he erythematous or vesicular varieties is not unusual.

#Describe the mixed type of dermatitis herpetiformis.#

In this type the eruption is made up of erythematous patches, vesicles,
bullae, and often with pustules intermingled, appearing irregularly or in
crops, and with a tendency to patch or group formation.

#Describe the characters of the vesicles, pustules and blebs.#

As a rule, these several lesions, especially the vesicles and blebs, are
somewhat peculiar: they are usually of a strikingly irregular outline,
oblong, stellate, quadrate, and when drying are apt to have a puckered
appearance. They are herpetic in that they show little disposition to
spontaneous rupture, occur in groups, and are usually seated upon
erythematous or inflammatory skin--in some respects similar to the
groups of simple herpes and herpes zoster.

#What is to be said in regard to the subjective symptoms?#

The subjective symptoms are usually the most troublesome feature of the
disease, consisting of intense and persistent itching and a feeling of
heat and burning.

#Are there any constitutional symptoms in dermatitis herpetiformis?#

As a rule, not, excepting the distress and depression necessarily
consequent upon the intense itchiness and loss of sleep. In the pustular
and bullous varieties there may be mild or grave systemic symptoms, but
even in these types the constitutional involvement is, in most
instances, slight in comparison to the intensity of the cutaneous
disturbance.

#What is the course of dermatitis herpetiformis?#

Extremely chronic, in most instances lasting, with remissions,
indefinitely. The skin is rarely entirely free. From time to time the
type of the disease may undergo change. From the continued irritation
and scratching more or less pigmentation results.

#What is to be said in regard to the etiology?#

The disease is in many instances essentially neurotic, and in
exceptional instances septicaemic. Pregnancy and the parturient state are
factors in some instances (so-called herpes gestationis). It is possible
in some instances that the eruption may be an expression of a mild
toxemia of gastro-intestinal origin. In some cases no cause can be
assigned. In the majority of patients the general health, considering
the violence of the eruptive phenomena, remains comparatively
undisturbed.

Nervous shock and mental worry are factors in some cases. Polyuria,
with sugar in the urine, has occasiona