Andrews pustular bacterid is a dermatological disease of unclear etiology, which is characterized by a chronic, often recurrent course. Symptoms of this condition are papular rashes that occur on the feet or palms, erythema of the skin, itching and soreness on the affected areas of the skin. Diagnosis is based on the results of a dermatological examination, histological examination of a biopsy of skin tissues in the affected area, and examination of the patient’s anamnesis. Treatment of this disease includes both the fight against local manifestations and general therapeutic measures aimed at eliminating provoking factors.
General information
Andrews’ pustular bacteroid (palmar-plantar pustulosis) is a chronic skin disease characterized by the development of pustules, often with purulent contents, and later with the formation of crusts, scales, keratinization disorders. The pathology was first described in 1934 by the American dermatologist J. Andrews, who at first mistook it for a form of psoriasis. Currently, Andrews pustular bacterium is considered a disease with an unclear etiology, the development of which may be to some extent due to the general condition of the organism and the type of its reactivity. This pathology affects both men and women with approximately the same frequency, almost never occurs in children. Andrews’ pustular bacteroid is considered a rather rare dermatological condition, its frequency in the population is currently not reliably determined.
Causes
The etiology and pathogenesis of the Andrews pustular bacterid have not been established at the moment, there are only a few hypotheses on this score. The popular version is that a peculiar type of delayed allergic reaction is involved in the development of this condition, which is partly confirmed by clinical data. Most patients with Andrews’ pustular bacteroid have a history of episodes of allergic pathologies (urticaria, angioedema, bronchial asthma). In addition, according to some researchers, desensitizing therapy reduces the severity of the manifestations of the disease, which also indicates the possibility of its allergic genesis.
Another popular theory of the development of Andrews’ pustular bacterium in dermatology is the influence of microorganisms from foci of chronic infection in the body – such can be carious teeth, tonsillitis, sinusitis. Proponents of this hypothesis also point to clinical data for this disease – almost all patients with a thorough examination reveal an active focus of bacterial infection. Moreover, during his treatment (oral sanitation, the use of antibiotics), the manifestations of the pustular bacteroid Andrews also subside, and sometimes a full recovery occurs.
There is an opinion that a combination of factors plays a role in the development of this dermatological condition: bacterial infection, allergic conditions (hypersensitivity to the components of the cell wall of microorganisms or to their toxins), features of the reactivity of the body. Attempts to prove the hereditary predisposition or genetic nature of the Andrews pustular bacterid were unsuccessful. Nevertheless, with a hereditary predisposition to allergies and other immunological disorders, the probability of developing palmar-plantar pustulosis increases somewhat.
Symptoms
Andrews’ pustular bacteroid most often affects people aged 20 to 50 years, its development is preceded by frequent allergic diseases or prolonged inflammatory processes of bacterial genesis. As a rule, pathology begins with a lesion of the palms, rashes on the soles join a little later, individual cases of isolated lesions of the hands or feet are described. Rashes with Andrews’ pustular bacteroid are usually symmetrical, first small papules are formed in the center of the palms or feet, filled with serous contents, which quickly becomes purulent. Pustules do not rise above the surface of healthy skin and after a while turn into dirty yellow crusts.
Hyperkeratosis, hyperemia of the skin occurs around pustules and crusts, in some cases local hyperhidrosis is noted. The formed pathological focus with Andrews’ pustular bacterium always grows, new pustules and crusts appear, the area of skin lesion gradually increases until it captures the entire sole or palm. In the future, the disease acquires a chronic relapsing character – pustules disappear during remissions and reappear during exacerbations. Hyperkeratosis leads to the formation of large scales on the skin, between which there are pustules and crusts. The duration of the course of the Andrews pustular bacterid can be many years, in many cases it is not possible to fully cure this condition.
Sometimes, with Andrews’ pustular bacteroid, pathological skin changes can pass to the area of the fingers and nail plates. This leads first to deformation and ingrowth of nails, and then to complete loss. Subjective symptoms of the disease usually include soreness when pressing on the affected area, including when walking, itching. These manifestations weaken during the period of remission of the Andrews pustular bacteiid and sharply increase with the exacerbation of pathology. There are no general or systemic manifestations in this pathology.
Diagnosis and treatment
Diagnosis of Andrews’ pustular bacteroid is carried out on the basis of the results of dermatological examination of the patient, bacteriological and microscopic examination of the contents of the pustules, examination of the patient’s anamnesis and the results of a general medical examination to identify inflammatory conditions provoking. A skin biopsy in the affected area and histological examination can play an auxiliary role in controversial cases. When examined on the surface of the palms and feet, peeling, hyperkeratosis, pustules and crusts of a purulent nature are determined. At the same time, bacteriological studies confirm the sterility of the contents of the pustules. The Minor test can reveal signs of local hyperhidrosis in areas of the skin affected by Andrews’ pustular bacteroid.
A general medical examination and anamnesis study of the patient with this disease in 90% of cases confirms the presence of a chronic inflammatory focus. Approximately two-thirds of people with Andrews’ pustular bacteroid have a history of allergic conditions, and the onset of this pathology coincides with an infectious disease. The histological structure of the pustule also has characteristic features – it is a single-chamber cavity, which is made by leukocytes (neutrophils and macrophages) with an admixture of a small number of lymphocytes. Destruction of the basement membrane of the epidermis does not occur with Andrews’ pustular bacterium. Edema is detected in the dermis, minor perivascular infiltration by lymphocytes and histiocytes.
Due to the unexplored etiology of the Andrews pustular bacterid, etiotropic treatment of this pathology has not been developed. According to most dermatologists, the elimination of the provoking factor – a chronic focus of bacterial infection – has the greatest effectiveness. The appointment of corticosteroids and antibiotics helps to reduce the severity of the symptoms of the disease during exacerbation. Locally, it is recommended to apply soothing ointments, bandages to reduce soreness. Also, immunostimulating agents and antihistamines are used for Andrews’ pustular bacteride, but their effectiveness remains questionable. During the period of remission, ointments and creams based on tar and other similar products can be used.
Prognosis and prevention
The prognosis regarding the patient’s life with Andrews’ pustular bacteroid is unequivocally favorable – this disease does not have any common manifestations and does not lead to the development of severe complications. However, with regard to recovery, the forecasts of specialists are much more uncertain – in many cases it is not possible to completely cure this condition, especially if you start therapy at the advanced stages of its development. The effectiveness of treatment and the likelihood of recovery in Andrews’ pustular bacteroid are largely determined by the nature and severity of chronic bacterial infection, as well as the reactivity characteristics of the patient’s body. For prevention, it is necessary to prevent the appearance of provoking pathologies – to eliminate bacterial infections in a timely manner and in full, and to regularly sanitize the oral cavity.