igus foliaceus.#

In this, the grave type of the disease, the blebs are loose and flaccid,
with milky or puriform contents, rupturing and drying to crusts, which
are cast off, disclosing the reddened corium. New blebs appear on the
sites of disappearing or half-ruptured lesions, and the whole surface
may be thus involved and the disease continue for years, compromising
the general health and eventually ending fatally.

In some cases of pemphigus (pemphigus vegetans) a vegetating or
papillomatous condition develops from the base of the lesion, with an
offensive discharge; it is usually a grave type of the malady.

Exceptionally cases (dermatitis vegetans) are met with which have a
close similarity in their symptoms to pemphigus vegetans, but in which
the eruption is more or less limited to the genitocrural region. The
disorder is not malignant and usually yields to cleanliness and
antiseptics.

#What is the character of the subjective symptoms in pemphigus?#

The subjective symptoms consist variously of heat, tenderness, pain,
burning and itching, and may be slight or troublesome.

#What is known in regard to the etiology of pemphigus?#

The causes are obscure; general debility, overwork, shock, nervous
exhaustion, and septic conditions (microorganisms) are thought to be of
influence. There seems no doubt that those who have to do with cattle
products, especially butchers, are subjects of acute and usually grave
pemphigus. Vaccination has exceptionally been responsible for the
disease, probably through some coincidental infection. The disease is
not contagious, nor is it due to syphilis. It may occur at any age.

It is a rare disease, especially in this country. Most of the cases
diagnosed as pemphigus by the inexperienced are examples of bullous
urticaria, bullous erythema multiforme, and impetigo contagiosa.

#What is the pathology?#

The lesions are superficially seated, usually between the horny layer
and upper part of the rete. Round-cell infiltration and dilated blood
vessels are found about the papillae and in the subcutaneous tissue. The
contents of the blebs, always of alkaline reaction, are at first serous,
later containing blood corpuscles, pus, fatty-acid crystals, epithelial
cells, and occasionally uric acid crystals and free ammonia.

#From what diseases is pemphigus to be differentiated?#

From herpes iris, the bullous syphiloderm, impetigo contagiosa and
dermatitis herpetiformis.