Subcorneal Pustular Dermatosis
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Contents |
Etiology
Epidemiology
- rare
- most commonly affects women > 40 years of age
Pathology
- benign but chronic disorder
- direct & indirect immunofluorescence staining of skin biopsy is commonly negative
- a subgroup may have IgA deposition against desmocollin 1
- accumulation of neutrophils in the subcorneal layer suggests the presence of chemoattractants in the uppermost epidermis
Clinical-manifestations
- chronic relapsing sterile pustular eruption
- primary lesions are flaccid pustules, several millimeters in diameter, on normal or mildly erythematous skin
- classic lesion is a '1/2-1/2' blister, in which purulent fluid accumulates in the lower 1/2 of the blister
- pustules may be grouped or isolated; they tend to coalesce
- pustules are superficial & rupture easily, resulting in a superficial crust
- mild hyperpigmentation often remains after pustular lesions have resolved
- most commonly affected areas include the axillae, groin, neck, & submammary region
- proximal flexural aspects of the extremities may be affected
- palmar, plantar, face & mucous membrane involvement is unusual
Laboratory
- serum protein electrophoresis: monoclonal gammopathy in 40%
- skin culture for bacteria, fungi
- skin scraping, KOH mount
Differential-diagnosis
Management
- dapsone is treatment of choice
- acitretin has been used successfully
- PUVA may be useful
- systemic or topical glucocorticoids generally not effective
- empiric antibiotics if cellulitis expected
More General Terms
References
- Groysman V and Sami N eMedicine: Subcorneal Pustular Dermatosis [1]
