Causes of blisters on a child’s fingers

What is pemphigus? Symptoms, causes and treatment

Pemphigus is a chronic autoimmune disease characterized by the appearance of a special type of blisters on the surface of previously healthy skin and mucous membranes. Among the types of pemphigus can be distinguished: vulgar, vegetative, erythematous and foliate.

Pemphigus can be diagnosed if acantholytic cells are detected, which are detected in a smear taken or as part of blisters in the epidermis itself (during histological examination). To treat pemphigus, glucocorticosteroids are first used (a whole course of treatment is prescribed). The latter always goes well with extracorporeal hemocorrection (plasmophoresis, cryoapherosis, hemosorption).

Causes

The reasons for the development of pemphigus have not yet been fully studied. One of the main causes of pemphigus is a violation of autoimmune processes, thereby the cells become antibodies to the immune system.

Violation of cell structure is subject to the influence of external factors, as well as aggressive environmental conditions. As a result, the communication between cells is disrupted, which leads to the formation of bubbles. The incidence rate in people with a hereditary predisposition is much higher.

Why does sweat rash occur?

Miliaria occurs due to blockage of the ducts of the sweat glands, which is facilitated by the structural features of the skin of young children and external conditions: if the child overheats and, accordingly, sweats a lot. Thus, a rash may appear if a child spends a long time in a hot room with high humidity, is wrapped up too warmly when walking, is dressed in tight clothes made of synthetic fabrics, or is wearing diapers in the heat. Sweat is not removed outside, remains in the skin and causes redness and rashes.

It is important!

Heat rash can be caused by frequent or excessive use of baby creams, especially fatty ones, and baby cosmetic oils.
Heat rash often occurs in children with a thick build and pronounced folds on the arms and legs.

As for the characteristics of the skin of newborns, it is still thin, and the excretory ducts of the sweat and sebaceous glands continue to form, so it cannot fully perform protective functions and quickly loses moisture. All this leads to the fact that the ducts of the sweat glands are easily clogged. In addition, babies cannot say that they are hot or take off uncomfortable tight clothes, and mothers tend to dress them warmer to be on the safe side.

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 causes, antibodies are formed that 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 upper layers of the epidermis without destroying the “bridges,” it is pemphigoid. Viral pemphigus also occurs without destruction of desmosomes.

Classification

Types of non-acantholytic pemphigus:

1. Non-acantholytic pemphigus is benign. Pathological elements are formed exclusively in the human oral cavity. Upon examination, inflammation of the mucous membrane, as well as its slight ulceration, can be detected.
2. Bullous form of non-acantholytic pemphigus. This is a benign disease that develops in both adults and children. Blisters form on the skin, but there are no signs of acantholysis. These pathological elements can spontaneously disappear without scarring.
3. Cicatricial non-acantholytic pemphigus. This pemphigoid is called pemphigus of the eye in the medical literature. Most often it is diagnosed in women who have crossed the 45-year age limit. A characteristic symptom is damage to the visual apparatus, skin and oral mucosa.

Classification of true pemphigus:

1. Erythematous form. This pathological process combines several diseases. Its symptoms are similar to seborrheic dermatitis, an erythematous variant of systemic lupus, as well as true pemphigus. Erythematous pemphigus in adults and children is very difficult to treat. It is worth noting that the disease is diagnosed not only in people, but also in some animals. A characteristic symptom is the appearance of red spots on the skin of the body and face, covered with crusts on top. Simultaneously with this symptom, seborrheic manifestations appear on the scalp.
2. Pemphigus vulgare. This type of pathology is diagnosed in patients more often. Blisters form on the skin, but there are no signs of inflammation. If pemphigus is not treated on time, pathological elements can spread throughout the entire skin. It is worth noting that they can merge and form large lesions.
3. Pemphigus foliaceus. This form received its name due to the characteristics of the pathological elements. Blisters form on the human skin, which practically do not rise above the epidermis (not tense). Crusts form on top of them, which tend to layer on top of each other. The effect of sheet material folded in stacks is created.
4. Brazilian pemphigus. There are no restrictions regarding gender and age. Cases of its development have been recorded in both young children and elderly people aged 70 to 80 years. It is also possible that it may progress in middle-aged people. It is worth noting that this variety is endemic and is therefore found only in Brazil.

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Hives are a condition characterized by a reddish, itchy rash on the skin that is caused by an allergic reaction. It is not contagious and is most often caused by a specific allergen, but in some cases the cause is unknown.

An allergic reaction to hives is fraught with serious complications that require urgent medical attention and are life-threatening. Therefore, you should not endure unpleasant attacks, but contact an allergist and find out how to treat urticaria in your particular case.

Symptoms

Considering that experts have identified several different types of this pathology, the symptoms of each of them will be very specific. Of course, there are a number of general trends and signs inherent in all types of the disease. This may include, for example, the wave-like course of the pathological process.

Periods of exacerbation alternate with the transition of pemphigus to a calmer stage, when the main symptoms subside or completely disappear. An important factor for the patient will be the fact that in the absence of timely diagnosis and prescription of an effective course of treatment, there is a high risk of developing severe conditions aggravated by concomitant diseases.

• The presence of crusts, ranging from pale pink soft to red dense, reminiscent of lichen;
• There is a deterioration in the general condition;
• Decreased immune response of the body;
• Formation of bubbles of varying densities;
• Also, in severe cases, separation of the layers of the epidermis is noted, and it can occur both in the lesion and away from it.
• Damage and ulcers of the mucous membrane of the mouth, nasopharynx or genitals;
• Pain when performing the act of swallowing or when eating;
• Bad breath, indicating damage to the mucous membranes;
• Hypersalivation or, in other words, increased salivation;
• In the seborrheic form, characteristic yellowish or brown-brown crusts appear on the scalp.
• Bubbles vary in appearance, ranging from flat to thin-walled, which burst with a slight touch. In their place, erosions and, subsequently, crusts form.
• In severe cases, an eroded surface of the skin may form in place of the blisters. Their feature is a tendency towards peripheral growth. Over time, such erosions occupy a large surface of the skin, causing pain and inconvenience to the patient.
• In children, manifestations of pemphigus are localized over the entire surface of the skin, including the limbs.

Experts say that with this disease, both a pure form of the pathological process and mixed forms that smoothly transform into one another can be observed. Therefore, the symptoms and signs of pemphigus in a given person may vary and indicate the presence of several types of disease.

Molluscum contagiosum in children

Molluscum contagiosum is more common in children than in adults. Children up to one year old practically do not get sick with molluscum contagiosum. This is due to the fact that in the first year of life the child’s circle of contacts is small: the child moves in a limited space, often specially prepared for him and under the strict supervision of adults, without trying to come into contact with other children. But as soon as a child begins to actively communicate and independently explore the world, the threat of becoming infected with molluscum contagiosum increases sharply.

The peak incidence of molluscum contagiosum in children occurs between the ages of 2 and 6 years. Immunity at this age is still weak. Children become infected through toys or dirty hands. The virus penetrates the skin in the place where the integrity of the skin is damaged - through wounds, abrasions, cracks. Children's skin is delicate and sensitive, and the activity of a preschool child is great. As a result, numerous microtraumas occur, opening the way for infection. Cases of infection with molluscum contagiosum while swimming in the pool have also been described.

From 6 to 10 years, the incidence of molluscum contagiosum decreases. Instilling household hygiene skills is of great importance. The sooner your child starts taking care of clean hands, the better.

Diagnostics

Experts say that a correct diagnosis can be made based on a comprehensive examination of the patient, which includes several important stages:

1. Examination of the patient for the presence of a clinical picture. At this point, the doctor establishes the nature of the lesions, their localization, the degree of development of the disease, etc.
2. Cytological analysis necessary to establish the presence of acantholic cells in smears of biomaterial.
3. Carrying out the Nikolsky test, which allows to differentiate pemphigus from similar pathological processes.
4. Method of direct immunofluorescence. This study allows us to detect the presence of immunoglobulin in the intercellular substance of the epidermis.
5. A histological study, which is based on a technique for detecting crevices and other damage within the epidermis.

Only the totality of all the results makes it possible to make an accurate diagnosis and prescribe an effective course of treatment, leading to the patient’s recovery.

Treatment of viral pemphigus

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

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

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

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

Since children with this diagnosis are usually treated in a hospital setting, to enhance the therapeutic course, therapeutic procedures can be carried out aimed at clearing the blood of antibodies:

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

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.

How to treat other forms of pemphigus?

The treatment process for pemphigus is quite complicated. Therefore, self-medication of this type of disease is under no circumstances acceptable. The disease progresses rapidly, affecting large areas of the skin, which leads to disruption of the internal organs.

Treatment of pemphigus is mandatory in a dermatological hospital. First of all, corticosteroid drugs, cytostatics and other drugs are prescribed to alleviate the course of the disease and the life expectancy of patients.

The drugs must first be taken in large doses. At the same time, pay attention to blood and urine sugar levels, monitor blood pressure and observe personal hygiene rules. With frequent changes of bed linen and underwear, secondary infection is prevented.

Preventing Blisters

The main preventive measure is to eliminate the source of the problem or the provoking factor. If you have never had a similar rash, but you are afraid of its appearance, for prevention purposes you need to regularly shower with neutral cleansers and adjust your diet. Start leading a healthy lifestyle, follow your routine and avoid stress.

If you are allergic to insect bites, use repellent when going outdoors. Also give preference to clothes made from natural fabrics.

Medicines for the treatment of pemphigus

The patient is advised to take glucocorticoids in high doses. The following drugs can be used for this:

• Metipred;
• Prednisolone;
• Dexamethasone;
• Polcortolon.

When symptoms begin to regress, the doses of these drugs are gradually reduced to the minimum effective. Patients with pathologies of the gastrointestinal tract are prescribed long-acting glucocorticoids:

• Metipred-depot;
• Diprospan;
• Depo-Medrol.

Treatment with hormonal drugs can cause a number of complications, but they are not a reason to discontinue corticosteroids. This is explained by the fact that refusal to take them can lead to relapses and progression of pemphigus.

Possible complications during treatment:

• acute psychosis;
• arterial hypertension;
• depressive states;
• insomnia;
• increased excitability of the nervous system;
• steroid diabetes;
• thrombosis;
• obesity;
• angiopathy;
• erosions or ulcers of the stomach and/or intestines.

If the patient’s condition sharply worsens while taking corticosteroids, the following measures may be recommended:

• diet: limiting fats, carbohydrates and table salt, introducing more protein and vitamins into the diet;
• drugs to protect the gastric mucosa: Almagel, etc.

In parallel with glucocorticoids, cytostatics and immunosuppressants are prescribed to increase the effectiveness of therapy and the possibility of reducing doses of hormonal agents.

The following medications can be used for this:

• Sandimmune;
• Methotrexate;
• Azathioprine.

To prevent electrolyte imbalance, the patient is recommended to take calcium and potassium supplements. And for secondary infection of erosions - antibiotics or antifungal agents.

The ultimate goal of drug therapy is to make the rash disappear.

Preventive measures

There are no specific measures to prevent the development of pathology. The higher the level of immune protection, the less chance of dermatological diseases.

Important:

• control the nature of chronic diseases;
• strengthen immunity;
• maintain personal hygiene;
• Healthy food.

Measures to prevent pemphigus in newborns:

• change your underwear more often;
• Caring for newborns with pustular skin lesions is prohibited;
• Take regular care of your child’s skin;
• strengthen the immune system of weakened children;
• daily wet cleaning and ventilation of the room are required.

If you notice any rashes on the skin, the formation of pustules and blisters, immediately contact a dermatologist.

Blisters on the back: what are they?

Blisters differ from other rashes in several ways:

• rise above the skin;
• have clear boundaries;
• are a manifestation of skin edema.

The appearance of watery tubercles is usually immediate (usually after exposure to an irritant). When the irritant is removed, the blisters disappear just as quickly. Bumps on the skin occur as a result of swelling and cause itching.

Some dermatologists call blisters exactly the kind of formations that we described above. They classify blisters with fluid after swelling or abrasions as other types of rashes. However, most doctors combine all these concepts into one type.

Forecast

The prognosis for acantholytic pemphigus is conditionally unfavorable. On the one hand, in the absence of effective treatment, there is a high probability of complications and death.

On the other hand, patients with pemphigus are forced to take glucocorticosteroids for a long time, and sometimes for life, which is fraught with the development of side effects. But hasty refusal of drugs leads to immediate relapse of the disease. Glucocorticosteroids do not eliminate the cause of the disease, but inhibit the pathological process and prevent its progression.