treatment of dermatitis herpetiformis involves the use of DDS - diamindiphenyl sulfone. The drug is taken in courses. A diet excluding gluten products is indicated. Local treatment is the same as for true pemphigus.

Treatment of viral pemphigus in adults involves the use of antiviral drugs - orally and locally. The drug is determined by the doctor after examining the contents of the blisters.

Forecast

Some cases of pemphigus in adults end favorably. Some have a tendency to become chronic and last for many years. Some cases without adequate treatment lead to the death of the patient. Death occurs due to extensive damage to the skin, secondary infection and the development of sepsis.

Pemphigus is an infectious disease that manifests itself in the form of blisters filled with clear liquid. Such blisters appear on the feet, hands, buttocks or mucous membranes. Viral pemphigus is more common in children than in adults. Exacerbations occur mainly in the spring and autumn.

Viral pemphigus is caused by.
You can get it in the following cases:

with a weakened immune system after an illness;
if personal hygiene is not observed;
when eating from common dishes;
during exacerbation of a chronic disease;
when communicating with a carrier of this infection;
with bad heredity.

Being in the same conditions, children's body reacts differently to viral pemphigus. Doctors explain that the reason for this is the formation of auto-aggressive bodies, which, at the slightest disruption in the body, manifest themselves in the form of watery blisters on the skin or mucous membranes (as with).

Symptoms

Photo of viral pemphigus in the mouth of a child

The first symptoms of viral pemphigus in children begin to appear 3-6 days after infection. Usually parents do not attach importance to these symptoms because they are nonspecific. The first symptoms include:

drowsiness;
fatigue;
poor appetite;
sudden change of mood;
high temperature.

IN in rare cases the child may have:

runny nose;
cough;
vomit;
headache;
diarrhea (other causes of diarrhea in yearlings).

All of the above signs manifest themselves within 12-36 hours. Then symptoms specific to viral pemphigus become apparent. These are watery blisters that may appear on the palms, feet (soles), mouth, or genitals.

The blisters themselves have the following characteristics:

elongated or oval shape;
itching and pain;
clear or whitish liquid inside;
redness around;
erosion after the bubble bursts;

If the disease affects the oral cavity, then yellow blisters with a red rim around will appear in the mouth and a high temperature will rise. Along with the bubbles appears bad smell from the mouth. The blisters hurt even if you don’t touch them, and the pain intensifies when swallowing, as well as when eating food. In order not to further irritate the oral mucosa, doctors advise avoiding cold, hot, sour or spicy foods during this period.

Viral pemphigus of the oral cavity is easily confused with, since the symptoms are identical in appearance. Therefore, at the first signs of illness, it is best to immediately contact medical institution for help. Getting a diagnosis early will help you avoid prescribing antibiotics, which can cause additional rashes on the body.

In severe forms of the disease, blisters appear on the knees, elbows, buttocks and crotches, and the lymph nodes in the neck may become enlarged.
If blisters form on the feet or palms, the consequence may be peeling of the nail plate. The peeling process itself is painless, and the nails begin to grow back after 2 weeks.
With viral pemphigus, the high temperature lasts no more than 5 days. After this time, the temperature returns to normal and the child begins to feel better. From the onset of the disease to complete recovery, approximately 10 days pass. But it should be taken into account that after recovery, the Coxsackie ecterovirus will be excreted along with the feces for another 3 months.

Treatment

The diagnosis of viral pemphigus can only be made by an infectious disease doctor, and it is he who will prescribe correct treatment. Therapy is aimed at eliminating symptoms. Therefore, external agents that have antimicrobial and anti-inflammatory effects are used to treat viral pemphigus. This method promotes regeneration skin, thanks to which wound healing occurs faster. At this time, the child should be given medications that strengthen the immune system.
Accept antiviral tablets Doctors do not advise it, since after 10 days the disease goes away on its own.

Dr. Komarovsky warns that in rare cases, viral pemphigus in children appears in the eye area. This can lead to blindness in the child. To prevent this from happening, you should contact specialists in time and begin treatment.

The word “pemphigus” refers to a whole group of diseases manifested by the appearance of blisters on unchanged skin and mucous membranes. They appear spontaneously, not after mechanical trauma, chemical or thermal burn; occupy not one, but several zones at once.

The most dangerous of this “cohort” is true pemphigus and its subspecies. In order not to die from their complications, constant use of drugs that suppress the immune system is required. huge amount side effects. Non-acantholytic forms of pemphigus (also called pemphigoid) are considered less severe. Separately, there is viral pemphigus, which develops in children and (less often) adults.

This is the most light form pemphigoid, which goes away on its own in the absence of diabetes mellitus and pronounced immunosuppression. Treatment consists of providing conditions for the prevention of suppuration and the speedy healing of erosions formed after the opening of the blisters. The main thing is to get diagnosed by an infectious disease specialist and a dermatologist and confirm that it is viral pemphigus that is occurring here.

What causes viral pemphigus?

The disease is caused by viruses of the Enterovirus genus - those that often provoke acute intestinal infection with diarrhea and fever, as well as inflammation of the upper respiratory tract with fever. Under certain conditions, some groups of enteroviruses can cause inflammation of the membranes enveloping the central organs. nervous system(meningitis); they can also cause damage to the brain substance (encephalitis). The group of enteroviruses also includes the causative agent of polio.

Viral pemphigus is caused by enteroviruses of the Coxsackie group, subspecies A16 and subspecies 71 of the main group. They are transmitted in many ways:

airborne: when talking, sneezing, kissing or coughing;
contact-household: through towels, cups, spoons, toys, door handles;
fecal-oral: when particles of the patient’s excrement are not washed off with water from his hands, they end up on the hands of a healthy person, with which he takes food.

There are a lot of subspecies of enteroviruses, each of them occupies a specific localization in the area. Until the age of 10-15 years, a child “gets acquainted” with viruses that “live” in his region and gets sick (this is not always severe forms, most often an enterovirus infection looks like a runny nose and fever). This is how he earns immunity. After 15 years, as long as he does not travel anywhere from his native region (usually a region or several regions of the country), he no longer suffers from enterovirus infection. The peak incidence occurs under the age of 10 years.

An adult usually becomes infected with viral pemphigus when he visits another region (most often, goes to the sea or abroad) or communicates with a sick child or adult who has come from afar.

The peak incidence occurs in spring and autumn.

The chance of becoming infected increases sharply if a child or adult:

recently suffered from an illness (especially a viral one);
suffers from diabetes;
recently suffered an exacerbation of a chronic disease;
genetically predisposed to blistering of the skin. On at the moment Researchers are working to clarify the fact of the alleged formation of skin-aggressive antibodies that appear when an enterovirus enters the body.

Not only will a person who has a sore throat, runny nose, diarrhea or headache accompanied by a fever, but also someone who looks healthy in appearance, be contagious, but:

is still in the incubation period (it is 6 days);
is not sick and will not be sick due to high activity own immune system, but is a carrier of the virus, excreting it in feces;
Over the next 3 months he suffered from an enterovirus infection.

It is impossible to “calculate” such people: even if you take a test from the throat, tonsils or feces, before allowing a relative who has arrived from the sea to see the child, it will take at least 2 weeks, during which the child will become infected. If the child is under one year old or is often ill, any guest who comes from afar should be considered potentially dangerous and allowed to visit the baby after washing their hands and, ideally, wearing a disposable mask covering the nose and mouth.

Mechanism of bubble formation

Human skin can be figuratively described as a water-spring “mattress” covered with a kind of “wall”. The “mattress” does not participate in the formation of bubbles - only the top layer, the epidermis, suffers.

The epidermal layer consists of 10-20 cell layers, which look like bricks under a microscope. The “bricks” of the second layer of the epidermis are connected to each other by peculiar “bridges”. On top of the “wall” there are layers of cells that are no longer quite similar to cells, reminiscent of applied cream. These are scales, corneocytes, necessary for protection from mechanical, chemical and physical damage.

If under the influence of internal or external reasons antibodies are formed, which destroy the “bridges” - desmosomes between the cells of the basal layer (this is called acantholysis and can be seen under a microscope), this is true pemphigus. If tissue fluid penetrates between the basal and top layers epidermis, without destroying the “bridges”, this is pemphigoid. Viral pemphigus also occurs without destruction of desmosomes.

Symptoms of the disease

Whether a person has become infected or not after contact with a sick person will not be visible immediately, but after 3-10 days of the incubation period. Next, children develop general signs, indicating that the child is sick:

weakness;
fatigue;
drowsiness;
loss of appetite;
may be: runny nose, sore throat, headache, cough, and sometimes loose stool.

The temperature rises, and a little later, after 12-36 hours, immediate symptoms of viral pemphigus - blisters - appear. They occur in the oral cavity: on the gums, on the palate, the mucous membrane of the lips, tonsils, and sometimes on the lateral surface of the tongue. They look like bubbles with yellowish contents, surrounded by a reddish corolla; painful. An unpleasant odor appears from the mouth. It becomes painful to drink and eat, especially when the food/drink is sour, salty, hot/cold or spicy, so young children may refuse to eat or drink completely.

A similar rash occurs on the extremities (the hands and feet are especially affected), as well as on the body: buttocks, genitals. There is a direct relationship between the number of rash elements and the severity of the disease: the more bubbles, the closer to the center of the body they are located, the more severe the course. In these cases, it is more rational to resort not only to local treatment, but also the use of systemic antiviral drugs.

Skin rash can be described as follows:

appears on unchanged skin;
elongated shape;
with a reddish rim around;
may hurt or itch.

After a while, the bubbles burst, and in their place red shiny areas up to 3 mm in diameter appear. They are also surrounded by red rims and are painful. After 2-3 days they become covered with crusts, which then fall off, leaving behind normal skin, sometimes only - dark spots.

A high temperature, which is difficult to reduce with the help of antipyretics, lasts about 5 days, then it decreases, and the person becomes better.

After rashes on the hands and feet, a few days after they have healed, the following picture may be observed: some nails gradually and painlessly peel off. There is no need to worry about this - the nail plates will soon grow back, without the slightest defect.

Complications

Enteroviral pemphigus is a disease that is usually mild, but in the presence of a weakened immune system it can be complicated:

meningitis - inflammation of the membranes of the brain. In most cases it has mild course, ending with recovery;
encephalitis - inflammation of the brain. It develops rarely and can occur in varying degrees of severity;
pneumonia;
myocarditis – inflammation of the heart muscle, which without proper treatment can result in heart failure. The cause of myocarditis is that the sequence of antigens that myocardial cells display to the immune system (as almost all cells do) is in a particular region identical to those of the Coxsackie virus, which causes pemphigus. The immune system “thinks” that the myocardium is a microbe and begins to attack it.

Developing in the first three months of pregnancy, viral pemphigus can cause miscarriage. Under the influence of this virus, severe fetal malformations can form, due to which artificial premature birth will have to be induced.

Differential diagnosis

Since viral pemphigus rarely occurs in adults, it is necessary to distinguish it from other dangerous diseases - varieties of true pemphigus, which appears more often in adulthood and requires prompt treatment. These are vulgar, vegetative, seborrheic and pemphigus foliaceus. In newborns, enteroviral disease is differentiated from dangerous staphylococcal infection– pemphigus of newborns.

Varieties of true pemphigus

Let's take a closer look at the 4 forms of the disease.

Vulgar form

Pemphigus vulgaris is the most common type of pathology, manifested by the appearance of blisters. It affects from 1 to 5 people per million of the population. The peak incidence occurs between the ages of 30-60 years. The pathology is associated with a malfunction in the activity of the immune system, when antibodies are formed to the “bridges” between the cells of the basal layer of the epidermis, destroying them.

The disease begins with the appearance of blisters on the oral mucosa. Bubbles burst quickly under the influence of food, so it is difficult to “catch” them. The erosions formed after the opening of these bulk elements are visible only later. They appear as painful plaque-covered areas, and when the plaque is removed with a spoon or spatula, a bright red, shiny surface is exposed. There is a foul odor from the mouth. If treatment is not started, erosions will not heal.

After a period of time from several days to several months (even up to 1 year), blisters appear on unchanged (that is, not swollen, not red or blue) skin. They are painless, filled with clear liquid, and do not itch. Sometimes such blisters have a thin red rim around them, as with viral pemphigus.

Distinguishes pemphigus vulgaris from viral:

no increase in temperature and no signs of intoxication (fatigue, decreased appetite) at the blistering stage. Fever and weakness appear only when the covers of these loose elements are damaged;
blisters on the body do not appear all at once, but in patches: there is a group of rash elements on the back, there are on the chest, they are also affected axillary fossae and inguinal folds;
only after a while, if you do not start treatment with immunosuppressive drugs, the rest of the skin is also involved in the process;
hands and feet - favorite places for viral pemphigus - are the last to be affected;
over time, the patient’s condition only worsens, whereas with viral pemphigus, spontaneous relief of symptoms is observed.

Leaf-shaped

Pemphigus foliaceus is the second form of true pemphigus. Its name is associated with its appearance: when the blisters are opened, layered crusts similar to leaves remain on the erosions.

This disease is the most common view pemphigus in children. In adults, it develops more often than pemphigus vegetans. The basis of the disease is the rupture of the connecting bridges between the cells of the basal layer of the epidermis under the influence of attacking own antibodies.

The disease begins with redness of areas of the skin, on which flat, flabby blisters soon appear. Less commonly, these rash elements may be indistinguishable from those of pemphigus vulgaris or resemble eczema or seborrheic dermatitis.

Favorite areas are not the hands and feet, as with viral pemphigus, but:

scalp;
breast;
back.

Although the bubbles are flabby, having a thin cover, they quickly burst. If you pull the tip of the peeled skin, the skin is also removed from the area where there was no bubble. After this, bright red areas form, from which discharge is noted. The transudate quickly dries out, forming crusts, but the erosions underneath them heal very slowly. In some cases, new blisters form under the crusts.

The discharge is released in portions, which, when dry, form layers on the surface of the erosion, resulting in a pattern on the skin reminiscent of areas of puff pastry. The eroded areas tend to merge, forming extensive wound surfaces underneath. Due to loss useful substances(proteins, electrolytes) through the skin, as well as due to the attachment bacterial infection the patient's condition worsens: sleep deteriorates, the person becomes moody, irritable, loses weight, and the temperature may rise. In addition, every movement that stretches the eroded skin is accompanied by pain.

Vegetative form

In this case, against the background full health Bubbles filled with clear liquid or ichor appear in the mouth. A little later or simultaneously, similar rash elements appear on the skin. Favorite localization:

axillary fossae;
inguinal folds;
area between the buttocks;
area behind the ears;
area under the mammary glands;
around the navel;
on the genitals, where the skin meets the mucous membrane.

The blistering elements of the rash have a flabby cover, so they quickly open up, forming erosions. Erosions differ from the same elements in other types of pemphigus: they are not only bright red, but after 7-14 days they are covered with papilloma-like outgrowths. Eroded surfaces tend to merge, resulting in lesions up to 15 cm in diameter. They release a liquid that has a foul odor. In addition, it is extremely painful or accompanied by a burning sensation that prevents the person from moving.

If a person is not treated, he becomes severely malnourished and may die either from malnutrition or from a bacterial infection on his body. open wounds and bedsores, and then blood, with the formation of ulcers in the internal organs.

Seborrheic form

This is a kind of “combined” form that combines the signs of true pemphigus, one of the variants of systemic lupus erythematosus and seborrheic dermatitis. It can begin characteristic symptoms, and then transform into a leaf-shaped or vulgar form.

The disease begins with the appearance on the skin of the cheeks and back of the nose of areas of redness, covered with thin grayish-yellow crusts of loose consistency. Blisters appear under these crusts, which quickly open, but due to the seborrhea-like crusts, this goes away almost unnoticed.

A little later, rash elements appear on the scalp. Here they look like red lesions covered with greasy scales (as in seborrhea). After them, scars form and hair falls out, which cannot grow on the scar tissue.

Around 5-7 years, the rash affects only the scalp. Then the disease may worsen, and then rashes appear between the shoulder blades, on the chest and back. Just like on the face, they are covered with dense crusts, the removal of which is extremely painful.

Pemphigus of the newborn period

Pemphigus of newborns is not true. Its cause is microbial damage to the skin. Previously, this pathology could only be caused by Staphylococcus aureus carried out modern research indicate that streptococci can also provoke the occurrence of the disease.

Children who are born prematurely or who are injured during childbirth are more likely to get sick. Coccal flora “flies” from the mouth or skin of medical staff or mothers who are its carriers. A newborn can become infected from people in contact with him who have a sore throat, have ulcers on his hands (or on the mother’s chest and stomach) or carious teeth in his mouth. The disease can develop if the second half of pregnancy proceeded with gestosis, and also if the umbilical cord wound in the child festered. Pemphigus of newborns is extremely contagious. When pathogens are transferred on bed linen or the hands of staff in the maternity hospital, outbreaks of its epidemic may develop.

The pathology appears from the 3rd to the 10th day of a newborn’s life. Initially, the skin of the body turns red in patches. In these places, blisters appear filled with transparent yellowish or yellow-gray contents, which quite quickly transform into purulent contents - also yellow or gray-white, but no longer transparent.

The bubbles are small at first, but soon begin to grow and merge with each other. Over time, they burst, forming itchy erosions and deeper lesions - ulcers. The discharge from ulcers and erosions dries, giving rise to the formation of crusts.

Favorite places for loose elements:

navel area and lower abdomen;
legs;
pens;
folds: cervical, inguinal;
in severe cases, blistering elements appear on the back, chest, and buttocks.

In addition to local manifestations, almost always, except for extremely mild cases, there are also general symptoms: increased body temperature to high levels, decreased appetite and decreased body weight, anxiety, crying; in severe cases - drowsiness.

Pemphigus of the newborn period is a dangerous pathology, often complicated by the entry of these extremely aggressive cocci into the blood, through which they spread to the internal organs, causing pyelonephritis, otitis media, pneumonia or dysfunction of several at once internal organs. Vomiting, increased breathing and heart rate are signs of a complicated course of the pathology.

Treatment of viral pemphigus

Treatment for pemphigus begins after diagnosis. This is done based on an examination and conversation with the patient’s parents or the patient himself, if he is an adult. The diagnosis is performed either by an infectious disease specialist or a dermatologist (a joint examination of these two specialists is more often used). After the examination, it is necessary to donate blood from a vein to check for antibodies to the enterovirus, but treatment is prescribed immediately, since the diagnosis of the virus will last at least 2 weeks.

Therapy is as follows:

If the blisters are itchy, prescribe antihistamines: “Fenistil”, “Erius”, “Zodak”, “Suprastin”. In case of severe itching, 2 of these drugs (for example, Suprastin and Erius) can be combined without exceeding the daily dosage.
With severe itching of rash elements general treatment supplemented by treatment of blisters with local antihistamines: “Psilo-balm”, “Fenistil-gel”.
To relieve the pain of the rash and reduce body temperature, Nurofen, Paracetamol, and Nise are used (the latter only for adults). Aspirin or acetylsalicylic acid should not be used by children!
Apply a special diet: exclude from your diet hot, smoked, sour and spicy foods and drinks that will irritate the inflamed oral mucosa. Also exclude hot food, give preference to those dishes and drinks that feel more harmonious when cold (okroshka, compotes, ice cream, fruit ice).
Rinse your mouth with antiseptic solutions: aqueous solution furacillin, chlorhexidine. For adults, you can use Orasept, Strepsils spray with lidocaine and other sprays containing an antiseptic and anesthetic.
Blisters on the skin can be treated with fucorcin or a solution of brilliant green.

In some cases, infectious disease doctors prescribe antiviral drugs. For children this is “Viferon” or “Laferon” in suppositories, for adults - “Cycloferon” in tablets or “Laferon” in the form of intramuscular injections.

To relieve itching, in addition to official medicine, folk remedies are successfully used:

Nettle juice lotions. To do this, the leaves of this plant must be crushed and then squeezed. Cotton pads are soaked in the resulting juice and applied to the itchy rash.
Lotions with aloe juice. The leaves of the plant are cleaned of skin and thorns, cut into small pieces, and the juice is squeezed out. Cotton pads are soaked in it and applied to the itchy blisters.
Compresses from a mixture of chopped herbs. You need leaves of wormwood, lilac, plantain and yarrow in equal volumes. They need to be crushed into a paste, and then applied to the skin covered with a rash, covered with a sterile gauze cloth and secured with a band-aid.
You can rinse your mouth with the following composition. 4 tbsp. chamomile, calendula and sage flowers are placed in a thermos, 500 ml of boiling water is poured in, and infused for 1 hour. Rinse your mouth with this infusion 2 times a day.

Prevention

There are no vaccines or serums for enterovirus - there are so many strains that it is impossible to guess which one you will come into contact with. If you or your child has been in contact with someone who has pemphigus, to reduce the chance that you will get sick, you need to eat well for the next week, enriching your diet sufficient quantity vitamin products(these are fruits, vegetables, natural freshly squeezed juices, raisins). It is also worth consulting with your doctor about whether you can take calcium supplements, and, if this does not harm your health, take Calcium-D3 or Calcium gluconate in an age-appropriate dosage for 3-7 days.

You can prevent the disease by doing hygiene measures after the street, transport, visiting the toilet and before eating. You need to teach your child not to communicate and not to come close to a coughing or sneezing person. If a relative or friend from another region comes to visit, and you small child and this happens in the summer or autumn, you need to ask him to either communicate less with the baby, or do this clean hands and wearing a mask (no matter how difficult and offensive it may be).

If the child is already sick, to prevent illness in other family members, you need to provide the baby with a separate cup, spoon, fork, and towel. It is necessary to carry out hygiene of his genitals and anus more often and change diapers, but do this with gloves to prevent viral particles from getting on your hands. Handling rash elements in the mouth and on the skin should also be done with gloves. A child should not share his toys with healthy children. Such rules will have to be followed not only during illness, but also for 3 months after it.

Diseases affecting the skin are most common in childhood. Pemphigus is one of these diseases. The disease has a rapid course and is characterized by the appearance of blisters on the skin and mucous membranes. If incorrect or untimely treatment it can cause serious complications in the future, so it is important to know its signs and treatment principles.

What kind of disease is viral pemphigus and how is it contracted?

Pemphigus is a disease viral nature, in which blisters filled with clear fluid form on the skin. Their number is rapidly increasing, small neoplasms can merge and, together with other blisters, cover large areas of the body. The disease is accompanied by itching and burning of the skin, and patients suffer severe pain.

The disease is considered seasonal; the virus is most active in autumn and spring. Blisters can appear not only on the skin, but also on the oral mucosa, sometimes they spread to the buttocks and genitals.

You can get infected with the virus anywhere. There are two methods of infection:

visit public places – kindergarten, school, beach, transport, etc.;
contact with objects touched by a sick person.

At risk are children with reduced immunity and hereditary predisposition, as well as those children who do not adhere to the rules of personal hygiene. Infection is caused by insufficient food processing and lack of the habit of washing hands after going outside.

It is worth remembering that lasting immunity to the disease is not developed. There are many strains of pemphigus, and the baby gets immune protection only from the one with which he was ill. For this reason, parents of children who have already encountered this disease should remain vigilant.

Differences between true and viral pemphigus

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In medicine, there are several classifications of the disease, but there are two main forms of pemphigus:

Causes of diseases

Viral pemphigus is infectious disease, which develops as a result of infection with the Coxsackie virus. The main condition for the onset of the disease is a weakened immune system, but the risk of infection increases with the following factors:

congenital autoimmune diseases;
hormonal disorders;
pathologies of the central nervous system;
negative impact of the environment;
decreased immunity due to taking potent medications;
failure to comply with hygiene rules;
contact with common objects.

True pemphigus is an autoimmune pathology characterized by severe course. The disease is chronic, there are periods of remission of different durations and severity of symptoms.

During acute phase Large blisters spread over the skin, and the person feels very unwell. The causes of the disease are unknown, but there are many theories: toxic, endocrine, etc.

These two types of pathology are easily confused due to the similarity of symptoms. However, unlike true pemphigus, viral pemphigus is quite easy to treat and does not pose a threat to human life.

Symptoms of true pemphigus

There are several varieties of true pemphigus, and depending on the form, symptoms may vary:

Ordinary (or enteroviral) is the most common. Patients develop blisters without signs of inflammation. Without treatment, they can merge, forming large lesions.
Erythematous. Red spots covered with crusts form on the body and face. Seborrhea appears on the scalp under the hairline. The disease is difficult to treat.
Leaf-shaped. The resulting blisters practically do not rise above the skin. The crusts of healing ulcers tend to layer on top of each other.
Vegetative. Erosion with an unpleasant odor appears on the body. The spots often have purulent contents.
Brazilian. Found exclusively in Brazil, affects humans of different ages.

Symptoms of viral pemphigus

Viral pemphigus has a seven-day incubation period. The first sign of illness is malaise. Blisters appear after 2-3 days, and sometimes their formation is accompanied by a rash. Blisters appear singly or immediately cover large areas of the skin, merging into one large lesion, as shown in the photo.

Viral pemphigus in children is accompanied by symptoms:

increased body temperature and fever;
the appearance of hyperemic lesions with blisters containing fluid;
cough, rhinitis, sore throat;
formation of blisters and wounds on the mucous membranes;
the presence of crusts at the site of burst blisters;
weakness;
loss of appetite;
sleep disturbance;
weight loss.

The first areas with blisters appear on the mucous membranes, and then spread further, but they can also be observed on the body - face, limbs. With a complex form of the disease, blisters even appear on the palms.

Age of patients

Children under 10 years of age are more susceptible to viral pemphigus, since immune system unable to cope with everyone external stimuli. Even a newborn baby can become infected from the 20th day of life - until this age the baby is still protected by maternal immunity. Among the adult population, the disease is very rare, but can occur in people who have recently had a viral infection. True pemphigus, according to statistics, affects people over 40 years of age.

Pemphigus caused by the Coxsackie virus

Course of the disease

Symptoms of the disease do not appear immediately; they usually take from a couple of days to a week. The first signs resemble a common cold:

the child complains of fatigue, becomes drowsy and plays little;
his appetite and mood worsen;
the temperature rises to 38.5°C;
there is a sore throat.

In some cases, the baby complains about headache, he develops a runny nose, cough, and diarrhea. This condition lasts up to 36 hours, the temperature can last for several days. After this, the child’s condition improves, but other symptoms begin to bother:

bubbles oval shape(when a bacterial infection occurs, their color changes from transparent to whitish);
blisters have a red rim, hurt and itch;
after opening them, erosions up to 3 mm in diameter are formed;
the ulcers become covered with crusts, which fall off within 2–3 days and leave dark spots (sometimes they are absent).

Blisters form on the hands, feet, and rarely on the buttocks, thighs and genitals. Possible enlargement of cervical and submandibular lymph nodes. If the disease affects the extremities, the patient's nails may peel off, but this process is reversible.

If rashes appear in the oral cavity, they quickly burst - painful ulcers form in place of the blisters. Most often they are located on the tongue and inner surface cheeks, sometimes affecting the palate. The child develops bad breath and refuses to eat. Pemphigus that develops in the mouth can resemble a sore throat, so to make a correct diagnosis you need to contact an infectious disease specialist. This is necessary so that the doctor does not prescribe antibiotics containing penicillin - they treat sore throat, but in case of enterovirus infection they cause the formation of small spots (rash).

According to statistics, all symptoms of viral pemphigus disappear within 10 days, and the person feels completely healthy.

The infectious agent remains in the body for about 3 months, the virus is excreted in the feces. To prevent infection of other family members, you should carefully monitor the baby’s hygiene.

Differences from herpes infection and gonorrhea

Among the symptoms of pemphigus, the main ones are the occurrence of blisters and painful erosions that affect the mucous membranes of the mouth and genitals. In this way it is similar to herpes, but there are also specific differences.

Pemphigus formations are oval or pear-shaped, they tend to increase in size and open when touched lightly. With herpes, the blisters are small, most often localized in the corners of the mouth and on the edges of the lips, on the wings of the nose and in the area of other natural openings. One lesion contains 2–10 vesicles, which are located in groups and reach no more than 1.5 cm in diameter.

With gonorrhea, as with pemphigus, the mucous membranes are also affected, but the ulcers are red in color, and purulent contents are released from the wounds. In addition to the characteristic rash on the genitals, the mucous membrane inside the vagina, rectum and urinary canal is affected.

Treatment of the disease

For minor damage to the skin and mucous membranes, treatment is not prescribed. As a rule, symptoms go away on their own within 1–1.5 weeks. To relieve pain and reduce fever, your doctor may recommend giving your child Ibuprofen, Nurofen, or Paracetamol. If after 7 days the signs of the disease do not disappear, it is necessary to undergo diagnostic tests again and consult a doctor to adjust the treatment.

The complex form of pemphigus with rapid progression and damage to large areas of soft tissue requires complex therapy(sometimes in a hospital setting). The following drugs are usually used to treat children:

Viferon – antiviral agent, which can be used for babies from 1 month. The suppository is administered twice a day, the course of treatment is up to 10 days.
Cytostatics, for example, Sandimmune. The remedies are necessary to block the further spread of the rash. The medication is used twice a day for 5 days. It is allowed from 6 years of age.
Glucocorticosteroids, such as Dexamethasone. The duration of therapy is no more than 3 days.

Since blisters and sores cause discomfort to the baby, they must be treated regularly. The most commonly used drugs are:

Depending on the complexity of the disease, the doctor may prescribe physical therapy: electrophoresis, magnetic therapy, electrical stimulation bladder. This type of treatment is used for children aged 1 month and older.

Regime and nutrition during illness

Pemphigus in children can be treated at home. It is important for parents to adhere to certain recommendations:

During treatment, it is important to adhere to a diet - food should be rich in proteins and vitamins, and fats and carbohydrates should be completely excluded from the diet. When feeding newborns, it is better to refuse complementary feeding and give only breast milk. Food for older children should be liquid (mashed potatoes, pureed cereals), at room temperature.

It's important to keep track drinking regime child - if he refuses to drink liquids, he can be offered to suck on cubes of frozen juice or water. Ice will help reduce pain and help maintain fluid and salt balance.

How to avoid infection?

Prevention of the disease is mainly aimed at strengthening the immune system and teaching the child the rules of hygiene. To prevent infection you must:

provide the baby with personal hygiene products (towel, toothbrush, etc.);
keep the child’s home and clothes clean;
treat any diseases in a timely manner;
provide good nutrition and give pharmacy vitamin complexes in accordance with age (if prescribed by a doctor).

If you have come into contact with a sick person, you need to start taking Calcium D3, Calcium gluconate or other drugs with similar composition. The baby needs to be provided with adequate nutrition, rich in vitamins.

In pediatrics there is severe pathologies, the mechanism of their appearance has not been sufficiently studied, which does not allow maximum probability identify the root cause and eliminate it. As a result, the prescribed treatment is not very effective, the disease progresses and leads to disability or death. One of these ailments is pemphigus - pemphigus, which is characterized by damage to the mucous membranes and skin.

Despite the danger of the diagnosis, parents should not panic, but do everything to alleviate the child’s condition. Moreover, the prognosis will largely depend on the form of the disease.

Exact reasons The occurrence of pemphigus in children has not been clarified. Scientists have not been able to find out why autoimmune processes are disrupted. Under the influence of unknown factors, the body activates the production of antibodies against its own cells.

Over the years of pathology research, many versions have been put forward based on analyzes biological fluid, blood, studying the nature of the lesions. The most reliable, having the right to exist, and not devoid of logic, were 4 theories that explain the occurrence of pathology.

Neurogenic theory: central nervous system disorders.
Endocrine: hormonal imbalance.
Infectious: viral or bacterial infection by an agent unknown to science.
Autoimmune: The body produces antibodies that destroy its own cells.

Most scientists support the autoimmune theory of the origin of pemphigus, because these same antibodies are easily detected in the blood of a sick child. The question is why the body begins to behave so strangely.

Doctors name the following factors that can lead to this development of events:

heredity;
infection with endogenous bacteria.

The latter enter the body through household contact or airborne droplets. It turns out that pemphigus - contagious disease, but why is it so rare?

Scientists suggest that the pathogen does not always force the body to destroy its own epithelium. Most likely, it simply lies dormant and makes a person a normal carrier. The pathology is often diagnosed in children of different ages, because their immune system is not yet formed and cannot protect itself from such attacks.

According to this theory of bacterial infection, an adult can become infected with pemphigus from a child through ordinary contact. Therefore, isolation with such a diagnosis is forced necessity. The course of the disease is largely determined by its form, since in pediatrics several types of pemphigus are distinguished.

Species

More often than others, viral pemphigus is diagnosed in children - the most common form of this disease and not dangerous. Provided timely and competent treatment occurs full recovery without any consequences or complications. But other types of pathology are much less harmless.

Vulgar / ordinary

The vulgar form of the disease can affect the skin and mucous membranes of even a newborn baby. The body begins to produce antibodies that destroy its own cells due to severe burns, prolonged exposure to the sun or treatment with drugs such as antihistamines, antibiotics or hormones.

The external symptoms of this type of pemphigus are very similar to blisters after burns. The clinical picture manifests itself according to the following scheme:

the formation of blisters with transparent contents, which are easily opened even upon contact with clothing;
if the blister shell ruptures, very painful erosion appears;
it does not heal for a long time, its edges constantly crack, it bleeds heavily at the slightest movement;
if the bubble was not opened by a careless movement, its center becomes covered with a crust, and the edges gradually grow and capture new spaces of the skin and mucous membranes.

And a specific localization pemphigus vulgaris does not have. Blisters can appear anywhere.

Along with development external symptoms The child's condition will gradually deteriorate. He will sleep poorly, refuse to eat, complain of muscle pain and headaches, and become lethargic and irritable.

Pemphigus vulgaris in children is a severe and dangerous form of the disease. Its course rapidly becomes malignant. Without timely selection of adequate treatment, complications in the nervous or endocrine systems. Death is also possible due to extensive purulent processes.

Vulgar (top) and vegetative (bottom) pemphigus

Vegetative

With vegetative pemphigus in children, the lesions do not grow, but are localized islands. However, in the absence of proper treatment this form the disease becomes vulgar. Within this species, two more types are distinguished.

Pemphigus Apollo

It is most often diagnosed in children after a long course of treatment with corticosteroids. First, purulent blisters form, then they open and expose wound surface, which gets wet and smells unpleasant. With this form of the disease there is a very high risk of contracting a secondary bacterial infection.

Neumann's pemphigus

Neumann's pemphigus in children is usually localized in armpits, genital area, on the head. Volumetric and scary in their own way are formed appearance growths resembling cauliflower. Erosion takes a very long time to heal. After they dry, flat warts remain on the skin.

If treatment of this type of pemphigus was carried out on time, the spread of the lesion does not occur.

Exfoliative/leaf-shaped

Pemphigus foliaceus - dangerous chronic disease, leading to serious complications. Most often occurs in children of preschool or primary school age.

Manifests itself through the following symptoms:

shallow lesions of the epidermis, most often on the scalp;
after opening, their surface peels off and begins to emit a repulsive odor;
since exfoliated epithelial cells heal for a long time and painfully, new blisters form under them;
This is how neoplasms layer on top of each other;
in advanced forms of the disease, a high temperature may rise.

It is very difficult and often ends in complete loss of hair.

Leaf-shaped (left) and seborrheic (right) forms of pemphigus in children

Seborrheic/erythematous

Erythematous pemphigus in its clinical picture resembles seborrheic dermatitis. Rarely seen. Usually diagnosed after long-term use unjustified medications (parents often give their children antibiotics for no reason). Leaks in enough mild form. It leaves no complications behind. It is localized on such areas of the body as the face, chest, back, and scalp.

The development of the disease occurs according to the following scheme:

Severely hyperemic lesions with clear contours appear on the child’s skin;
bubbles form in their place;
they quickly burst and become covered with gray-yellow crusts;
if you pull them off, erosion is exposed.

In an advanced state, in the absence of proper treatment, it can develop into pemphigus vulgaris.

Viral / infectious / enteroviral

There are a lot of discrepancies in the sources regarding this particular form of the disease. Considering the viral origin (as an option) of this pathology, infectious pemphigus is not classified by some doctors as a separate group, but includes the 4 described above. Other experts still say that this is one of the varieties, often matching its symptoms with multiple lesions of the skin and mucous membranes in children.

As a distinct type, enteroviral pemphigus primarily affects the palms and soles. The culprits are considered to be enteroviruses, more specifically (subspecies A16) or enteroviruses themselves, subspecies 71. In the first case, the palms suffer, but the disease is quite mild. If the body has been attacked by enteroviruses of 71 subspecies, the pathology takes on epidemic proportions, which is often complicated by meningitis or encephalitis.

Most often, the pemphigus virus finds shelter in the body of a weakened child. It is characterized by seasonality - real epidemics break out in spring and autumn. Changes in climate and season also contribute to the spread of the disease.

The clinical picture manifests itself in different ways:

localization on the palms and soles, less often - the genitals, buttocks, thighs;
the bubbles have an elongated or oval shape;
transparent content;
soreness and itching of the affected areas;
a red rim forms around the blisters;
after opening, erosions are exposed;
a crust appears on their surface, which soon disappears.

At the same time, the child becomes lethargic, loses appetite, sleeps poorly and feels overwhelmed.

Since pemphigus is very similar to others skin diseases, which are so often found in children of different ages, parents cannot make a diagnosis on their own. It is necessary to undergo appropriate diagnostics carried out by a dermatologist.

Diagnosis and course of treatment

The diagnosis of pemphigus is made to a child during an external examination, based on the appearance of the rash. Next, the dermatologist can refer you to an infectious disease specialist who will conduct serological studies to detect antibodies through blood, stool and cerebrospinal fluid tests (if complications such as encephalitis or meningitis are suspected). May be assigned cytological examination liquid inside the bubbles. Once the diagnosis is confirmed, appropriate treatment is carried out.

Treatment for pemphigus will depend largely on what form of the disease was identified in the child.

Viral form

Treatment of viral pemphigus involves the use of the following systemic drugs:

antiviral: Viferon, Laferon, Cycloferon;
glucocorticosteroids: Dexamethasone, Prednisolone;
cytostatics stop cell division immune cells: Sandimmune, Azathioprine, Methotrexate;
antipyretics: Ibuprofen, Paracetamol, Nimesil, Mefenamic acid;
antihistamines relieve itching: Cetrin, Diazolin, Fenistil.

For external treatment of affected skin areas, the following may be prescribed:

antiseptics: Chlorhexidine, Methylene blue, Miramistin;
combination preparations of antiseptics and anesthetics: Oflocain, pharmaceutical talkers;
antimicrobial local anesthetics for irrigating the oral cavity if viral pemphigus has affected the child’s mucous membranes: Forteza, Orasept;
antipruritic lotions made from nettle juice, aloe, and walnut oil.

Since children with this diagnosis are usually treated in inpatient conditions, to enhance the therapeutic course can be carried out medical procedures aimed at purifying the blood of antibodies:

hemosorption using a carbon filter;
plasmapheresis - replacement of the liquid part of the blood with similar solutions without microbes, immune complexes and antibodies.

Only a doctor can tell how to treat viral pemphigus, because in each individual case it can acquire some special features. As for other forms of pemphigus, the therapeutic course for them is also determined individually.

Other forms

The basis of treatment for non-viral forms of pemphigus in children comes down to prescription the following drugs and procedures:

glucocorticoids in high dosages;
as they can cause serious side effects, immunosuppressants are prescribed in parallel;
intravenous administration human immunoglobulin in high doses;
administration of an anti-CD20 monoclonal antibody;
plasmapheresis;
V special cases- antibiotics and antifungal drugs;
allotransplantation bone marrow or stem cells is not encouraged, as it can be fatal, but is still used in cases where the chance of survival is already minimal.

Scientists are still researching this mysterious disease and looking for more effective techniques How to treat pemphigus in children to reduce the risk of complications and deaths. Many laboratories are working to discover new drugs that could help those suffering from this disease.

Parents can alleviate the condition of their child only by competent care and compliance with all medical prescriptions.

Care

After confirmation of the diagnosis, if the child is not being treated in a hospital, parents must provide him with proper care, which will provide good support to the main course of treatment.

First of all, parents are interested in whether it is possible to bathe a child with viral pemphigus. This is not recommended, since, given infectious nature diseases, the affected areas can spread further, and weeping erosions will take much longer to heal.
You will need a special diet that excludes spicy and sour foods.
Clothing should be as loose as possible, made from natural materials.
It is better if there is a constant flow of fresh air to the wounds.
The room in which a child with pemphigus is lying must be well ventilated.
Isolation for a week is simply necessary to avoid infecting the rest of the household.

There cannot be a single prognosis for pemphigus in children, because this pathology has been studied too little and many forms of the disease are diagnosed. If the viral variety is treated quickly enough, then the rest are fraught with not only dangerous complications in the form of sepsis and encephalitis. In the absence of proper treatment, it cannot be ruled out fatal outcome. Especially if it is a newborn whose immunity is too weak to fight its own antibodies.

I would like to hope that in the near future the etiology of this disease will be determined more accurately and effective drugs will be developed for its treatment.