Mucha — Habermann acute varioliform parapsoriasis with the formation of hypertrophic scars in a teenager

The article describes a case of Mucha – Habermann varioliform (smallpox-like) parapsoriasis in a teenager. Parapsoriasis is a heterogeneous group of chronic inflammatory dermatoses that are characterized by the presence of spots and/or papules and plaques covered with small scales. The relevance of parapsoriasis is due to the ambiguity of the etiopathogenetic mechanisms of the disease, the lack of a generally accepted classification. Interest in the disease is partly due to the possibility of transformation of parapsoriasis to T-cell lymphoma (fungal mycosis). Description of the clinical case. Patient A., 14 years old, went to the skin and Venereological dispensary in Surgut with complaints of multiple rashes on the skin of the trunk and limbs, accompanied by minor soreness, burning and moderate itching. Ill for about 10 days, the beginning of the disease was associated with hypothermia. The appearance of the rash was preceded by a sharp rise in body temperature to 38 °C, chills, weakness, malaise. Objectively: the pathological skin process was widespread. Rashes were localized in the torso area on the skin of the chest, back, abdomen, upper and lower limbs. It is represented by multiple miliary and lenticular papules of pink-red color, pustules. In the Central part of most elements, zones of necrosis or ulcerative defects from 0,2 to 2 cm in diameter, hemorrhagic crusts were visualized. The diagnosis of acute varioliform parapsoriasis was made on the basis of clinical and anamnestic data and the results of additional research methods. The treatment used antibacterial drugs, detoxification methods, physiotherapy (light therapy). The outcome of treatment is improvement. When actively called after 6 months, hypertrophic and smallpox-like scars of the skin of the trunk and extremities were found during examination. This clinical example is of interest to dermatovenerologists and pediatricians. It illustrates the relative goodness of the course of dermatosis, despite the brightness and acuteness of clinical manifestations. Timely treatment has significantly improved both the child's condition and quality of life. Due to the rare occurrence of acute lichenoid parapsoriasis, doctors may experience difficulties in making a diagnosis. The case is presented in order to attract the attention of the medical community to the problem of parapsoriasis.

1. Федеральные клинические рекомендации. Дерматовенерология 2015: Болезни кожи. Инфекции, передаваемые половым путем. 5-е изд., перераб. и доп. М.: Деловой экспресс, 2016. 768 с. [Federal clinical recommendations. Dermatology 2015: diseases of the skin. Of sexually transmitted infections. 5th ed., Rev. and DOP. M: Business Express, 2016. 768 p.]

2. Каламкарян А. А., Мордовцев В. Н., Трофимова Л. Я. Клиническая дерматология. Редкие и атипичные дерматозы. Ереван, 1989. С. 357-361. [Kalamkaryan A. A., Mordovtsev V. N., Trofimova L. J. Clinical dermatology. Rare and atypical dermatitis. Yerevan, 1989. 357-361 р. (In Russ.)]

3. Яковлев А. Б., Шатохина Е. А. Каплевидный парапсориаз Брока и острый вариолиформный парапсориаз Муха – Габерманна: вопросы терминологии и терапии // Кремлевская медицина. Клинический вестник. 2018; 1: 128-134. [Yakovlev A. B., Shatokhina Ye. A. Broca's teardrop-shaped parapsoriasis and acute varioliform parapsoriasis Mucha-Habermann: questions of terminology and therapy / Kremlevskaya meditsina. Klinicheskiy vestnik. 2018; 1: 128-134.]

4. Суколин Г. И. Иллюстрированная клиническая дерматология. М., 2009. 248 с. [Sukolin G. I. the Illustrated clinical dermatology. M., 2009. 248 p.]

5. Иванов О. Л. Парапсориаз. Клиническая дерматовенерология. Рук-во для врачей в 2 томах / Под ред. Ю. К. Скрипкина, Ю. С. Бутова. М.: ГЭОТАРМедиа, 2009. Т. 2. С. 351-370. [Ivanov O. L. Parapsoriasis. Clinicaldermatovenerology. A guide for doctors in 2 volumes. Underthe editorship of Yu. K. Skripkin, Yu. S. Butov. M.: GEOTARMedia, 2009. Vol. 2. Р. 351-370.] Рис. 4. Высыпания на коже туловища и живота у пациента М. через 8 месяцев после лечения [данные получены авторами] / Rash on the skin of the trunk and abdomen in patient M. 8 months after treatment [data obtained by the authors] Рис. 5. Высыпания на коже спины у пациента М. через 8 месяцев после лечения [данные получены авторами] / Rash on the skin of the back in patient M. 8 months after treatment [data obtained by the authors]

6. Разнатовский И. М. Парапсориазы. В кн.: Кожные и венерические болезни. Руководство для врачей / Под ред. Ю. К. Скрипкина, В. Н. Мордовцева. Т. 2. М., 1996; 2 (5): 157-170. [Raznatovsky I. M. Parapsoriasis. In The Book: «Skin and venereal disease. A guide for physicians», under the editorship of Yu. K. Skripkin, V. N. Mordovtseva. M., 1996; 2 (5): 157-170.]

7. Разнатовский И. М. Парапсориазы. Лимфомы кожи. Рук-во для врачей под редакцией А. В. Самцова. СПб, 2000. Р. 238-252. [Raznatovskiy I. M. Parapsoriazy. Skin lymphomas. A guide for doctors. Pod redaktsiyey A. V. Samtsova, SPb, 2000; 238-252.]

8. Карпов В. В., Исламов В. Г., Гусев Е. В., Пирогов Ю. С. Парапсориаз у военнослужащих // Российский журнал кожных и венерических болезней. 2011; 3: 23-27. [Karpov V. V., Islamov V. G., Gusev E. V., Pirogov Yu. S. Prepares havea militarycontingen ttroops // Russian journal of skin and venereal diseases. 2011; 3: 23-27.]

9. Bowers S., Warshaw E. M. Pityriasis lichenoides and its subtypes // J. Amer. Acad. Dermatol. 2006; 55: 557-572.

10. Цветкова Г. М., Мордовцев В. Н. Эритематозно-сквамозные и папулезные дерматозы неясной этиологии. Патология кожи. В 2 т. Частная патоморфология кожи / Под ред. В. Н. Мордовцева, Г. М. Цветковой. М.: Медицина, 1992. Т. 2. С. 105-132. [Tsvetkova G. M., Mordovtsev V. N. Erythematous-squamous and papular dermatosis of unknown etiology. Skin Pathology. 2 vols. Private pathomorphology of the skin / Ed. by V. N. Mordovtseva, G. M. Tsvetkova. M.: Medicine, 1992. Vol. 2. Р. 105-132.]

11. Парфенова М. А., Белоусова И. Э., Самцов А. В. Язвенно-некротический подтип болезни Муха – Габермана: описание случая // Вестник дерматологии и венерологии. 2013; 4: 73-78. [Parfenova M. A., Belousova I. E., Males of A. B. Ulcero-necrotic subtype of the disease and Mucha – Haberman: description of the case // Vestnik of dermatology and venereology. 2013; 4: 73-78.]

12. Асхаков М. С. Парапсориаз // Вестник молодого ученого. 2017; 2 (17): 34-39. [Askhakov M. S. Parapsoriasis // Bulletin of a young scientist. 2017; 2 (17): 34-39.]

13. Gauglitz G. G., Korting H. C., Pavicic T., Rucicka T., Jeschke M. G. Hypertrophic scarring and keloids: pathomechanisms and current and emergingtreatment strategies // Mol Med. 2011; 17 (1-2): 113-25.

14. Van der Veen W. M., Bloemen M. C., Ulrich M. M., Molema G., van Zuijlen P. P., Middelkoop E. et al. Potential cellular and molecular causes of hypertrophic scar formation // Burns. 2009; 35 (1): 15-29.