急性泛发性发疹性脓疱病5例

５例急性泛发性发疹性脓疱病,均有典型的临床表现,经组织病理学检查证实,５例发病均与用药有关。     

Anisakis simplex sensitization-associated urticaria: short-lived immediate type or prolonged acute urticaria

Acute urticaria is defined as evanescent wheals with a duration period of up to 6 weeks. Yet within acute urticaria, IgE-mediated urticaria lasts rarely more than 48 h, whereas longer duration periods are frequently unfruitful with respect to diagnostic work-up. We hypothesize the differences in immunologic features in immediate type urticaria versus prolonged acute urticaria within the model of Anisakis simplex (A. simplex) sensitization-associated urticaria. We included 57 patients with gastro-allergic Anisakiasis (GAA) and urticaria duration of less than 48 h and 17 patients with A. simplex sensitization-associated prolonged acute urticaria (PROL), defined as urticaria duration between 3 days and 6 weeks. As control group served 23 patients with A. simplex sensitization-associated chronic urticaria (CU+). We compared total IgE as well as specific IgE, IgG and IgG₄ against A. simplex. Median total IgE was higher in GAA than in PROL or CU+ [442 (interquartile range, IQR 198–995) vs. 117 (68–261) or 251 (94–382) kU/l, respectively]. Median-specific IgE was higher in GAA than in PROL or CU+ [62 (IQR 24.1–99) vs. 12.3 (6–30.9) or 14.2 (6.2–44.9) kU/l, respectively]. The differences were statistically significant at P < 0.001 for GAA against PROL and at P < 0.003 for GAA against CU+. Also, specific IgG and IgG₄ levels were higher in GAA than in PROL or CU+ at the same significance level. The levels of total IgE or specific immunoglobulin isotypes were not significantly different between PROL and CU+. In the model of A. simplex sensitization-associated urticaria, immediate-type urticaria in GAA is immunologically different from prolonged acute urticaria, which, in turn, shows features nearer to chronic urticaria than to gastro-allergic Anisakiasis. Thus, in an allergological evaluation of urticaria, we propose a possible benefit of a distinction of the duration period at 48 h, and not 6 weeks, when differentiating acute versus chronic urticaria.     

Therapy of acute and chronic urticaria

Background The drug management of chronic urticaria can be divided into three approaches: (i) blockade of released histamine at the receptor sites; (ii) blockade of histamine release from mast cells; and (iii) blockade of other mediators and possible inflammatory and cellular components. The first approach is the most successful and widely used. It primarily involves the use of H₁-antihistamines, although tricyclic antidepressants and H₂-antihistamines also have a place. Treatments The usefulness of classic H₁-antihistamines, such as hydroxyzine, may be limited by side-effects (most notably, sedation). The four most widely used of the newer antihistamines are loratadine, terfenadine, astemizole and cetirizine. These antihistamines are significantly superior to placebo and have similar efficacies comparable with hydroxyzine. Novel agents and methods, including nifedipine, sulphasalazine and plasmapheresis have been tried with some success in refractory patients. Guidelines If acute cases are inadequately controlled, short-term oral corticosteroids may be added. Systemic corticosteroids are occasionally indicated for the management of severe acute urticaria, severe serum sickness, pressure urticaria or urticarial vasculitis, or to break the cycle of a resistant case, but have no place in regular therapy for chronic urticaria. For those with severe acute urticaria with signs of respiratory distress, possible treatments include subcutaneous epinephrine, systemic corticosteroids and intramuscular H₁-antihistamines. Patients with chronic urticaria inadequately controlled on H₁-antihistamines alone may benefit from the addition of a classic antihistamine, a tricyclic antidepressant or an H₂-antihistamine. A short course of systemic corticosteroids may help those with severe chronic refractory disease.     

急性泛发性发疹性脓疱性皮病12例临床病理分析

目的：了解急性泛发性发疹性脓疱性皮病(AGEP）的发病原因、临床病理特征及治疗情况。方法：回顾性分析12例AGEP患者的临床资料。结果：12例患者中2例有银屑病史。男女发病之比为1：3，平均发病年龄31.3岁。7例患者发病前有明确的用药史，4例有病毒或细菌感染史，11例患者有发热及白细胞和嗜中性粒细胞增多。ACEP病程短暂且有自限性。组织病理学检查示表皮内或角质层下脓疱和真皮浅层水肿。去除可能的发病因素(药物和清除感染灶），给予中、小剂量的糖皮质激素口服或注射，患者基本痊愈。结论：AGEP为一种较少见的疾病，多由药物引起，临床及病理上具有特征性，去除诱发因素和及时应用糖皮质激素是治疗的关键。     

急性泛发性发疹性脓疱病79例临床分析

目的:分析急性泛发性发疹性脓疱病(AGEP)发病诱因、临床特点、治疗方法及疗效.方法:对我科79例住院AGEP患者进行回顾性分析.结果:发病前有药物和感染史比例基本相等;男女比例1:1;各个年龄均能发病,中位数14岁,男性发病年龄低于女性;C反应蛋白异常率93.75%;有一种以上肝酶异常率45.6%,男性异常率高于女性(P=0.045);心电图异常率44.4%.治疗主要采用糖皮质激素、抗生素、抗组胺药等,88.6%病例痊愈,11.4%好转.成人组的住院天数明显长于儿童组(P=0.038).结论:AGEP患者肝酶和心电图异常率较高,提示该病有一定的内脏损害,但治疗效果较好,应注意随访.     

急性发疹性脓疱病15例临床分析

本文叙述了AGEP的诱因，临床症状，检查治疗和转归。     

急性泛发性发疹性脓疱病(AGEP)20例临床分析

目的了解急性泛发性发疹性脓疱病的临床特点，提高对本病的认识。方法结合文献复习对20例AGEP的患者进行回顾性分析。结果20例患者中，18例由药物诱发，另外2例原因不明。典型的AGEP表现为突发的红斑基础上浅在无菌性脓疱，伴有发热。结论药物是引起AGEP主要的原因。随着抗生素种类的增多，以及临床上的滥用，AGEP势必呈明显增加的趋势。正确地掌握该病的诊断要点，将减少临床上的误诊、误治。     

Anxiety and depression in patients with chronic urticaria and generalized pruritus

Thirty-four dermatology out-patients with chronic idiopathic urticaria and 34 with idiopathic generalized pruritus were investigated using standardized self-assessment psychological questionnaires to determine the incidence of significant symptoms of depression and anxiety. These patients were compared with age- and sex-matched but otherwise unselected general dermatology out-patients. Using the Beck depression inventory, significantly more patients with generalized pruritus (32.4%) had depressive symptomatology (score greater than 14) than controls (13.2%, P less than 0.05). Although more patients with chronic urticaria had depressive symptomatology (14.7%) than controls (4.4%), the difference was not statistically significant. Using the Speilberger state-trait anxiety inventory there were no significant differences between the patients with pruritus or urticaria and their controls with respect to state or trait anxiety scores above the upper 90% probability limit for the general population. Thus, significant depression may be expected in a substantial proportion of patients with idiopathic generalized pruritus but in a relatively small proportion of those with chronic urticaria.     

Solar urticaria: a report on 57 cases.

BACKGROUND: Solar urticaria (SU) represents an uncommon skin disorder, characterized by pruritic erythema and wheals after sun exposure, that sometimes restricts normal daily life. OBJECTIVE: To evaluate data concerning sex, age, natural history, associated diseases, and eliciting wavebands of 57 SU cases. METHODS: Questionnaire for anamnestic data, laboratory examinations, phototesting. RESULTS: Sex: 25 (44%) males, 32 (56%) females. Age: The peak age was between 20 and 30 years. Skin type (ST): 12 (21%) ST II, 39 (68%) ST III, and 6 (11%) ST IV. Time between onset and complete disappearance of SU was from 2 to more than 6 years; the main peak (37 patients) between 4 and 6 years. There were histories of atopic dermatitis 12 (21%) and asthma or rhinitis 15 (26%). Association with other urticarias (U): 13 (21%) dermographic U, 2 food U, 3 heat U. Increased immunoglobin E (IgE): 19 (33%). Eliciting wavebands: 38 (67%) visible light (VIS), 16 (28%) long ultraviolet (UVA), 3 natural sunlight. Minimal urticarial dose (MUD): 20-37.5 J/cm2 for VIS-sensitive patients, 5-10 J/cm2 for UVA. CONCLUSIONS: In our series: 1. SU affects both sexes usually when they are under 30 years of age; 2. nearly half the patients are free of disease within 5 years; 3. in about one fourth of cases SU is associated with dermographic urticaria or displays a history of atopic dermatitis; 4. the wheals are elicited mainly by VIS or UVA; 5. SU can be prevented, at least in part, by antihistamines or by PUVA therapy.     

药物所致急性全身发疹性脓疱病11例临床分析

目的：提高临床医师对药物引起急性全身发疹性脓疱病的认识。方法：分析１１例急性全身性发疹性脓疱病的病因、症状、体征、实验室检查和病理,诊断及鉴别诊断。结果：１１例患者发病前均有药物史,临床上均有发热,全身性红斑,小脓疱。病理显示角层下脓疱。结论Ｌ：药物是引起急性全身性发疹性脓疱病的主要原因之一,其药物以抗菌素和解热镇痛类药继主,发热和泛发小脓疱是该病的特点,根据病因,临床表现,诊断并不困难,但需与胞     

成人色素性尊麻疹3例报导

色素性尊麻疹大多发生于儿童,然成人也有发生.现将我院近年来诊治的3例成人病例作一报告.     

Sirolimus-associated lymphoedema: eight new cases and a proposed mechanism

Sirolimus, an inhibitor of the mammalian target of rapamycin (mTOR), is increasingly used as an agent for post-transplant immunosuppression and the treatment of solid organ and haematological malignancies and hamartomas. Its advantages include a lack of nephrotoxicity and a lower incidence of nonmelanoma skin cancers; adverse effects include delayed wound healing, increased lymphocoele formation and rarely lymphoedema. We report a series of eight cases of severe, sustained, unilateral and bilateral lymphoedema in patients receiving sirolimus for post-transplant immunosuppression, classify their lymphoscintigraphy findings and propose a mechanism of aetiology based on the interaction of mTOR with key mediators of lymphangiogenesis.     

Methotrexate-responsive chronic idiopathic urticaria: a report of two cases

Chronic idiopathic urticaria (CIU) may be severe and refractory to standard therapies. We describe two patients with CIU, neither of whom had detectable autoantibodies, in whom control of the disease was achieved with methotrexate.