苔藓样糠疹：治疗回顾

治疗苔藓样糠疹的药物种类繁多，已有报道认为抗生素、紫外线、氨甲喋呤和皮质类固醇有效，但均为非特异性治疗。由于病例少见，开展临床对照研究困难，多数治疗报道是病例报告或开放性研究。由于此炎症性皮肤病的免疫触发机制认识不清，因而不能较好地解释苔鲜样糠疹的免疫病理学。在病原、病理机理不清的情况下，治疗仍凭经验。     

苔藓样糠疹

苔藓样糠疹(pityriasis lichenoides)有三种不同的类型,分别为发热溃疡坏死性苔藓样糠疹(pityriasis lichenoides with ulceronecrotic hyperthermia,PLUH)、急性苔藓痘疮样糠疹(pityriasis lichenoides et varioliformis acuta,PLEVA)、慢性苔藓样糠疹(pityriasis lichenoides chronica,PLC).在三型之间有一些移行状态,分别具有不同亚型的特点,说明这三种亚型之间是有联系的,一些患者可以同时有PLEVA和PLC的皮损表现.     

婴儿慢性苔藓样糠疹一例

患儿,男,1岁5个月。躯干四肢丘疹、斑丘疹半年。组织病理特征符合慢性苔藓样糠疹,给予口服罗红霉素及外用他克莫司软膏后病情改善。     

苔藓样糠疹:治疗回顾

治疗苔藓样糠疹的药物种类繁多,已有报道认为抗生素、紫外线、氨甲喋呤和皮质类固醇有效,但均为非特异性治疗。由于病例少见,开展临床对照研究困难,多数治疗报道是病例报告或开放性研究。由于对此炎症性皮肤病的免疫触发机制认识不清,因而不能较好地解释苔藓样糠疹的免疫病理学。在病原、病理机理不清的情况下,治疗仍凭经验。     

局部用药治疗慢性苔藓样糠疹1例

1 临床资料:患者男性,22岁.因四肢、躯干起淡红褐色丘疹10年就诊.10年前无明显诱因发现双上肢起米粒大淡褐色、淡红色皮损,多数与皮肤一样平,仅少数皮损稍高出皮面,不痒、不痛.半年后发现胸、背、下肢亦有类似皮损.随年龄增长皮损缓慢扩大,从无消退现象,数量上增加不甚明显,但颜色缓慢逐渐加深,部分呈灰褐色.     

局限型慢性苔藓样糠疹

报告1例局限型慢性苔藓样糠疹.患者女,28岁.左肘关节屈侧反复出现瘙痒性红色斑丘疹、鳞屑3年.皮肤科检查:左肘关节屈侧及附近皮肤见红斑、斑丘疹及鳞屑,其中夹杂有色素减退斑、瘢痕.皮损组织病理检查示表皮角化过度,局灶性角化不全和轻度海绵水肿;真皮浅层血管扩张充血明显,红细胞外渗,血管周围少量淋巴细胞浸润.根据临床和组织病理特点,诊断为局限型慢性苔藓样糠疹.     

急性痘疮样苔藓样糠疹1例

1临床资料 患者男,32岁,躯干、四肢皮疹半年来诊.患者半年前无明显诱因躯干、四肢起红斑、小丘疹,上覆细薄鳞屑,部分丘疹顶端水疱、破溃,形成溃疡、结痂,痂皮脱落后遗留瘢痕,皮疹成批发生.曾在外院诊断为湿疹,用中药治疗(具体不详)效果不佳.家族中无类似病史.体格检查:体温36.4℃,脉搏73次/min,呼吸20次/min,血压15.6/10 kPa.一般情况可,系统检查无异常.皮肤科检查:躯干、四肢散在分布的鳞屑性暗红色、紫红色斑丘疹、丘疹、丘疱疹,上覆鳞屑不易剥离,剥离后无薄膜现象及点状出血;红斑直径约1～4mm,丘疹、丘疱疹约粟粒至绿豆大小,部分皮疹中央有坏死或溃疡,个别皮疹愈后有色素沉着及痘疮样凹陷,见图1.     

急性痘疮样苔藓样糠疹1例

1病历摘要 患者男,18岁,因全身出脱红斑、丘疹伴瘙痒1个月余,于2006年12月来我院就诊,1个多月前患者无明显诱因双上肢屈侧出现红斑、匠疹,渐累及全身,且出现水疱、脓疱、结痂,自觉瘙痒．除自行外用药物（具体不详）外,未进行其他治疗,既往健康,否认家族成员有相似疾病史.     

急性痘疮样苔藓状糠疹

患者男，51岁。主诉：全身红斑、丘疹、水疱、鳞屑伴瘙痒1个月余。现病史：1个月前无明显诱因在腹部、背部出现散在的红斑、丘疹伴瘙痒。当地卫生院诊断为过敏性皮炎，给予马来酸氯苯那敏、维生素C口服，外用曲安奈德尿素软膏等治疗，无明显疗效，皮疹逐渐增多，渐波及全身。既往身体健康，无类似皮疹史。家族中亦无类似患者。     

急性苔藓痘疮样糠疹1例

1病历摘要 患儿男,14岁.因全身出现红斑、丘疹、鳞屑伴瘙痒2个月余,于2008年11月1日来我院就诊.2个多月前患儿无明显诱因腹部起鳞屑性红斑、丘疹,伴瘙痒,渐累及全身.     

Pityriasis lichenoides chronica

A 19-year-old woman presented with a five-year history of guttate macules and yellow to skin-colored papules with collarette of fine scale on the trunk and the upper and lower extremities. Guttate pityriasis lichenoides chronica is an uncommon presentation of this T-cell-mediated disease. It is of unknown etiology; however, an infectious agent has been suspected. It is considered in a spectrum with pityriasis lichenoides et varioloformis acuta and rarely mycosis fungoides and CD30 lymphomas. Improvement has been shown after treatment with oral tetracyclines, ultraviolet B and UVA1 phototherapy, and PUVA photochemotherapy.     

Pityriasis lichenoides acuta (PLEVA) pemphigoides: A rare bullous variant of PLEVA

Although the clinical presentations of patients with pityriasis lichenoides et varioliformis acuta (PLEVA) may vary, bullae are not usually part of the clinical spectrum. To date, only two other cases of a bullous variant of PLEVA with evidence of autoantibodies against hemidesmosomal antigens have been reported. The term PLEVA pemphigoides was suggested for this unique clinical, pathological and serological combination of both PLEVA and bullous pemphigoid.     

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。     

Pityriasis lichenoides chronica ac varioliformis acuta

Ohne Zusammenfassung     

Pityriasis lichenoides chronica presenting as hypopigmentation

Seven black or dark skinned patients with pityriasis lichenoides chronica (PLC) are described, who presented with widespread hypopigmentation. The evidence on which a diagnosis of PLC was made is presented and the differential diagnosis discussed. The hypopigmentation was noted in some patients to be especially marked on the proximal parts of the limbs and axillary folds. A diagnosis of PLC should be considered in all dark skinned patients with a widespread hypopigmented rash.