红斑型天疱疮合并寻常型银屑病1例

红斑型天疱疮合并寻常型银屑病１例王飞①赵德明①患者男，５８岁。因头面、躯干红斑、鳞屑伴瘙痒４年，加重１月于１９９２年３月住院治疗。患者４年前始头面、胸背出现大小不等红斑，瘙痒，抓后皮肤易破，红斑逐渐增多。曾外用多种皮质类固醇乳膏和服用中成药，效果不佳...     

两型亚急性皮肤型红斑狼疮病情演变的分离现象

目的：探讨两型亚急性皮肤型红斑狼疮（SCLE）患者病情演变的差异。方法：对40例SCLE患者进行3－14年的随访分析,比较两型SCLE患者临床表现和实验室检查异常变化、治疗反应及预后。结果：在随访中,环形红斑型患者的疹型变化较少,病情较轻,部分患者出现干燥症状;而丘疹鳞屑型患者中大部分逐渐演变成SLE。环形红斑型患者仅21.7％发生轻度肾脏受累,皮质类固醇用量较少,无死亡病例;丘疹鳞屑型患者中64.7％发生肾脏受累,皮质类固醇用量较大或合并使用免疫抑制剂,1例死亡,3例发展为尿毒症。结论：环形红斑型是SCLE中较为良性的一型,预后较好,而丘疹鳞屑型则易发展为SLE,预后较差。     

红斑型天疱疮误诊1例

 报告红斑型天疱疮误诊1例。患者女,42岁,全身红斑、鳞屑1年。皮肤科检查：面部对称性水肿性红斑,上覆黄白色细痂屑;躯干、四肢见环形浸润性暗红斑,边缘稍隆起,中央消退见褐色色沉,边界清楚,腹部红斑基础上见3个黄豆大小的水疱,疱液清亮,疱壁松弛,尼氏征可疑阳性。天疱疮抗体Dsg1、Dsg3均阳性。面部皮损组织病理结果示：角化不全,角质层及棘层上部裂隙,可见棘突松解现象。直接免疫荧光：棘层上方IgG网状沉积。诊断：红斑型天疱疮。予泼尼松片、羟氯喹联合甲氨蝶呤片治疗后,面部红斑减轻,躯干皮损消退后出院,随访1年皮疹无复发。     

瘤型麻风伴Ⅱ型麻风反应误诊1例

患者男,46岁,全身红斑、结节10年,加重1个月。患者曾多次于外院就诊,以"皮炎""泛发性湿疹""结节性红斑"治疗,无明显好转。双侧眉毛、睫毛脱落,全身大小不一红斑、结节,两侧尺神经、左侧腓总神经轻度增粗。皮损组织病理:表皮增生,真皮浅层可见无浸润带,深部血管周围大量组织细胞浸润,其中可见泡沫样细胞抗酸染色阳性。诊断:瘤型麻风伴Ⅱ型麻风反应/麻风结节性红斑。     

界线类偏结核样型麻风伴Ⅰ型麻风反应1例

患者男,39岁,因＂反复面部、四肢红斑伴感觉减退3年,水肿性红斑1周＂就诊。体检：面部肿胀,额部、眉间、两颊部、唇部可见水肿性红斑;右胸部亦见相似皮损;右臀股部可见直径约15cm的环形红斑,中央浅白色,外周红色,浸润明显;左侧尺神经轻度粗大,余浅神经未触及。组织病理支持＂界线类偏结核样型麻风伴Ⅰ型麻风反应＂。     

多发性巨大型环状肉芽肿2例

例1男,63岁。躯干、双上肢起环形红斑1年。例2男,58岁。背部起环状红斑10个月。2例均根据临床表现和组织病理诊断为巨大型环状肉芽肿。     

亚急性皮肤型红斑狼疮2例

根据皮损特点不同亚急性皮肤型红斑狼疮可分为两型:环状红斑型和丘疹鳞屑型.我科先后诊治2例亚急性皮肤型红斑狼疮,现报告如下.     

中西医结合治疗胫前型营养不良型大疱性表皮松解症1例

患者男,48岁。双下肢红斑、水疱、结节伴瘙痒40年,加重10年。皮肤科情况：双侧足背、胫前红斑、水疱、瘢痕及粟丘疹,可见甲营养不良伴部分趾甲脱落,尼氏征阴性。皮损组织病理示：表皮角化过度,表皮下见一裂隙,真皮浅层细血管增生伴纤维细胞增生,裂隙旁见粟丘疹样角质囊肿。诊断：胫前型营养不良型大疱性表皮松解症。经中西医结合治疗后病情缓解,现仍在随访中。     

红斑型天疱疮伴发格林-巴利综合征1例

报告1例红斑型天疱疮伴发格林巴利综合征。患者男,40岁。全身反复水疱5年,根据临床表现和免疫病理确诊为红斑型天疱疮,不规则服用糖皮质激素,皮损未痊愈。2周前始四肢麻木、乏力进行性加重。根据神经系统损伤的临床表现、MRI及脑脊液蛋白-细胞分离诊断格林巴利综合征。     

多形红斑型药疹40例临床分析

目的　分析多形红斑型药疹增多原因,探讨如何提高疗效及减少发生。方法　对 40例多形红斑型药疹致敏药物、临床表现、实验室检查及治疗进行分析。结果　①致敏药物多为青霉素类、解热镇痛类及中药类;②临床常见,重型较多;③以糖皮质激素为主综合治疗,疗效高。结论　多形红斑型药疹增多与多用、滥用及伪劣药品相关;糖皮质激素为主、全身治疗与局部治疗结合能显著提高疗效;规范用药,加强监管能减少其发生。     

Elevation of IgA anti-epidermal transglutaminase antibodies in dermatitis herpetiformis

Background  Dermatitis herpetiformis (DH) is a papulovesicular eruption caused by ingestion of gluten. It is characterized by the deposition of IgA in the dermal papillae. IgA antibodies directed at tissue transglutaminase (TG2) are elevated in gluten-sensitive diseases including DH and coeliac disease (CD). More recently, antibodies directed at epidermal transglutaminase (TG3) were identified in patients with DH, and this may be the dominant autoantigen in this disease.
Objectives  To measure IgA antibodies to TG3 and TG2 in patients with DH and CD, and control populations.
Methods  Serum IgA antibodies against TG2 and TG3 were measured from adults with DH, adults and children with CD, patients with psoriasis, adult Red Cross blood donors, and paediatric controls.
Results  Patients with DH and CD had elevated levels of IgA anti-TG2 antibodies compared with control populations. The levels in the patients with DH and adults with CD were similar. IgA anti-TG2 antibodies were higher in the children with CD compared with adults with DH and CD, and with control populations. Patients with DH and adults with CD had elevated levels of IgA anti-TG3 antibodies compared with children with CD and control populations. There was a trend towards higher levels in the patients with DH compared with adults with CD.
Conclusions  IgA antibodies to TG3 are elevated in patients with DH and adults with CD. The progressive expansion of the epitope-binding profile of IgA antitransglutaminase antibodies in patients with CD may explain the development of DH in patients with undiagnosed CD during their adult life.     

Psychological factors in prurigo nodularis in comparison with psoriasis vulgaris: results of a case-control study

BACKGROUND: It has been suggested that psychological factors such as repressing anger and altruistic interpersonal behaviour may play a role in the aetiology of chronic itching in prurigo nodularis (PN). Whether these issues are specific for PN or are also common in other chronic skin diseases, e.g. psoriasis, has not been investigated until now. OBJECTIVES: To investigate psychosomatic problem areas and psychiatric comorbidity in patients with PN in comparison with patients with psoriasis. METHODS: Ninety-four patients with PN and 91 patients with psoriasis were administered the Hospital Anxiety and Depression Scale, Toronto Alexithymia Scale, State-Trait Anger Expression Inventory, Inventory of Interpersonal Problems, Screening for Somatoform Disorders and the Whiteley Index for hypochondriasis. RESULTS: After Bonferroni post hoc adjustment, the metrical scales demonstrated no significant differences between patients with PN and those with psoriasis. There was only a tendency to less 'anger-out' and to less autocratic/dominant and more insecure/submissive behaviour in the patients with PN. Patients with PN were, in general, comparable with those with psoriasis with regard to alexithymia, somatization symptoms, hypochondriasis, anxiety and depression, with 18% cases of anxiety and 22% cases of depression. CONCLUSIONS: The hypotheses formulated in the literature on the specific aetiology of PN could not be proven for the majority of patients with PN in our study. Concerning their psychopathology, patients with PN were comparable with those with psoriasis. Therefore the clinical management of PN should include psychosomatic assessment.     

NB-UVB联合8-MOP PUVA治疗小腿斑块状银屑病疗效评价

目的: 评价NB-UVB联合8-甲氧补骨脂素（8-MOP） PUVA治疗斑块状银屑病的疗效。方法: 分别对16例银屑病患者双侧小腿进行PASI评分,一侧给予NB-UVB照射,另一侧给予NB-UVB联合8-MOP PUVA,每周3次,共治疗20次。结果: NB-UVB治疗侧治疗前后PASI评分分别为8.21±2.97和2.31±1.01,差异有统计学意义(P＜0.05);NBUVB联合8-MOP PUVA治疗侧分别为8.33±2.54和1.20±0.93,差异有统计学意义(P＜0.05)。治疗后NBUVB联合8-MOP 治疗侧较NB-UVB治疗侧PASI更低,差异有统计学意义(P＜0.05)。结论：NB-UVB联合8-MOP PUVA可明显促进小腿顽固部位皮损的消退。     

皮肌炎合并恶性肿瘤5例临床分析

目的　探讨皮肌炎合并恶性肿瘤的临床特点。方法　回顾性分析 5例皮肌炎合并恶性肿瘤的临床特征。结果　患者年龄 5 2～ 70岁 ,平均 63 .5岁 ,4例表现为恶性红斑 ,2例并有表皮坏死。患者血清肌酶均升高 ,程度与是否合并肿瘤无明显关系。结论　皮肌炎合并肿瘤 ,与表皮坏死、年龄有一定相关性 ,血清肌酶升高与是否合并肿瘤无明显关系。恶性红斑提示预后不良。     

Peripheral blood eosinophilia in association with generalized pustular and erythrodermic psoriasis

Background In recent studies, it has been documented that the eosinophil cells play active role in many kinds of inflammatory disorders. Measurements of the mediators released by eosinophils and cell counts in serum and skin have provided some evidence indicating the role of eosinophils in psoriasis. Objective To evaluate the blood eosinophil cell count in patients with erythrodermic psoriasis and generalized pustular psoriasis. Methods In this study, 48 patients with histopathologically proven psoriasis (33 with erythrodermic, 15 with generalized pustular); 43 patients with maculopapular, erythematous, or bullous drug eruption with widespread involvement; and 51 patients with basal cell carcinoma were included. These three groups were compared with each other in terms of their absolute eosinophil cell counts and percentage of eosinophils. Results Forty‐one point seven per cent of patients with psoriasis had peripheral blood eosinophilia compared with 58.1% of the patients with drug eruption and 11.8% of patients with basal cell carcinoma. The percentage of patients with eosinophilia both in patients suffering from psoriasis and drug eruption were significantly increased compared with the patients with basal cell carcinoma (P < 0.001). The absolute median eosinophil cell counts both in patients with psoriasis and drug eruption were also significantly differed from patients with basal cell carcinoma (259.2, 439.1 and 183.1, respectively; P < 0.001) Conclusions Peripheral blood eosinophilia seems to be associated with severe forms of psoriasis. This finding may suggest that the eosinophils have significant roles in the pathogenesis of these types of psoriasis.     

Hypergammaglobulinemic Purpura Associated with Sjögren's Syndrome and Chronic C Type Hepatitis

Although hypergammaglobulinemic purpura usually occurs secondarily on the lower legs in several disorders, purpura has also recently been reported to be associated with chronic C type hepatitis (HCV). To define the differences in the clinical, histological and laboratory findings and the prognosis of hypergammaglobulinemic purpura associated with those two disorders, we examined ten patients with hypergammaglobulinemic purpura, 6 patients with hypergammaglobulinemic purpura associated with Sjögren's syndrome (SjS) and 4 patients with hypergammaglobulinemic purpura with chronic C type hepatitis. Five of 6 patients with SjS were female. Attacks of purpura occurred in the pretibial area in all cases. Triggering factors included long walks and prolonged standing. The mean duration of attacks was 6.4 days. No systemic manifestations were associated. Anti-Ro/SS-A and anti-La/SS-B antibodies were expressed in one case. Spontaneous regression was noted in all cases; however, recurrence was noted in one. On the other hand, all the 4 patients with hypergammaglobulinemic purpura associated with HCV were men. Purpura was indurated in a few cases. Involved sites included the knee, forearm, abdomen and thigh in addition to the lower leg. The mean duration of attacks was 12.6 days. Recurrent purpura was noted in one case. Cryoglobulin was positive in three cases. In one patient with severe recurrent purpura, attacks stopped with prednisolone 10 mg/day. Histologically, leukocytoclastic vasculitis was detected in three cases associated with SjS and two cases with HCV. In conclusion, hypergammaglobulinemic purpura associated with HCV appears to occur unilaterally with a sex predilection for men and the manifestations last longer than those associated with SjS. Severe palpable purpura was also noted in association with HCV; systemic prednisolone resulted in good control.     

Distinct temperament and character profiles in first onset vitiligo but not in alopecia areata

Alopecia areata (AA) and vitiligo (V) are diseases that are correlated with psychiatric disorders before, during and after diagnosis. The Temperament and Character Inventory (TCI) is a well‐established approach for investigating personality traits in various psychosomatic diseases. The aim of this study is to compare and investigate the differences in the TCI between patients with first onset AA, patients with V and healthy controls (HC). Participants in the study included 42 patients with first onset AA, 50 adult patients with V and 60 HC who had no history or diagnoses of psychiatric or dermatological disorders. All participants were assessed with the TCI and the Dermatology Life Quality Index (DLQI). Among the temperament traits, the extravagance, disorderliness and total novelty‐seeking scores were lower, and the worry and pessimism scores were higher in patients with V compared with patients with AA and the HC. The mean score of the enlightened second nature and the total self‐directedness score of the character traits were higher in patients with V compared with patients with AA and the HC group. In the AA group, there was a negative correlation only between the reward dependence total score and the DLQI score. This study suggests that patients with first onset V have a distinct temperament, such as being unenthusiastic and unemotional, and character profiles, such as worry and pessimism, independent of their psychiatric comorbidities, and patients with AA do not have a different personality from the non‐affected population.     

五例成年女性头癣临床表现及病原菌分析

成人头癣感染因症状轻微,临床表现不典型,易造成误诊误治,本文回顾性分析5例成人头癣患者的临床表现、病原菌检查及治疗。5例患者均为女性,年龄26～75岁,平均年龄54.4岁,其中4例绝经,1例有使用免疫抑制剂史。3例患者为紫色毛癣菌感染,并有使用同一理发器具史,临床表现为脂溢性皮炎样及脓疱损害,轻微脱发。2例患者为犬小孢子菌感染,表现为局限性脱发、红斑、脓疱等。5例患者均给予伊曲康唑胶囊联合外用硝酸舍他康唑乳膏,3例患者已痊愈,随访半年,未见复发。2例患者用药不规律,治疗效果欠佳,后失访。     

Tissue and blood superoxide dismutase activities and malondialdehyde levels in different clinical severities of acne vulgaris

Background Acne vulgaris is one of the commonest dermatological diseases and its pathogenesis is multifactorial. Objectives To determine the role of oxidative stress in acne vulgaris and to determine a possible link with the clinical severity. Methods Twenty‐three patients with different grades of acne vulgaris and 23 age‐ and sex‐matched controls were enrolled. Superoxide dismutase (SOD) activities and malondialdehyde (MDA) levels were measured spectrophotometrically at tissue and blood levels. Results There were no significant differences in SOD activities and MDA levels between patients and controls. However, significant differences were found in patients with severe acne in comparison with those with mild and moderate acne. Moreover, comparison between different patient subgroups and controls revealed statistically significantly higher SOD activities in patients with mild acne in comparison with patients with moderate and severe acne, and with controls. Furthermore, severe acne showed statistically significantly lower SOD activities and higher MDA levels when compared with other patient subgroups and controls. Conclusions Oxidative stress exists in patients with acne vulgaris and may play a role in aetiopathogenesis and/or progression of the disease. The addition of drugs with antioxidative effects seems to be valuable in the treatment of acne vulgaris.     

鱼刺伤肉芽肿10例临床分析

回顾分析2019年1月至2020年5月我院10例鱼刺伤肉芽肿的临床资料及治疗效果.10例患者中,男3例,女7例,平均发病年龄49岁;3例从事与海产相关的厨师职业,5例有鱼类或海鲜刺伤史;1例有菜刀切伤史,1例有手部外伤史.皮损主要表现为上肢红斑、结节,伴破溃结痂.3例患者皮损局限于手部,其余患者皮损沿淋巴管播散.所有患...