带状疱疹愈合部位发生银屑病-Wolf's同位反应1例

患者男,38岁。6周前左胸及背部出现带状疱疹皮损,2周后治愈。20d前,皮损愈合处出现簇集分布的鳞屑性红斑丘疹。皮损组织病理符合银屑病,提示为带状疱疹Wolf's同位反应。     

高IgE综合征一例

患儿女,13岁,因全身反复起红斑、丘疹、脓疱伴痒13年,加重1年,于2010年6月入院治疗.患儿自出生后1周,头面部及全身起红斑、丘疹、水疱,间有糜烂、渗出,伴明显瘙痒.皮损反复发作,时轻时重.经常有脓疱、结节等皮损出现,多次在当地被诊为毛囊炎、疖肿、麦粒肿、蜂窝组织炎等感染性疾病.8岁前患儿经常出现发热、咳嗽,约每月1次.皮损重或发热时在当地静脉滴注头孢类抗生素,皮损和发热可好转.6年前,下颏处出现一皮下包块,无发热,在外院就诊,查及肺部有结节阴影.皮损组织病理检查,诊为寻常狼疮?结节病?先后给予抗结核药物及泼尼松口服治疗1周,皮损无明显好转,回当地医院静脉滴注头孢类抗生素,并继续应用以上口服药物,4周后下颏处皮损消退,停用糖皮质激素和抗结核药.     

带状疱疹后嗜酸性粒细胞性皮病样Wolf’s同位反应

患者女,49岁。右侧上肢和胸背部红斑、丘疹和水疱3 d。患者27 d前曾疾患带状疱疹,皮损愈合15 d后,于原部位出现红色斑丘疹及水疱。皮肤科检查:右侧上肢、腋下、胸部及肩胛部可见带状分布的红色的斑疹、丘疹和水疱。皮损组织病理:表皮无异常,真皮全层大量嗜酸性粒细胞和淋巴细胞围绕血管及附属器周围浸润,浸润区水肿明显。诊断:带状疱疹后嗜酸性粒细胞性皮病样Wolf’s同位反应。予系统应用糖皮质激素后,皮损消退。     

二期梅毒疹1例

临床资料患者,女,22岁。主因肛周、外阴、腋下、颈部扁平丘疹2个月于2011年1月来我院皮肤科就诊。患者缘于2个月前肛周出现数个绿豆大小扁平丘疹,皮损渐增大、增多并扩展至外阴,无明显自觉症状。1个月前腋下出现类似皮损,起初为数个扁平丘疹,后丘疹扩大融合,中央渐愈合形成一环状皮损。同时颈部出现环形斑丘疹,少许鳞屑。患者一般情况可,     

6种疣合并发生1例

患者男,28岁,工人。面部扁平丘疹半年,周身数处赘生物、丘疹3个月。患者半年前面部出现数个米粒大、圆形扁平丘疹,无自觉症状,未治疗,随后皮损扩延至双手背及前臂。3个月前,前胸部出现半球形肤色丘疹十多个,轻度瘙痒,双手背、甲周、足底、肛周亦出现米粒至黄豆大赘生物,摩擦及撞击时有出血。曾在外院治疗肛周皮损,后又复发,其他皮损未做治疗。既往无免疫缺陷类疾病。否认不洁性生活史,其妻无同样皮损发生。体检:系统检查未见异常。皮肤科情况:面部、前臂、双手背可见米粒至绿豆大、圆形扁平丘疹,表面光滑,质硬,褐色,密集对称分布,不融合。前…     

内分泌、代谢、营养障碍性皮肤病

973032 糖皮质激素引起黑棘皮病1例报告/李艳平//新医学。-1997,28（3）。-145 男,33岁。在持续高热5天2周后逐渐感皮肤粗糙、干燥、色变黑。患者家族中无类似病史,发病前数月因眼疾共用糖皮质激素总量相当于泼尼松1500mg。体检:面、颈、四肢伸侧片状色素沉着,腋窝、腘窝等部位皮损处皮沟加深,皮嵴隆起或呈密集的粟粒大小角化性丘疹,触之天鹅绒样感觉。两次皮损活检均符合。其余实验室检查无特殊发现。给予维生素A、E、C,随访3年中未使用激素,皮损明显好转。（张小莲）     

拉莫三嗪致中毒性表皮松解型药疹伴真菌性肺炎1例

患者男,24岁。全身红斑、丘疹、斑块伴痒痛3d。曾有卡马西平过敏史,因"病毒性脑炎"致"癫痫"8周,口服糖皮质激素及抗癫痫药(拉莫三嗪、丙戊酸钠及左乙拉西坦)3周后致高热伴全身充血性红斑、口唇糜烂3d,诊断为中毒性表皮松解性药疹。胸部CT示肺部感染。中后段痰液真菌培养、G试验及GM试验提示肺部曲霉感染,予糖皮质激素、抗生素、抗真菌药、丙种球蛋白联合治疗15d,皮损颜色变浅,无新发皮疹,无发热。后皮损再次增多,追问病史,患者家属私下自行加用拉莫三嗪2d,嘱其停用该药,经糖皮质激素及丙种球蛋白治疗后痊愈。     

毛囊黏蛋白病一例

临床资料患者,男,56岁。因头面部、四肢红斑丘疹伴瘙痒就诊。患者5个月前无明显诱因面部出现丘疹,自觉瘙痒明显,后皮损相继出现在头部、颈部、四肢,部分皮损融合成斑块,伴明显脱发。曾于当地医院给予外用糖皮质激素药膏治疗,无明显缓解,随来我院就诊。     

成人非对称性近屈曲部疹2例

报告2例成人非对称性近屈曲部疹.例1.女,21岁.2周前右大腿内侧近腹股沟处及胭窝出现红斑、丘疹.皮肤科检查:右大腿内侧和右腘窝见红斑、斑丘疹,皮损中心融合成片,10d后皮损自行消退.例2.女,28岁.因右胁部、胸部红斑及丘疹伴瘙痒4 d就诊.皮肤科检查:右侧胁部、胸腹部散在直径2～5 mm的红斑、丘疹.左侧躯干仅见零散分布互不融合的红斑、丘疹.2周后皮损自愈.2例患者均诊断为非对称性近屈曲部疹.     

幼儿Sweet综合征1例

患儿男,2岁7个月。面部、颈部及手背突发水肿性红色丘疹及斑块2周。皮损组织病理示:真皮浅中层水肿、弥漫中性粒细胞浸润及大量核尘。诊断:Sweet综合征。糖皮质激素治疗效果良好。     

肉芽肿性口周皮炎二例

报告2例肉芽肿性口周皮炎。例1男,6岁。面部红斑、丘疹5个月就诊。曾外用糖皮质激素软膏后皮疹渐增多。例2女,28岁。口周、鼻周红斑、小丘疹2个月余就诊。2例均表现为面部腔口周围直径1—3mm大小的淡红色坚实小丘疹,皮损组织病理检查：真皮毛囊周围上皮样细胞肉芽肿改变。结合临床表现及组织病理学检查,2例均确诊为肉芽肿性口周皮炎。例1口服琥乙红霉素颗粒200mg/次,每日4次、1％克林霉素凝胶和0．03％他克莫司软膏外用,治疗2个月后皮疹完全消退,1个月后口周皮疹又复发。例2在行组织病理活检后皮疹自行消退,提示本病具有临床自愈倾向。     

Papular Acantholytic Dyskeratosis Localized to the Perineal and Perianal Area in a Young Male

A case of Papular acantholytic dermatosis restricted to the perianal area is being reported in a 26 year old male without involvement of the genitalia, groin and upper thighs for the first time in English literature. The patient presented with long standing grayish white confluent papules with eroded areas in the perianal region which were asymptomatic for a long time before the area got macerated. He did not respond to many weeks of topical steroids but is now showing improvement with topical tacrolimus ointment 0.1% applied twice daily. This entity appears to be very uncommon and also underreported. It is also suggested that this entity be included in the long list of non venereal anogenital lesions as it may mimic perianal warts or molluscum contagiosum.     

阿维A联合外用糖皮质激素治疗类天疱疮样扁平苔藓一例

患者,男,58岁。周身紫红色扁平丘疹伴痒2个月。组织病理及免疫病理检查结果符合类天疱疮样扁平苔藓。给予口服阿维A胶囊30 mg日1次、雷公藤20 mg日3次,外用卤米松、哈西奈德于丘疹处。半个月后随访,水疱已全部消退,皮疹颜色较前明显变淡。     

Papular elastolytic giant cell granuloma: a clinical variant of annular elastolytic giant cell granuloma or generalized granuloma annulare?

A 71-year-old man with asymptomatic red papules on the trunk and upper arms was reported as a case of papular elastolytic giant cell granuloma. A skin biopsy specimen from a papule on the back showed similar findings to those of annular elastolytic giant cell granuloma. However, centrifugal annular lesions were not clinically observed. He was successfully treated with tranilast and topical steroids.     

Lichen planopilaris

Background

Lichen planopilaris (LPP) is an inflammatory condition of unknown etiology that affects pilosebaceous units, mainly of the scalp, and results in scaring alopecia.

Objective

A 51-year-old male presented with a pruritic eruption on the cheek consisting of atrophic macules and erythematous folliculocentric papules.

Results

Biopsy revealed a perifollicular lymphocytic infiltrate and vacuolar degeneration of the dermoepidermal junction consistent with LPP. Many treatment modalities have been utilized, with varying degrees of success. Our patient responded poorly to topical steroids. After nine months of topical tacrolimus therapy, his lesions resolved entirely.

Conclusion

The treatment of our patient demonstrates tacrolimus as a novel topical therapeutic option for patients with LPP.     

Alitretinoin treatment of lichen amyloidosis

Lichen amyloidosis (LA) is characterized by the deposition of amyloid that may respond to chronic scratching that may be secondary to atopic dermatitis, stasis dermatitis, or interface dermatitis. Despite the development of several therapeutic strategies, including topical steroids, oral antihistamines, cyclosporine, and retinoids, an effective treatment for LA has not been established. A 49‐year‐old woman who has been treated irregularly for atopic dermatitis for 7 years presented with localized brownish papules on the left forearm and right elbow. They developed 3 months prior and were becoming more prominent despite of treatment with cyclosporine, oral antihistamines, and topical steroids for 5 months prior to presentation. A skin biopsy revealed amyloid deposition in the dermal papillae and the patient was diagnosed with LA associated with atopic dermatitis. A 6‐month course of daily oral alitretinoin 30 mg produced marked improvement in the thickness and color of the hyperkeratotic papules without aggravation of the patient's atopic dermatitis. Histologic evaluation showed clearance of amyloid deposition and almost normalization of the epidermal changes. Herein, we report a case of LA treated with alitretinoin and suggest that it could be a potential treatment option for LA, especially in patients with inflammatory skin diseases including atopic dermatitis.     

Cornifying Darier's disease

A 48-year-old Caucasian man recounted the onset of keratotic papules on the trunk at the age of 8 years, with subsequent spread to the forearms, scalp, and forehead. His most severe disease was present on the legs. He complained of pain, itching, and noted exacerbations in the summer and with sweating. The family history was negative. On physical examination, the most striking finding was that of extensive, markedly hyperkeratotic plaques on the lower legs >(Fig. 1). His scalp, forehead, chest, and back exhibited mild involvement, with scattered brown keratotic papules, while his forearms showed mildly hyperkeratotic plaques. Flat-topped brown papules were present on the dorsum of the hands, with a few keratotic papules on the palms, and a few nails with distal notching and red longitudinal streaks. There were no palmar pits or oral mucosal lesions. A shave biopsy was performed of a plaque on the leg, and showed a papillomatous and markedly hyperkeratotic lesion >(Fig. 2). Suprabasal acantholysis in the elongated rete produced characteristic lacunae. The acantholysis was associated with dyskeratosis including corps ronds and grains >(Fig. 3). Together, these features were characteristic of Darier's disease. Treatment years earlier with topical retinoids, topical steroids, topical keratolytics, and multiple oral antimicrobials had been unsuccessful, and isotretinoin had been discontinued due to elevated triglycerides. Treatment was initiated with acitretin and, after 3 months, mild improvement was noted     

Intermittent topical corticosteroid/tacrolimus sequential therapy improves lichenification and chronic papules more efficiently than intermittent topical corticosteroid/emollient sequential therapy in patients with atopic dermatitis

Atopic dermatitis (AD) is a common, chronic, relapsing, severely pruritic, eczematous skin disease. Topical steroids are the mainstay of treatment. However, the adverse effects of steroids on hormonal function are the major obstacle for their use as long-term topical therapy. Intermittent dosing with potent topical steroids and/or combination therapy with steroid and tacrolimus have been frequently used in the daily management of AD to overcome the problems accompanying the long term use of steroids. We compared the clinical effects of topical steroid/tacrolimus and steroid/emollient combination treatments in 17 patients with AD. An intermittent topical betamethasone butyrate propionate/tacrolimus sequential therapy improved lichenification and chronic papules of patients with AD more efficiently than an intermittent topical betamethasone butyrate propionate/emollient sequential therapy after four weeks of treatment. Only one out of 17 patients complained of a mild, but temporary, burning sensation after tacrolimus application. The intermittent topical steroid/tacrolimus sequential therapy may be a useful adjunctive treatment for AD.     

环状鲍温样丘疹病一例

患者,男,40岁。包皮黑褐色斑丘疹3个月。查体见境界清楚的黑褐色丘疹,呈环状分布。组织病理示：表皮层不典型增生及角化不全,表皮呈乳头瘤样增生,可见挖空细胞,棘细胞排列紊乱,部分细胞异型。诊断：鲍温样丘疹病。局部给予咪喹莫特乳膏,仍随访中。     

Rheumatoid papules treated with dapsone

A patient with a long history of seropositive rheumatoid arthritis presented with a progressive papular eruption on the trunk. A skin biopsy showed a neutrophilic and palisaded granulomatous dermatitis compatible with rheumatoid papules. The eruption failed to respond to topical and systemic corticosteroids and the patient was treated with dapsone with complete resolution of the rash. Rheumatoid papules are a rare disorder seen in a variety of collagen vascular diseases. The literature concerning the treatment of rheumatoid papules is scanty. In this patient, dapsone was an effective treatment.