暂时性棘层松解性皮病1例

正1病历摘要患者女,41岁。因躯干及四肢红斑、丘疹及丘疱疹3个月余,于2016年5月8日来我院就诊。3个月余前患者接受窄谱中波紫外线(NB-UVB)治疗时背部出现烫伤样皮损,继而在烫伤部位出现散在分布的米粒大红斑、丘疹及丘疱疹,轻度瘙痒;皮损发展迅速,数天内波及胸部及四肢。既往史:寻常性银屑病20余年。家族中无类似疾病患者。     

女性更年期痤疮患者的临床特征及睾酮和雌二醇水平的检测

目的 探讨女性更年期痤疮患者血清性激素水平的变化,临床特征及治疗方法。方法 对66例患者的临床特征及治疗进行了观察;测定其中35例患者的血清睾酮和雌二醇水平。结果 患者睾酮、雌二醇与正常人对照组相比较差异无显著性,但睾酮/雌二醇显著高于正常人对照组(P<0.05)。63.6%的患者在更年期发病。皮损以上唇及颏部最多,其次为颊部、额部,多呈散在分布,以粉刺及炎性丘疹或丘脓疱疹为主,少数有炎性结节。多为轻至中度痤疮。78.8%的患者一般治疗即可治愈,其余患者用性激素治愈。结论 更年期因卵巢功能衰退,雌激素分泌减少,雌雄激素比例失衡,肾上腺源性雄激素相对过甚而导致痤疮。更年期痤疮多为轻至中度,皮损以粉刺、炎性丘疹或丘脓疱疹为主,以上唇及颏部最多。绝大多数患者一般治疗即可治愈。     

大疱性类天疱疮89例临床分析

目的 探讨大疱性类天疱疮患者的临床表现、实验室检查和治疗的特点。方法 回顾性分析89例大疱性类天疱疮患者的临床资料。结果 89例患者,男女之比1.07:1,平均发病年龄58岁。皮损除典型的水疱、红斑外,还有多形红斑、疱疹样皮炎样损害。33.7%的患者有口腔粘膜损害,6.7%的患者以口腔水疱、糜烂为首发症状。18%的患者尼氏征阳性。间接免疫荧光法检测阳性率74.4%,直接免疫荧光法检测阳性率94.9%.皮质类固醇以及皮质类固醇联合免疫抑制剂是治疗大疱性类天疱疮的主要手段,除接受冲击治疗的患者外,控制皮损所需的皮质类固醇剂量平均值为65.5mg(相当于泼尼松).结论 组织病理和免疫荧光检测是确诊的主要依据,控制皮损的皮质类固醇最大用量存在个体差异。     

月经疹2例报告

月经疹２例报告赵广，肖戎，李长空，李莉月经疹是发生在女性的一种少见皮肤病，临床以红斑丘疹、丘疱疹为特征，因皮损表现多形性，伴有不同程度瘙痒，所以临床上多诊断为过敏性皮炎等疾病，现将我们见到的２例报告如下。１临床资料例１．女，３０岁。躯干反复出现多形性...     

以非水疱为初发皮疹的大疱性类天疱疮34例

目的 探讨以非水疱为初发皮疹的大疱性类天疱疮患者的临床表现、实验室检查和治疗特点。方法 回顾性分析34例以非水疱为初发皮疹的大疱性类天疱疮患者的临床资料。 结果 34例患者中男女之比1.83 ∶ 1，始发年龄平均为（59.79 ± 15.63）岁。在出现典型的水疱之前，表现为红斑、丘疹、丘疱疹、斑块、风团、结节、多形红斑样皮疹等多形性表现，以同时出现红斑、丘疹/斑块（占35.29%）为多见。结论 在所分析的病例中，近1/3大疱性类天疱疮患者初发表现为多形性，以同时出现红斑、丘疹/斑块多见。     

全身化疗引起光化性角化病的炎症

本文报告7例因实体肿瘤而接受全身化疗的病人,在暴光部位发生红斑-丘疹-鳞屑性皮疹,类似药疹。仔细检查发现这些皮损实际上都是发炎的光化性角化症。例1.68岁男性,因患复发性胆管腺癌,全身     

191例重症药疹临床分析

目的 探讨重症药疹发生发展的规律。方法 按年代、型别、致敏药物分类,回顾性分析191例重症药疹患者的临床资料。结果 剥脱性皮炎组的患病年龄超过中毒性表皮坏死松解组及重症多型红斑组。肺炎、败血症、消化道出血、电解质紊乱是常见的并发症。抗生素致敏患者年龄大于抗癫痫药所致者.且抗癫痫药致敏者潜伏期长于其他类药物。结论 解热镇痛药、磺胺、抗生素为主要致敏药物。不同年代、不同型别及不同药物所致重症药疹均有其特殊性。     

丘疱疹性日光疹——多形性日光疹的一种亚型

多形性日光疹(PMLE)在不同患者中常表现为多形性损害但在个别人则常仅呈单一性损害。作者分析了去夏威夷旅游者中的150例光感性皮炎患者,74％患者见于1～6月,80％患者年龄在20～50岁,女:男为4.2:1,97％为白种人,80％属Ⅰ或Ⅱ型皮肤。所有患者主要表现为红斑丘疹、丘疱疹和水疱,少数有淤点及由丘疹融合成的斑片。最常见的受累部位是臂部(80％)、下肢(60％)和上胸部     

HIV感染并发光敏性皮炎

报告1例HIV感染并发光敏性皮炎。患者男,34岁。因全身泛发斑丘疹、斑块伴瘙痒1年余入院。皮肤科检查见全身暗红色斑丘疹、斑块,以颜面、四肢多见,呈对称分布。光试验显示中波紫外线（UVB）及长波紫外线（UVA）最小红斑量均明显降低。抗HIV抗体初筛及确证试验均阳性。CD4细胞计数为15个／μL。诊断：HIV感染并发光敏性皮炎。确诊后严格避免日光照射,予羟氯喹及抗组胺药物等治疗,1周后皮损减轻。     

牛痘样水疱病样皮肤淋巴瘤与慢性活动性EB病毒感染的关系

目的 报道6例牛痘样水疱病样皮肤淋巴瘤,并研究其与慢性活动性EB病毒感染的关系.方法 临床病理分析、皮损免疫组织化学染色、血清学分析、EB病毒编码RNA原位杂交、外周血EB病毒DNA测定.结果 6例患者皮损均为反复发作的丘疹、丘疱疹、坏死、痘疮样瘢痕,其中4例还伴有程度不同的颜面、手足水肿.所有患儿均有长期间断发热等症状.皮损病理可见表皮多房性水疱,真皮全层大量淋巴细胞浸润,细胞形态异形,可见病理分裂象.4例皮损病理免疫组化染色,可见大量CD56阳性细胞,散在的CD3和CD45RO阳性细胞,T细胞内抗原-1和粒酶B染色阳性,诊断为牛痘样水疱病样皮肤NK/T细胞淋巴瘤;2例组化染色CD3和CD45RO阳性,CD56阴性,诊断为牛痘样水疱病样皮肤T细胞淋巴瘤.6例皮损均可见EB病毒编码RNA原位杂交阳性肿瘤细胞,血清学检查EB病毒衣壳抗原IgG抗体滴度升高,其中2例滴度为1:5120,2例为1:2560,2例为1:1280;2例患者外周血EB病毒DNA拷贝数高于正常.6例患儿均证实患有慢性活动性EB病毒感染.结论 牛痘样水疱病样皮肤淋巴瘤主要表现为颜面手足肿胀、水疱、痘疮样瘢痕,病理表现主要为真皮异形淋巴细胞浸润和血管中心坏死,免疫表型以NK/T型多见.慢性活动性EB病毒感染与该型淋巴瘤发病密切相关.     

Envenoming caused by a Portuguese man-o'-war (Physalia physalis) manifesting as purpuric papules

We report the case of a 42-year old woman who was envenomed by a Portuguese man-o'-war (Physalia physalis). She presented an anomalous reaction manifested by purpuric papules that appeared after the initial phase of envenoming (around 24 hours later), when linear erythematous and edematous papules were observed. Late-onset reactions in accidents involving cnidarians commonly include chronic eruptions and local pigmentation.     

Shiitake Mushroom Dermatitis: A Review

Shiitake mushroom dermatitis is a cutaneous reaction caused by the consumption of raw or undercooked shiitake mushrooms. Symptoms include linear erythematous eruptions with papules, papulovesicles or plaques, and severe pruritus. It is likely caused by lentinan, a heat-inactivated beta-glucan polysaccharide. Cases were initially reported in Japan but have now been documented in other Asian countries, North America, South America, and Europe, as this mushroom is now cultivated and consumed worldwide. Shiitake mushroom dermatitis may result from mushroom ingestion or from handling, which can result in an allergic contact dermatitis.     

Parthenium dermatitis presenting as photosensitive lichenoid eruption. A new clinical variant

Parthenium hysterophorus is the commonest cause of airborne contact dermatitis (ABCD) in India. The disease usually manifests as itchy erythematous, papular, papulovesicular and plaque lesions on exposed areas of the body. Rarely, however, the disease may present as actinic reticuloid or photocontact dermatitis. We have observed a different clinical variant of this disease where certain patients with Parthenium dermatitis have presented with discrete, flat, violaceous papules and plaques on exposed areas of the body closely simulating photosensitive lichenoid eruption. We had 8 patients, 6 males and 2 females between 30 and 62 years of age, with itchy, violaceous, papules and plaques on the face, neck, ears, upper chest and dorsa of the hands for 6 months to 6.5 years. Four of these patients had a history of improvement of the lesions up to 30% in winter and aggravation of lesions on exposure to sunlight. There was no personal or family history of atopy. Cutaneous examination in all patients revealed multiple flat, violaceous, mildly erythematous papules and plaques on the forehead, sides and nape of neck, ears, 'V' area of the chest, and extensor aspects of the forearms and hands. Skin biopsies from these lesions showed features of chronic non-specific dermatitis. Patch testing with standardized plant antigens showed a positive patch test reaction to Parthenium hysterophorus in all patients, with a titre of contact hypersensitivity (TCH) varying from undiluted to 1 : 100. We conclude that Parthenium dermatitis may occasionally present with lesions very similar to the lesions of photosensitive lichenoid eruption in morphology and distribution. This clinical presentation of Parthenium dermatitis needs to be recognized to avoid misdiagnosis.     

Photosensitive erythema multiforme and erythema multiforme-like polymorphous light eruption

BACKGROUND: Photosensitive erythema multiforme (EM) is a rare disorder. It usually occurs only if a herpes virus infection or ingestion of drugs precedes exposure to sunlight in selected patients. METHODS: We report a 37-year-old man who had recurrent EM eruptions following sun exposures over a period of 20 years. Lesions were prevalently located on exposed skin, but unexposed skin and mucosa of the oropharynx were also affected. The patient had poor tolerance to sunlight and denied having herpes simplex infection or using drugs. RESULTS: Provocative phototest induced clinically and histologically similar lesions at low dose thresholds of UVA (10 J/cm2) and UVB (100 mJ/cm2). CONCLUSION: On the basis of clinical and histological findings and results of phototesting, a diagnosis of photosensitive EM was made. The EM-like variant of polymorphous light eruption is discussed in the differential diagnosis.     

Red Sea Coral Contact Dermatitis

Six of nine adults who developed Red Sea coral contact dermatitis had seafood allergies. Contact with the "fire" coral was followed by a series of skin eruptions starting with an immediate pruritic urticaria-like lesion which forced the victims out of the water. Within minutes the affected area became erythematous and edematous with eventual blister formation approximately 6 hours after the initial contact. The blisters resolved, leaving violaceous papules and plaques in a streaky fashion corresponding to where the coral brushed the skin. The lesions became shiny and lichenoid in 3 weeks while pruritus persisted. Treatment with topical corticosteroids and oral antihistamines reduced the severity of the disease but did not stop its evolution to the lichenoid stage. Complete resolution usually occurred after 15 weeks, leaving residual hyperpigmented macules.     

Persistent pruritic papules and plaques associated with adult‐onset Still's disease: Report of six cases

Typical skin rash, which appears and disappears along with respective rise and fall of fever, is well‐known, and included as one of the major criteria of adult‐onset Still's disease (AOSD) (Yamaguchi's criteria). In addition, various skin lesions are occasionally observed in association with AOSD. Persistent pruritic eruptions present with some clinical features, such as urticarial erythema, flagellate erythema, erythematous, slightly scaly or crusted papules, and/or plaques on the trunk and extremities. These lesions show unique histological features such as dyskeratosis with a peculiar, distinctive distribution in the upper epidermis and cornified layers with focal hyperkeratosis. We describe herein six cases of AOSD, which presented with skin lesions of persistent pruritic papules and plaques. All six cases were female, and three of them were elderly women. The patients presented with linear erythematous streaks, scaly erythema, keratotic papules, infiltrative plaques and irregular coalesced erythemas. By contrast, histological features were characteristic, and dyskeratotic cells were found in the horny layers as well as in the upper layers of the epidermis. Persistent pruritic eruption is an important cutaneous sign for the diagnosis of AOSD.     

多形性日光疹的临床类型和光试验研究

对３１１例多形性日光疹（ＰＭＬＥ）患者的研究可将其分为丘疱疹型、小丘疹型、大丘疹形、红斑水肿型和混合型等五个临床亚型。分别测定其对ＵＶＡ和ＵＶＢ的最小红斑量（ＭＥＤ），双变量相关分析示在ＰＭＬＥ及其五个亚型中缺乏正常对照组中存在的正性相关关系。小丘疹型中对ＵＶＡ和ＵＶＢ的ＭＥＤ值以及在红斑水肿型中对ＵＶＢ的ＭＥＤ值均见显著减低。表明ＰＭＬＥ各亚型的临床特征和作用光谱不尽相同，可能还包含着几组发病机制不同的光敏性皮肤病。     

Reproduction of the skin lesions of polymorphous light eruption: a case report and a review of the Japanese literature

A case of polymorphous light eruption with plaque-type lesions is reported. A 55-year-old male had pruritic erythemas and plaques on the head, the face, the nape, the back of the hands, and the left loin within days following sun exposure. The patient's minimal erythema dose (MED) (60 mJ/cm2) of sunlamp irradiation for ultraviolet (UV) B was normal. Three once-daily exposures to 2 MED of UVB (Epstein's repeat phototest technique) produced pruritic papules with a similar microscopic appearance to that of the patient's skin lesion, indicating that the action spectrum causing the lesion seemed to be within the UVB waveband.     

Truncal lesions do not exclude a diagnosis of Gianotti-Crosti syndrome

A boy aged 2 years and 10 months had a pruritic eruption and low-grade fever for 1 week. Examination revealed discrete erythematous papules and papulovesicles on his buttocks and extensor surfaces of four limbs. Several papules were also present on his back. No lymphadenopathy and no hepatosplenomegaly were noted. Investigations failed to identify a single viral aetiology. Topical calamine lotion and a sedating oral antihistamine to be taken at night were prescribed. The truncal lesions subsided in 3 weeks. Complete remission of all lesions was seen after 6 weeks. Although most patients with Gianotti-Crosti syndrome only have the typical acrally distributed eruption, additional truncal lesions, if few in number, do not exclude the diagnosis.