Sneddon-Wilkinson subcorneal pustulosis - Skin
The etiology is unknown. However, SPD sometimes occurs in association with IgA paraproteinemia, IgA myeloma, pyoderma gangrenosum, ulcerative colitis, and Crohn's disease.
There is no racial or ethnic predilection, but the disease is more common in women and in those over the age of 40.
Lesions tend to be asymptomatic, but patients may report itching or burning. Although the disorder's presentation may look severe, it is a benign condition.
SPD usually presents as crops of small, flaccid pustulo-vesicles that coalesce into annular or serpiginous configurations on previously normal skin. The lesions most commonly occur symmetrically on the flexural extremities, as well as the axillae, groin, abdomen, and inframammary skin. The pustules dry up after a few days, leaving scaling and crusts that may resemble impetigo. This is followed by new crops of vesicles or pustules developing at the periphery of older lesions, leaving annular or polycyclic lesions. The lesions resolve without scarring but may leave post-inflammatory hyperpigmentation. This cycle may repeat itself a few days or weeks later if the patient is not treated.
L13.1 – Subcorneal pustular dermatitis
25147002 – Subcorneal pustular dermatosis
- Bacterial impetigo – is asymmetrical, has bacteria present on Gram stain, and responds to anti-staphylococcal antibiotics
- Dermatitis herpetiformis – favors extensor surfaces; histology shows subepidermal neutrophils
- Pemphigus foliaceus – histology shows acantholysis
- Pustular psoriasis – histology shows intraepidermal spongiform pustules
- Necrolytic migratory erythema (associated with glucagonoma syndrome) – lacks actual pustules, and patients have oral mucous membrane erosions; histology shows necrobiosis of the upper epidermis
- Acute generalized exanthematous pustulosis – a widespread pustular eruption on a background of erythroderma
- SPD-type IgA pemphigus – intraepidermal IgA deposits on immunofluorescence