英夫利西单抗诱发脓疱性银屑病一例

44岁女性患者,掌跖红斑、丘疹、脓疱20 d.既往强直性脊柱炎病史12年,近期复发后接受英夫利西单抗治疗,强直性脊柱炎病情明显改善,但手足出现红斑、丘疹和脓疱.皮肤科情况:双手、双前臂和双足散在浸润性红斑、丘疹和脓疱,部分皮损上覆痂皮,右足内侧见脓疱融合.皮损组织病理:棘层上部可见中性粒细胞浸润,形成脓疱,棘层肥厚,上...     

维胺酯 雷公藤 美满霉素等治疗连续性肢端皮炎1例

临床资料 患者女，20岁，学生。双手指反复起红斑，脓疱10年，10年前右手食指外伤后未节皮肤红肿疼痛，经局部治疗伤口愈合，但手指红斑不消退，并逐渐在红斑上出现群集性小脓疱，数日后脓疱干燥结黄痂，脱落后露出红色糜烂面，轻度灼痛，脓疱反复发作且加重，皮损累及双手十指，致指甲变形，碎裂，脱落。     

呈网状红斑改变的扁平苔藓

报告1例呈网状红斑改变的扁平苔藓。患者女,34岁。全身泛发网状红斑22年,伴瘙痒,有口腔黏膜及甲受累。皮肤科检查见全身泛发网状红斑,部分红斑消退后局部有轻度萎缩,散在水疱,尼氏征阴性。双手多个指甲甲板萎缩、吸收。上腭见片状糜烂面。组织病理检查示表皮变薄,基底细胞广泛液化变性,真皮浅层淋巴细胞呈带状浸润。诊断：扁平苔藓。给予阿维A40mg/d口服3个月后皮损明显变平,颜色变暗。     

疱疹样脓疱病

患者女,23岁。颈部、腋下反复起脓疱10年,泛发全身伴发热2个月,于2004年5月入院治疗。患者10年前无明显诱因颈部、腋下出现许多小脓疱,经治疗可消退,但反复发作,每年发作约10余次。皮损局限于颈部、腋下,无发热。5个月前怀孕,2个月前皮损突然增多,泛发全身,伴有发热,体温最高达39.5℃。家庭成员中无类似疾病患者。皮肤科检查:面颈部、躯干大片红斑,表面覆黄色痂皮,脱屑,背部许多粟粒大脓疱,部分脓疱表面结痂。双耳后、发际处及项背部见多处红斑,上覆细小鳞屑(图1A、B);双手掌、手背多处暗红色圆形红斑,中心颜色较深,边缘颜色较浅。20甲正常…     

阿维A治愈一例连续性肢端皮炎

患者男,43岁。因反复甲周起红斑、脓疱5年,加重并泛发四肢2年于2003年9月5日入院。初起无诱因于左拇指甲下出现针头大的脓疱,脓疱破溃后形成红斑、黄色痂皮,继之红斑下方再次出现脓疱,如此反复未引起重视。2年前20个指趾甲出现类似损害,甲板相继消失,关节僵直,活动受限,皮损进一步向四肢近端蔓延。患病过程中无发热,曾患过肺结核,已治愈。     

兄妹同患泛发性脓疱性银屑病

例 1　男 ,3 2岁。全身反复起红斑鳞屑皮疹及脓疱 2 0年。1991年皮疹泛发。皮肤科情况 :全身皮肤大面积潮红脱屑 ,散在或密集脓疱 ,双腋下、腹股沟脓疱融合成脓湖。双手指甲可见顶针样损害 ,右手无名指甲下积脓 ,沟纹舌 ,双下肢可见红斑鳞屑皮疹 ,剥除鳞屑 ,可见薄膜现象及筛状出血。实验室检查 :脓培养无细菌生长。组织病理 :表皮角化过度 ,表皮内见Ｋｏｇｊｉ脓疱 ,真皮浅层有少量淋巴细胞浸润 (见图 1)。诊断 :脓疱型银屑病。图 1　组织病理例 2　女 ,2 6岁 ,例 1之妹。 1990年高热、全身起脓疱 ,经激素治疗后脓疱消退。 1991年人流后 ,…     

药物超敏综合征

躯干、四肢见泛发的不规则暗红斑,双前臂皮损融合成大片,表面被覆片状白色鳞屑,部分皮损表面轻度糜烂,少量黄褐色痂皮     

双侧带状疱疹1例

1 临床资料 患者女,61岁.左前额、右肩部潮红斑,伴疼痛1周.约10天前出现左前额、右肩部刺痛,7天前上述部位出现红斑、水疱,疼痛加剧.有"胆囊炎"病史10年,发病前劳累过度.体检:精神差,系统检查未见异常.皮肤科情况:左前额、左侧头皮及右肩部可见大片不规则潮红斑,其上可见簇集的水疱或脓疱,绿豆至黑豆大小,部分融合、破裂,形成黄色痂皮,痂皮融合成片状,伴少量渗出.     

大疱性类天疱疮伴食管恶性黑色素瘤1例

报道大疱性类天疱疮（BP）伴食管恶性黑色素瘤（PMME）1例。患者女,61岁,既往PMME史3年余,现黏膜破溃4个月,加重伴周身红斑水疱0.5个月。皮肤科检查：面部出现水肿性红斑,红斑基础上覆厚腻黑痂;躯干、四肢泛发水肿性红斑、丘疹,红斑及正常皮肤基础上可见粟粒至甲盖大小水疱,疱壁紧张,疱液清亮,部分水疱破溃渗出结痂,尼氏征阴性;口腔可见溃疡;外阴部黏膜糜烂。组织病理及免疫荧光检查均符合BP。诊断：BP伴发PMME。     

以甲周损害为首发的寻常型天疱疮一例

<正>临床资料患者,男,35岁。因"双手甲周水疱、暗红斑5个月,躯干红斑、水疱4个月,口腔糜烂2个月"就诊。患者5个月前,无明显诱因发现双手指甲周部出现黄豆大水疱,疱壁薄,内含透明液体,自行用外物戳破后,液体渗出,局部皮损干涸结淡黄色痂壳,痂壳脱落后遗留暗红色色素沉着;伴甲板凹凸不平。     

重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白联合治疗泛发性连续性肢端皮炎一例

患者,男性,16岁,右手指甲周皮肤起红斑、脓疱9年,右手第4和5指指节间关节畸形1年入院。皮肤科检查：右手掌背及第1、4和5指弥漫性红斑,表面散在或密集米粒大小脓疱,部分形成脓湖或脓痂,指甲脱失,手指末端变细;第4、5指指节间关节屈曲畸形,功能受限。四肢皮肤见散在分布少数浸润性红斑,表面有少量小脓疱。患者家族中无银屑病史及类似疾病史。实验室检查：血常规：WBC 7.77×109/L、中性粒细胞百分比57.6%、淋巴细胞百分比30.28%、RBC 4.75×1012/L、HGB 136g/L、PLT 278×109/L。肝功能检查：ALT 13 U/L、AST 17 U/L、ASP 160 U/L、γ-GT 17 U/L、TBIL 19.2 umol/L。抗核抗体(-)、抗dsDNA抗体（-）。梅毒螺旋体特异抗体和艾滋病抗体检测阴性。Hbs-Ag（-）,HCV-cAg（-）。脓疱细菌培养无细菌生长。结核菌素纯蛋白衍化物(PPD)试验（+）;胸部X片检查未见明显异常。心电图检查大致正常。诊断：泛发型连续性肢端皮炎。入院后予阿维A胶囊、火把花根片、复方甘草酸苷注射液等联合糠酸莫米松乳膏、莫匹罗星软膏及钙泊三醇倍他米松软膏治疗,经2周治疗皮损部分消退,偶有少量新脓疱形成,受累手指疼痛减轻,但病情仍继续进展,右手第2指和左手第5指亦受累。为遏制病情进一步发展,审慎地权衡利弊后,遂决定开始rhTNFR:Fc治疗。治疗12周后,四肢皮损消退,新脓疱形成停止,但手指畸形和功能无改善,治疗获得部分成功。     

Acropustulosis repens

BACKGROUND: Pustular eruptions of the extremities of the fingers and toes (acropustulosis) have been grouped under the single term "Hallopeau's acrodermatitis continua", which is a severe disease, with uninterrupted course, and successive eruptions that may become generalized. However, there is a form of acropustulosis with few lesions, evolving with remissions and relapses, with a benign course. It is necessary to separate these two forms of acropustulosis. METHODS: I had the opportunity to observe six patients with a mitigated form of acropustulosis that does not fit into the diagnostic criteria of Hallopeau's acrodermatitis continua, which should be considered an independent clinical entity. RESULTS: Sometimes, there is only one lesion in each eruption. The pustules are sterile and appear in small crops, located on the hyponychium or on the nail bed. The result is partial onycholysis or nail detachment. After each eruption there is complete recovery. Histopathology shows a nonspongiform pustule filled with neutrophils, with subcorneal localization. Four patients had follow-up for at least 2 years, and one patient presented psoriasis lesions on the scalp after 11 years. CONCLUSIONS: Acropustulosis as I described it can be differentiated from Halopeau's acrodermatitis continua using the following diagnostic criteria: (1) it is a benign condition; (2) the pustules are located on the hyponychium or nail bed; (3) pustules can be single or occur in small groups; (4) they reccur in flares, with restitutio ad integrum during the periods of remission; (5) the pustules are sterile; (6) microscopic study shows a subcorneal pustule (spongiform aspect is rare). A similar condition to that found in my cases was described by Radcliff-Crocker (H. Radcliff-Crocker, Diseases of the Skin, London: H.K. Lewis, 1888), termed "dermatitis repens".     

Successful Treatment of Pediatric Nail Psoriasis with Periodic Pustular Eruption Using Topical Indigo Naturalis Oil Extract

Abstract: Psoriasis of the nail greatly affects quality of life because of the difficulty in achieving long‐lasting remission. Pustular psoriasis of the nail apparatus is characterized by the formation of sterile pustules, starting on one or two fingers or less often on the toes, and spontaneous improvement has rarely been observed. This case presents a girl with refractory nail psoriasis accompanied by periodic pustular eruption that responded well to topical treatment with indigo naturalis oil extract drops, achieving a remission of longer than 1 year.     

Infantile generalized pustular psoriasis: Successful disease control with intermittent etretinate

Infantile generalized pustular psoriasis is a rare form of psoriasis and the best treatment is controversial. We experienced a 2‐year‐old female with erythema on her neck and axilla starting at 3 months of age. She presented with recurrent annular and geographic scaly erythema with a few pustules on the neck, precordium and axilla, but no fever. The histopathology revealed subcorneal neutrophilic infiltration and microabscesses without Kogoj's spongiform pustules. The initial diagnosis was subcorneal pustular dermatosis. However, she developed widespread geographic erythema and numerous pustules over her entire body with a fever when she got a cold. A second skin biopsy revealed monolocular pustules and Kogoj's spongiform pustules in the subcorneal layer. Etretinate was administrated after a diagnosis of pustular psoriasis was made and her condition improved gradually. The choice of treatment depends on patient age, general condition and the disease severity.     

Generalized pustular toxic erythema: pathogenetic relationship between pustule and epidermal appendage (hair follicle or sweat duct).

Seven patients are described, who had generalized toxic erythema with sterile pustules. Study of serial sections of the pustules confirmed a specific localization to hair follicle or epidermal sweat duct. Five patients had a past history of medications, exposure to an organic solvent, or infections.     

急性泛发性发疹性脓疱性皮病1例

报告1例急性泛发性发疹性脓疱病。患者女，75岁，躯干、四肢起红斑，部分融合成大片，其上密集分布粟粒至米粒大的脓疱，部分脓疱互相融合成“脓湖”，右下肢部分片状脱屑。组织病理示角层下脓疱。患者在发疹前2h使用过青霉素等药物。     

Bacterial interdigital scaly erythema (Kitamura): a possible new clinical entity

Four patients with scaly erythema on their finger webs and sides of their fingers during summer are described. These patients were working in either butcher's shops or a sushi bar, where they handled raw meat, chicken or fish for many hours. The eruptions first appeared as scaly erythema, sometimes accompanied by small pustules, on the second, third and fourth finger webs, and later the erythema extended to the sides of the fingers and palms. Maceration and/or shallow erosion sometimes appeared on the finger webs. Symptoms were usually mild; the patients complained of slight itching, irritation or pain. Direct examination of specimens stained with Parker blue-black ink containing KOH revealed scales containing bacterial granules or filaments. Several species of bacteria were cultured including Corynebacterium sp. Fungus was not detected in either KOH specimens or in cultures. The lesions responded rapidly to topical or oral antibiotics; however, they recurred frequently during hot and humid weather. Hitherto a similar condition has not been described and is possibly a new clinical entity. Copyright (R) 2000 S.Karger AG, Basel     

Small pustules in Kawasaki disease. A clinicopathological study of four patients

We report the clinical and histological changes of small pustules that developed in four patients with Kawasaki disease (KD). The small pustules were superimposed on the urticarial erythema and symmetrically arranged on the genital area, buttocks, axillae, and extensor surface of the extremities. These lesions showed spongiform pustules histologically and were different from miliarial pustules. Reviewing previous reports, the clinical and histological characteristics of pustules in KD are summarized herein. This study indicates that small pustules underwent the consecutive changes related to the generalized polymorphous exanthem in KD.     

表现为中毒性表皮坏死松解症的急性泛发性发疹性脓疱病

报告1例表现为中毒性表皮坏死松解症的急性泛发性发疹性脓疱病。患者男，36岁。因上呼吸道感染口服对乙酰氨基酚及静脉滴注头孢拉定，5d后全身起红斑，脓疱，多数脓疱融合成脓潮，表皮大片脱落，呈中毒性表皮不死松解症表现，组织病理检查符合急性泛发性发疹性脓疱病诊断，予以糖皮质激素及万古霉素等治疗后皮损痊愈。     

林可霉素致急性泛发性发疹性脓疱病一例

【摘要】 患者男,28岁。因咳嗽在当地诊所肌内注射林可霉素注射液并口服咳嗽停颗粒、红霉素治疗,1 d后自头面部出现红斑,迅速波及躯干、四肢,3 d后在全身红斑基础上出现大量密集针尖至粟粒大小脓疱,伴全身皮肤灼痛、发热。皮肤科检查：全身90%以上体表面积弥漫水肿性潮红斑,充血明显。发际、面部、四肢屈侧、躯干皱褶部位（腋下、腹股沟）红斑基础上可见大量针尖至粟粒大小黄白色脓疱。双下肢肿胀,未见口腔黏膜及生殖器黏膜处红斑或糜烂。右肘皮损组织病理检查：局部表皮角质层下小脓疱,脓疱内见中性粒细胞聚集及坏死的角质形成细胞,伴真皮浅层淋巴细胞、嗜酸性粒细胞浸润。实验室检查：白细胞26.9 × 109/L,中性粒细胞0.88,淋巴细胞0.08,C反应蛋白127.89 mg/L,天冬氨酸转氨酶44.2 U/L,丙氨酸转氨酶77.3 U/L。诊断：急性泛发性发疹性脓疱病。治疗：入院当日给予静脉滴注甲泼尼龙60 mg/d,症状迅速缓解后快速减量,第7天出院。