慢性苔藓样角化病1例

患者男,31岁。舌部溃疡11年,四肢及腰腹部紫红色鳞屑性丘疹5年。皮损组织病理示:表皮角化过度,灶性角化不全,可见个别坏死角质形成细胞,少量淋巴细胞游入表皮,基底细胞液化变性,可见较多胶样小体,真皮浅层可见中等量淋巴细胞呈带状浸润。诊断:慢性苔藓样角化病。     

慢性苔藓样角化病

报告1例慢性苔藓样角化病。患者女,20岁。面部、躯干及四肢紫红色丘疹和斑块约20年。皮肤科检查:面部、躯干及四肢可见紫红色丘疹和斑块,皮损相互融合呈网状及线状,部分为毛囊性丘疹,皮损表面覆少量灰白色鳞屑,伴轻度瘙痒。Auspitz征阴性。未见口腔溃疡、眼损害及甲损害等。皮损组织病理检查:表皮角化过度伴角化不全,棘层不规则肥厚,基底层色素增加,灶状基底层变性,可见胶样小体;真皮浅层可见由淋巴细胞及组织细胞为主的带状浸润。诊断:慢性苔藓样角化病。予口服阿维A治疗6个月后皮损变平。     

局灶性肢端角化过度

报告1例局灶性肢端角化过度患者。患者女,37岁。左侧拇指、大鱼际扁平丘疹7个月,无自觉症状。皮损组织病理检查:表皮局限性角化过度,颗粒层及棘层增厚,基底细胞灶状液化变性,真皮浅层血管周围稀疏炎性细胞浸润。弹性纤维染色真皮弹性纤维大致正常,未见明显弹性纤维断裂及减少,弹性纤维染色阴性。诊断:局灶性肢端角化过度。     

线状光泽苔藓一例

23岁女性患者。右前臂多发性丘疹15 d。右前臂散在暗红色斑片,可见条带状、群集、粟粒大小的肤色扁平丘疹,表面有光泽,互相不融合。皮损组织病理示:角化过度伴灶状角化不全,基底细胞灶状液化变性,表皮下裂隙形成,裂隙上方表皮变薄,下方真皮乳头扩张,扩张的真皮乳头内淋巴细胞及组织细胞呈灶状浸润,浸润灶两侧的表皮突呈"抱球状"向内包绕。诊断:线状光泽苔藓。     

慢性苔藓样角化病1例

报告慢性苔藓样角化病1例。患者男,22岁,因躯干、四肢反复出现紫红色丘疹和斑块9年就诊。皮肤专科检查:躯干及四肢可见紫红色丘疹及斑块,皮损对称分布、相互融合呈网状的苔藓样改变,上覆少许糠状鳞屑。Auspitz征阴性。未见口腔、眼、生殖器及甲损害等表现。腹部皮损组织病理检查示:表皮角化过度伴小灶状角化不全,颗粒层楔形增厚,棘层萎缩变薄,基底层细胞液化变性;真皮浅层可见由淋巴细胞和组织细胞为主的慢性炎性细胞呈带状浸润。根据临床表现及组织病理检查结果,诊断为慢性苔藓样角化病。治疗上予口服阿维A酸每日20 mg、维生素E 100 mg每日3次、枸地氯雷他定8.8 mg每日1次,并联合外用卡泊三醇软膏及维生素E乳膏,治疗3个月后皮损稍有好转。目前患者仍在随访中。     

盘状红斑狼疮继发口唇鳞状细胞癌1例

报告1例盘状红斑狼疮继发口唇鳞状细胞癌。患者女,62岁。面部、右侧手背盘状红斑30年,上唇菜花状增生物1年,迅速增大3月。皮肤组织病理检查:盘状红斑处皮损示角化过度,棘层萎缩,表皮突变平,基底细胞液化变性,真皮层有淋巴细胞灶性浸润。菜花状增生物皮损示:真皮内广泛分布由表皮细胞形成的癌细胞巢,癌巢内表皮细胞轻度异形性改变,可见病理性核分裂,有大量角化珠形成。癌细胞团周围少许炎症细胞浸润。诊断盘状红斑狼疮继发口唇鳞状细胞癌。     

毛囊角化病并发回状颅皮

报告1例毛囊角化病并发回状颅皮。患者男,46岁。头皮、颈项部丘疹、斑块伴瘙痒30余年,泛发全身10余年。皮肤科检查:头皮皱褶呈深沟壑状,其上可见表面砂砾样的球状斑块,面部皱褶加深,可见针尖至粟粒大褐色丘疹,以口周为重。颈项部、前胸及后背正中线、四肢、腋窝密集分布多个褐色丘疹、斑块,部分融合成片,部分苔藓样变,可见散在抓痕、糜烂及结痂,皮损以四肢伸侧及胸背部正中线为著。头皮皮损组织病理检查示表皮灶状缺损,角化不全,见角化不良细胞,灶状颗粒层增厚,可见嗜碱性颗粒,灶状棘层松解。背部皮损组织病理检查示轻度角化过度,棘层肥厚,表皮突网状延伸,局部棘层松解形成裂隙,其下真皮浅层可见少许红染碎块状物沉积,刚果红染色(±),其余真皮上部小血管增生,血管周围淋巴细胞浸润,色素失禁。诊断:毛囊角化病并发回状颅皮。     

斑块型汗孔角化症伴细胞异型1例

报道1例颈部斑块型汗孔角化症(PK)伴细胞异型。患者男,59岁,颈部红斑,丘疹10年。皮肤科检查:左侧颈部单发5 cm×8 cm的不规则红色斑块,境界清楚,边缘呈轻度堤状隆起,皮沟加深,部分皮损结痂伴轻度脱屑。皮肤组织病理检查:表皮角化不全,中性粒细胞聚集,局灶表皮内可见角化不全柱,其下为角化不良细胞,表皮下部棘细胞排列紊乱,少数细胞核较大,真皮浅层大量淋巴细胞,浆细胞。诊断:PK伴细胞轻度非典型增生。     

慢性苔藓样角化病1例

报告１例罕见的慢性苔藓样角化病，患者女性７０岁。躯干、上肢发生角化性丘疹，部分皮疹排列成线状，伴口腔粘膜糜烂。组织病理变化为：表皮角化过度，棘层不规则肥厚与萎缩，基底细胞液化变笥。真此上部密集淋巴样细胞浸润。用皮质类固醇激素治疗无效，口服依曲替酯有效。讨论了此病的临床特点、组织病理、超微结构及治疗。     

慢性阻塞性肺部疾病的皮肤表现

报告30例严重慢性阻塞性肺部疾病患者的皮肤表现。其中17例,女13例。平均年龄为70.2岁。患有其它系统疾病者不包括在内。皮 肤科检查结果如下:肘和(或)股部角化过度17例、杵状指13例、烟草色甲4例、黄甲综合征1例、甲癣2例、甲弯曲2例、甲裂出血3例、匙状甲2例、光化性角化病6例、基底细胞癌5例、干燥病12例、鱼鳞病2例、压力性紫癜1例、肋缘     

银屑病样表现的移植物抗宿主病1例

患儿男,5岁。躯干、四肢皮疹伴瘙痒1周。7个月前,因患"急性B淋巴细胞白血病"行异基因造血干细胞移植术,术后发生两次急性移植物抗宿主病,临床表现为绿豆大鲜红色丘疹,压之退色,疹间皮肤正常,曾予糖皮质激素或免疫抑制剂治疗,丘疹可消退。皮肤科情况:面、颈、躯干及四肢伸侧可见散在分布大小不一的圆形或椭圆形干燥性红斑,上覆白色鳞屑,指/趾甲无受累,Auspitz’s征阴性。皮损组织病理示:表皮不规则增厚,浆痂形成,灶性海绵水肿,灶性基底细胞液化,表皮内可见个别坏死角质形成细胞,真皮浅中层血管周围可见稀疏的单一核细胞浸润。诊断:银屑病样表现的慢性移植物抗宿主病。     

Chronic ulcerative stomatitis

Chronic ulcerative stomatitis (CUS) has recently been described as a new disease entity characterized by chronic ulceration of oral mucosa which responds to treatment with hydroxychloroquine. It has a particular type of stratified epithelium-specific, antinuclear autoantibody as an immunological marker. Twelve cases have been reported in the literature. We present a 40-year-old woman with an 11-year history of chronic oral ulcerations. Other dermatological diseases, including oral lichen planus, pemphigus vulgaris and cicatricial pemphigoid, as well as bullous lupus erythematosus, were excluded. The clinical diagnosis of CUS was confirmed on the ground of the immunological and ultrastructural findings. The lesions initially responded to high doses of systemic corticosteroids but relapsed promptly after dose reduction. Dapsone was ineffective. Hydroxychloroquine, given at a dosage of 200–400 mg/day, led to a complete and longlasting remission.     

Recurrent focal palmar peeling

Recurrent focal palmar peeling, previously known as keratolysis exfoliativa, is an idiopathic condition characterized by chronic palmar and occasionally plantar peeling. It can be exacerbated by environmental factors, and may be misdiagnosed as chronic contact dermatitis. Accurate diagnosis is from the history and examination. It is supported by a negative patch test result. Three cases of recurrent focal palmar peeling are presented, of which two were misdiagnosed as chronic dermatitis. Although there are few references on recurrent focal palmar peeling, it is likely to be a common condition that rarely presents to dermatologists because it is largely asymptomatic, A correct diagnosis is essential due to the social, occupational and legal implications if misdiagnosed.     

Chronic arsenicism

BACKGROUND: Arsenic is an ubiquitous natural element. Chronic and low level ingestion or inhalation may result in chronic arsenicism first characterized by skin changes.CASE REPORT: A 75 year old man, non-insulin-dependent diabetic, presented a diffuse hyperpigmentation with scattered white spots on the trunk. He complained of asthenia. Clinical diagnosis of chronic arsenicism was confirmed by arsenic determination in urine, plasma and phaneres. Thorough investigations led to discover very high arsenic levels in the own wine of the patient. This was probably the result of a wrong use of sodium arsenite-based fungicide, for cultivating his vine yard.DISCUSSION: Chronic arsenicism has become rare but it should always be kept in mind. Clinical presentation, with particular cutaneous features and routes of exposure are reviewed. Treatment is symptomatic. As arsenic is known to be a strong carcinogenic agent, patients with chronic arsenicism have to be followed up during a long time.     

Chronic benign familial pemphigus

A case of chronic benign familial pemphigus (CBFP) is described in which a severe exacerbation was associated with infection with Herpesvirus hominis. This occurrence, which has a bearing on treatment, may not be as uncommon as the absence of previous reports would suggest.     

Chronic spontaneous urticaria is not an allergic disease

The links between chronic urticaria, IgE sensitization and allergy have been much discussed but little studied. We investigated IgE sensitization and allergy in 128 adult chronic urticaria patients during 2006-2008. During a one-day hospitalisation, the patients answered a standardized questionnaire and underwent blood serum analysis, physical tests and skin prick-tests. IgE sensitization to environmental allergens was defined by the positivity of at least one skin prick test and/or elevated levels of serum IgE?≥?300 Kui/L. The chronic urticaria was considered allergic if: i) a high correlation between positive skin prick tests to a clinically relevant allergen and the case history was found; ii) complete remission of urticaria occurred within two months of allergen withdrawal. Of 105 patients with interpretable skin prick tests, 46.7% were IgE sensitized. Two patients had clinically relevant positive skin prick tests but their chronic urticaria had many other triggering factors and neither was in complete remission after withdrawal of these allergens. IgE sensitization is higher in chronic urticaria patients than in the global adult population, suggesting that it is one important etiopathogenic factor in chronic urticaria. However, it cannot be considered as the expression of an IgE-mediated allergy but as a chronic inflammatory disease, more frequent in IgE sensitized people and favoured by multiple factors, among which IgE-mediated allergy is exceptional.     

Chronic urticaria due to Blastocystis hominis

A 24-year-old woman had a 9-week history of second to third daily urticaria that began after an episode of contact urticaria to topical bufexamac. She was found to have an underlying gastrointestinal infection with Blastocystis hominis. This was thought to be clinically relevant as she had a history of mild chronic diarrhoea. After treatment of the Blastocystis hominis, her urticaria ceased. This could indicate the importance of performing stool microscopy and culture on all patients with chronic urticaria of unknown aetiology. The relationship of urticaria to intestinal parasites and the possibility that non-steroidal anti-inflammatory medications could act as cofactors that help precipitate an urticarial reaction is discussed.     

Considerable Variability in the Efficacy of 8% Capsaicin Topical Patches in the Treatment of Chronic Pruritus in 3 Patients with Notalgia Paresthetica

Notalgia paresthetica (NP) is a focal neuropathic itch condition manifesting in intense chronic or recurrent episodic itch in a hyperpigmented, macular, uni- or bilateral skin area located below and/or medially to the scapulae. Achieving satisfactory relieve in NP patients is challenging. In this case-series three female NP patients were treated with 8% capsaicin patches following a spatial quantification of their alloknetic area with a von Frey filament. The use of a von Frey filament in order to delimit the precise area of itch sensitization and thus patch application, proved clinically feasible. Although 8% topical capsaicin relieved itch in all three patients, the duration of the effectiveness varied greatly from only 3 days to >2 months. The treatment was well tolerated in the patients and there appear to be no significant hindrances to applying this treatment with NP as an indication, although it may only exhibit satisfactory effectiveness in certain patients. Placebo-controlled double-blinded trials are needed to confirm the effectiveness of the treatment and assess predictive parameters of the treatment outcome.     

自身免疫性甲状腺疾病与慢性荨麻疹关系探讨

目的：探讨慢性荨麻疹与自身免疫性甲状腺疾病之间的关系。方法：采用放射免疫法对58例慢性荨麻疹患者及30例正常体检人群的甲状腺功能及抗甲状腺自身抗体进行了检测，结果：58例慢性荨麻疹患者中，有8例（13．8％）血清中存在抗甲状腺球蛋白抗（TGA）；7例（12．1％）存在抗甲状腺微粒体抗体（TMA）；慢性荨麻疹组的TGA和TMA水平均显著高于对照组(t值分别为2．762和2．695，P＜0．01）。但两组的T4、RT3、FT3、TSH值比较差异均无显著性（P＞0．05）。结论：慢性荨麻疹的发病有自身免疫机制参与。     

Chronic meningococcemia

A case is reported of a 70-year-old woman with chronic meningococcemia. She had intermittent fever, purpuric papules disseminated on the trunk and limbs, headache, arthralgia and myalgia for 5 weeks. Treatment with ceftriaxone was rapidly successful.