急性泛发性发疹性脓疱病1例

患者男,31岁。10d前因感冒服用药物后,全身出现红斑及针尖大脓疱,于2005年10月入院。患者10个月前曾因感冒服用阿莫西林及头孢类药物后,双腋窝突发片状红斑,上有针尖大脓疱,伴轻度瘙痒。皮损逐渐蔓延至全身,伴发热,曾在当地医院诊治(具体治疗不详),皮损未完全消退。8个月前又因感冒服用药物后(具体用药不详)全身皮损加重,经用中药(具体药物成分不详)治疗后皮损消退。10d前因感冒服用药物后,全身再次出现红斑、针尖大脓疱,同时伴有发热,体温达38℃以上。既往体健,否认有药物过敏史,否认有银屑病家族史。体格检查:体温37℃。胸部、肩背、腹部…     

干燥综合征合并噬血细胞综合征一例北大核心CSCD

患者女,66岁,因口眼干5年伴发热8d入院.入院前8d,患者因发热、咳嗽于外院就诊,诊断为呼吸道感染,予头孢类药物治疗3d后无好转,遂来我院.患者既往胆囊切除术后2年.个人史及家族史无特殊.入院体检：体温41℃,脉搏62次,呼吸19次,血压108/62 mmHg（1 mmHg=0.133 kPa）,除双侧腋下触及肿大淋巴结、脾脏肋下2 cm外,余各系统检查无异常.皮肤科情况：全身皮肤干燥、粗糙,双小腿可见糠秕样鳞屑,全身可见少许抓痕,未见瘀点、瘀斑.     

克林霉素引起中毒性表皮坏死松解型药疹1例

1临床资料 患者女,38岁,因全身红斑3 d,伴水疱2d于2008年8月19日入院.患者6d前因牙痛,在当地诊所静脉点滴克林霉素、甲硝唑注射液(剂量、生产厂家不详)4d,牙痛好转.于8月16日夜晚头面、颈、躯干出现密集点状红斑,按之退色,伴痒.17日诊为"药疹",停用上述药物,予静脉点滴地塞米松10 mg、葡萄糖酸钙注射液10 mL、肌注扑尔敏注射液1支,但皮疹继续增多,并很快融合成片,发展至全身,皮疹深红,并出现水疱,皮肤触痛,继用上述药物无效.8月19日入我院.既往体健,无药物过敏史.     

博来霉素致鞭挞样皮炎一例

患者女,36岁,因全身鞭挞样红斑伴瘙痒11 d入院。发病前1 d,患者因肝血管瘤行肝动脉栓塞术,博来霉素10 ml（3万U）与碘克沙醇约6 ml乳化混合后注入明胶海绵栓塞,行数字减影血管造影,栓塞成功。术后第2天,患者下腹部出现条索状平行红斑,类似鞭挞痕迹,瘙痒明显。予口服氯雷他定抗过敏治疗,患者瘙痒症状未见明显好转,皮损进一步发展累及颈部、面部以及双大腿内侧。否认既往药物、食物等过敏史,否认发病前自行使用其他药物或食用香菇……     

重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白联合糖皮质激素治疗中毒性表皮坏死松解症一例

患者男，20岁。因全身弥漫性红斑伴发热7 d至我院就诊。患者发病前1个月因运动致腰痛，曾口服保泰松片，就诊前7 d背部出现散在红斑，迅速增多，2 d后累及全身，同时出现发热。当地医院予以地塞米松等治疗，仍反复发热，皮疹持续增多扩大，融合呈弥漫性。患者既往体健，否认药物及食物过敏病史……     

带状疱疹愈后继发寻常狼疮：Wolf同位反应一例

患者男，20岁。因全身弥漫性红斑伴发热7 d至我院就诊。患者发病前1个月因运动致腰痛，曾口服保泰松片，就诊前7 d背部出现散在红斑，迅速增多，2 d后累及全身，同时出现发热。当地医院予以地塞米松等治疗，仍反复发热，皮疹持续增多扩大，融合呈弥漫性。患者既往体健，否认药物及食物过敏病史……     

药物致泛发性色素性扁平苔藓1例

色素性扁平苔藓病因不明,病程较长,部分和药物使用有关[1].皮损可局部分布或泛发全身,无自觉症状或有轻度瘙痒.笔者在门诊见到1例由于药物引起的泛发性色素性扁平苔藓,表现为全身泛发性色素斑和斑片,伴有唇黏膜损害,现报道如下. 1 临床资料 患者,男,63岁,全身泛发性色素性斑片2周伴瘙痒求治.该患者2月前因结核在我单位结核门诊治疗,予以异烟肼、利福平、链霉素治疗,1周后面部出现红褐色斑块,渐延及全身,并伴有轻度瘙痒.结核门诊医生考虑到药物引起的反应,遂停止结核病的治疗,给予口服抗组织胺药物及外用药治疗,2天后瘙痒减轻,皮损逐步消退,不留痕迹.     

白蚀丸引起急性黄疸型药物性肝炎1例

患者女,69岁.因全身皮肤瘙痒、黄疸伴尿色发黄4 d,于2004年7月31日来我科就诊.患者患白癜风已3年余,6个月前曾作过体检,当时肝、肾功能正常.2004年4月15日起采用白蚀丸2.5 g,1日3次内服,卤米松软膏每日1次外涂治疗,治疗至30 d时,面部、四肢及躯干的部分皮肤色素脱失斑周边出现色素沉着;60 d时,部分小的色素脱失斑消失;80 d时患者全身皮肤出现轻度瘙痒,但未引起重视;治疗至108 d时,感觉全身不适、乏力、纳差,尿色发黄,巩膜黄染,随后全身皮肤呈橘黄色,并进行性加深,尿呈深黄色.就诊时因怀疑黄疸型肝炎与药物有关,遂停用白蚀丸.     

误诊为药疹的传染性单核细胞增多症并发甲型肝炎1例

患者女,22岁.因面部出现红斑、丘疹5 d,加重且泛发全身2d,于2009年9月2日至我科就诊.患者发疹前1周因人工流产手术服用头孢类药物,服药后2 d面部出现红斑、丘疹,伴剧烈瘙痒,之后皮损逐渐蔓延至躯干、四肢,自行外用糖皮质激素类软膏、氧化锌洗剂等治疗后瘙痒有所减轻.在外院诊断为"药疹",给予地塞米松10 mg/d静脉滴注治疗2 d病情无明显好转.病程中发热、畏寒、咽痛、乏力、腹泻、关节肌肉酸痛不适.精神食欲欠佳,尿色黄,大便色淡.既往无青霉素、头孢类药物过敏史,家族史、婚育史无特殊.     

多西紫杉醇致急性泛发性发疹性脓疱病1例

患者女,54岁.因全身皮肤红斑10 d,脓疱伴发热5 d于2008年12月7日入住我科.患者2008年11月26日于某医院行右乳腺癌改良根治术后行单药多西紫杉醇化疗,剂量120 mg/d,静脉滴注.2 d后足部出现红斑、丘疹,并迅速波及全身,5 d后于原皮损基础上出现密集脓疱,伴发热,体温最高39.2℃,当地医院予静脉滴注头孢类抗生素,拔除化疗留置PICC管,未见好转.     

Toxic epidermal necrolysis successfully treated with etanercept

Toxic epidermal necrolysis (TEN) is a rare and acute severe adverse reaction to drugs, characterised by massive apoptosis and widespread epidermal and mucosal detachment. Although no gold standard therapy exists, human i.v. immunoglobulins have recently been described as an effective treatment for this disease. We report a case of phenobarbital-induced TEN in a 59-year-old white woman where the epidermal detachment stopped 48 h after beginning the etanercept treatment with complete healing after 20 days. To the best of our knowledge, this is only the second reported case of TEN successfully treated with etanercept.     

非ST段抬高急性冠状动脉综合征的早期紧急介入治疗：126例分析

目的评价非ST段抬高急性冠状动脉综合征（ACS）中、高危患者早期经皮冠状动脉介入治疗（PCI）的临床疗效。方法185例中、高危非ST段抬高ACS患者，根据药物治疗后病情变化，分别在入院1—2d内（126例，早期介入组）或3．14d（59例，延迟介入组）行冠状动脉造影（CAG）及PCI。所有‘罪犯”病变均予治疗，介入方法有经皮冠状动脉腔内成形术（PTCA）＋支架、直接置入支架等。观察两组手术成功率、心绞痛缓解时间、住院时间和PCI后30d及6个月心源性死亡、心绞痛复发等不良心脏事件发生率。结果早期介入组手术成功率与延迟介入组相似，分别为97．9％和95．6％（P〉0．05），但入院至心绞痛缓解时间分别为（2．9±1．1）d和（6．0±3．6）d（P〈0．05）；住院时间分别为（9．7±4．3）d和（14．2±6．6）d（P〈0．05）；在住院期间，两组患者均无急性心肌梗死、猝死及心功能恶化发生。30d随访期间早期介入组总不良心脏事件发生率较延迟介入组明显减少，二者分别为2．6％和13．6％（P〈0．01）。结论非ST段抬高ACS患者进行早期介入治疗是积极、有效的治疗措施，近、远期临床效果较满意，手术成功率及安全性较高，可作为大多数非ST段抬高ACS患者的首选治疗方法。     

Treatment of acquired syndactyly by gauze-fixed epidermal graft after radiosurgery

BACKGROUND: Acquired syndactyly is a rare disease that occurs mostly after disease, trauma, or other inflammatory conditions. It is usually treated by surgical incision with a flap or full-thickness skin graft, which is very invasive and requires hospitalization. OBJECTIVE: The objective was to treat acquired syndactyly with an epidermal graft by suction blister after radiosurgery, because this procedure is much less invasive and can be performed in an outpatient base. METHODS: A 65-year-old Korean woman had acquired syndactyly after various traditional treatments for tinea pedis. Five days after separation of syndactyly with radiosurgery, we prepared an epidermal sheet by suction blister, placed it on sterile meshed gauze, and applied it to the separated lesion. RESULTS: The patient's lesion was completely healed after 7 days. CONCLUSION: Gauze-fixed epidermal graft after radiosurgery is a very effective and simple treatment for shallow acquired syndactyly.     

The effects on epidermal DNA synthesis of the butyrate esters of clobetasone and clobetasol, and the propionate ester of clobetasol

An animal model for evaluating the effects of drugs on epidermal DNA synthesis has been used to determine the time of onset, period of maximum activity and duration of effect of two topically applied proprietary glucocorticosteroids, clobetasone butyrate and clobetasol propionate. Both drugs produced maximum inhibition of epidermal DNA synthesis by 24 h after application. Clobetasol propionate exhibited a significantly earlier onset (4 1/2 h) and longer duration (36 h) of activity than clobetasone butyrate (6 and 24 h respectively). A systemic effect was not observed at any time after the application of clobetasone butyrate but was observed for up to 24 h after the application of clobetasol propionate. Clobetasol butyrate was also assayed in this system and was found to be as potent as clobetasol propionate. It is concluded that the alcoholic, as opposed to the ketonic, grouping in the 11 positions of the steroid ring profoundly alters the potentials of this molecule for systemic activity.     

Chinese herbal medicine (Tuhuai extract) exhibits topical anti-proliferative and anti-inflammatory activity in murine disease models

Abstract:  While psoriasis is one of the most common skin disorders in humans, effective, safe and inexpensive treatments are still largely unavailable. Chinese herbal medicine (CHM) has been used for centuries for treating psoriasis and several reports claim that systemic administration of one such CHM, Tuhuai, mainly composed of flos sophorae, smilax glabra roxb and licorice, is effective in psoriasis. However, the mechanisms by which this CHM improves psoriasis are not yet clear. Two universal features of psoriasis are epidermal hyperplasia and inflammation. Moreover, drugs that specifically inhibit epidermal hyperplasia and/or inflammation are widely used to treat psoriasis. Here, we investigated whether topical applications of Tuhuai extract exhibit anti-proliferative and anti-inflammatory activities in two murine models of inflammatory dermatoses. To assess Tuhuai's potential anti-proliferative effect, we disrupted epidermal barrier function twice-daily for 4 days in normal hairless mice followed by topical applications of either 1% Tuhuai extract or Vehicle to both flanks immediately after each barrier perturbation. Changes in epidermal proliferation and apoptosis were evaluated by immunohistochemistry and TUNEL staining. To assess the anti-inflammatory effects of Tuhuai, both irritant (phorbol ester) and acute allergic contact dermatitis (oxazolone) models were used. Whereas topical Tuhuai extract did not alter epidermal proliferation or induce irritation in normal skin, it both reduced epidermal hyperplasia in the epidermal hyperproliferative model, and reduced inflammation in both irritant and allergic contact dermatitis models. As topical Tuhuai extract exhibits anti-proliferative and anti-inflammatory properties in a variety of human models of inflammatory dermatoses, Tuhuai could provide an effective, relatively safe and inexpensive therapeutic alternative for the treatment of inflammatory dermatoses, including psoriasis.     

心脏支架术后扁平苔藓一例

患者，男，60岁。四肢紫红色扁平丘疹伴瘙痒2个月余。组织病理特点符合扁平苔藓。外用糠酸莫米松乳膏和复方蛇脂软膏，患者皮疹基本逐渐好转。患者冠脉支架术后20天出现典型的扁平苔藓皮损，植入的Xience支架主要由钛材料制成，推测皮损的出现可能与植入支架的材质有关。     

A 2-year-old girl with Stevens--Johnson syndrome/toxic epidermal necrolysis treated with intravenous immunoglobulin

Toxic epidermal necrolysis and Stevens-Johnson syndrome are severe skin reactions, usually to drugs, associated with a widespread destruction of the epidermis. Widespread purpuric macules and epidermal detachment of less than 10% of the body surface is indicative of Stevens-Johnson syndrome, whereas epidermal detachment between 10% and 30% is called Stevens-Johnson-toxic epidermal necrolysis overlap. Epidermal detachment involving more than 30% of the total body surface is designated as toxic epidermal necrolysis. These generalized reactions are known to occur in association with various drugs. Treatment is primarily supportive care, and there are no specific therapy regimens. Therapeutic modalities such as corticosteroids, cyclosporin, thalidomide, cyclophosphamide, and plasmapheresis, usually based on a symptomatic approach, have been tried in single patients or in small series. Intravenous immunoglobulin has recently been shown to provide rapid improvement in all three of these skin reactions. We report a 2-year-old girl who developed Stevens-Johnson syndrome-toxic epidermal necrolysis overlap after receiving ampicillin-sulbactam for an upper respiratory tract infection. She was treated successfully with a 4-day course of intravenous immunoglobulin.     

Retinoic acid provokes a regeneration-like proliferative response in murine epidermis

Retinoic acid (RA) is an inducer of epidermal proliferation by a mechanism of action which is not fully known. We examined the proliferative response of hairless mouse epidermis to a single topical application of different doses of RA (0.1–1000 nmol). The mitotic rate was assessed using the stathmokinetic method, and change in epidermal cell numbers were scored per microscopic vision field in tissue sections. Cell cycle parameters were measured by bivariate bromodeoxyuridine/DNA flow cytometry on isolated epidermal basal cells after pulse labelling up to 10 days after RA treatment. The results showed a dose-dependent increase in mitotic activity with a maximum at 3 days after RA application, and a dose-dependent hyperplasia with a maximum at 4 days after RA application. Cell-cycle analysis showed an immediate proliferative response after RA application similar to that following various skin irritants. Although differences in the G2 phase transit were seen, this indicates a similar mechanism of action of RA-induced epidermal proliferation and that associated with epidermal regeneration in general.This study was reported in part at the XVth Congress of the Intarnational Society for Analytical Cytology, 25–30 August/1991, Bergen, Norway     

Toxic epidermal necrolysis induced by lansoprazole

Toxic epidermal necrolysis is a rare, severe cutaneous reaction, mostly caused by drugs. It affects the skin and mucous membranes, with involvement of more than 30% of body surface. We describe the case of a young woman, previously healthy, who developed skin detachment of more than 90% of the body surface 15 days after being administered lansoprazole for peptic disease. The treatment consisted in discontinuation of the drug involved and early administration of intravenous human immunoglobulin, which led to a satisfactory outcome of the case, substantiating the impact of early diagnosis and treatment on the morbidity and mortality of these patients.     

Subpopulation of murine epidermal Langerhans cells identified by lectin-binding sites

Summary Lectin-binding profiles of epidermal Langerhans cells (LCs) were investigated in three strains of mice using immunofluorescence procedures. Three lectin-binding profiles were observed in each strain of mice. Most epidermal LCs reacted with concanavalin A (Con A) and Ricinus communis agglutinin 1 (RCA-1), whereas none reacted with Dolichos biflorus agglutinin (DBA). Peanut agglutinin (PNA) and wheat germ agglutinin (WGA) reacted with some of the epidermal LCs. These binding profiles were similar from site to site of the body in all strains of mice. We also investigated the lectin-binding profiles of epidermal Ia positive (Ia⁺) cells migrating into the grafted skin up to 165 days after transplantation. BALB/c (H-2^d) murine skin was grafted onto the back of (C3H/He×BALB/c)F1 (H-2^k×H-2^d) mice. The percentages of migrating I-A⁺ epidermal cells reactive with PNA and WGA were different from those of the normal epidermis soon after grafting and reached a normal level at 43 days after grafting. Our results demonstrated that there is a heterogeneous population of epidermal LCs defined by lectin-binding profiles.