异维A酸联合昆明山海棠治疗24例掌跖脓疱病

目的:观察异维A酸胶丸联合昆明山海棠片治疗掌跖脓疱病效果。方法:治疗组采用异维A酸胶丸口服,每日2次,每次10 mg,同时口服昆明山海棠片,每日3次,每次2片。并与单纯口服昆明山海棠片对照。结果:治疗组治愈率75.0%,与对照组比较差异有统计学意义。结论:异维A酸胶丸联合昆明山海棠片联合治疗掌跖脓疱病,疗效确切,不失为临床有效治疗方法之一。     

昆明山海棠治疗无菌性脓疱性皮肤病35例疗效观察

目的 观察昆明山海棠治疗无菌性脓疱性皮肤病的疗效及作用机制。方法 昆明山海棠30－50g/d分3次剪服共4周，并用该药液浸泡患处，治疗无菌性脓疱性皮肤病患者35例，同时用放免疫法检测8例患者血浆TXB2和6－keto-PGF1α水平。结果 治愈率为60％，总有效率为97．4％，治疗前后血浆TXB2和6－keto-PGF1α含量有显著差异（P＜0．01）。结论 昆明山海棠是治疗无菌性脓疱性皮肤病的一种有效药物，其抗炎机制部分是通过降低TXB2和6－keto-PGF1a水平来实现的。     

昆明山海棠治疗32例无菌性脓疱性皮肤病的疗效观察

用昆明山海棠治疗32例无菌性脓疱性皮肤病,其中疤疹样脓疤病1例,连续性肢端皮炎4例,脓疱性银屑病19例,掌跖脓疤病8例。治愈22例,治愈率为68.7％,显效5例,好转4例,无效1例,总有效率为96.8％。一般服药一周开始生效,水煎剂比片剂疗效好。停药后复发者,再用此药仍有效。此药副作用小。其疗效可能与该药之良好抗炎及免疫抑制作用有关。     

昆明山海棠对无菌性脓疱病患者血清IL-8水平的影响

为探讨昆明山海棠 (TH)水煎液治疗无菌性脓疱病的药理机制 ,用酶联ELISA法检测了 8例患者血清IL - 8表达水平。结果与 12例正常人相比 ,无菌性脓疱病患者血清中IL - 8表达水平增高 (P <0 0 1)。IL - 8水平与患者外周血白细胞总数呈正相关 (γ =0 7917)。而经TH治疗后 ,患者血清IL - 8表达水平下降 (P <0 0 1)。表明TH治疗无菌性脓疱病的抗炎机制部份是通过影响IL - 8表达来实现。     

细菌性皮肤病

970089 昆明山海棠治愈角层下脓疱病2例/王正文…//中国皮肤性病学杂志。-1996,10（4）。-210 均为中年妇女,结合皮损形态、好发部位均为在胸、腹、腋窝及四肢近端见成群簇集小脓疱,病程反复发作1年多及3年,病检示角层下脓疱内含多数嗜中性粒细胞,棘层轻度海绵样水肿,其间散在少数嗜中性粒细胞,真皮浅层血管周围嗜中性粒细胞及淋巴细胞浸润,确诊后经昆明山海棠生药治疗半月后皮损控制,例1巩固治疗3月,半年未见复发,例2巩固治疗观察2月未见复发。昆明山海棠有良好的抗炎及免疫调理作用,副作用小,值得推广。参2（张秉正）     

昆明山海棠治疗掌跖脓疱病疗效观察

掌跖脓疱病是一种局限于掌跖部位的慢性复发性皮肤病。2008年3月-2010年6月笔者采用昆明山海棠片治疗掌跖脓疱病48例,取得了满意疗效,现报道如下：     

急性泛发性发疹性脓疱病18例临床分析

目的 探讨急性泛发性发疹性脓疱病皮损特点及治疗.方法 收集18例急性泛发性发疹性脓疱病的临床资料,并从发病诱因、皮疹特点、病理、治疗效果等方面进行分析.结果　发现急性泛发性发疹性脓疱病均为急性起病,明确的用药史;皮疹广泛,有非毛囊性脓疱;组织病理:角质层下和棘层上部可见脓疱,真皮浅层血管周围见中性粒细胞及淋巴细胞浸润;糖皮质激素治疗效果明显.结论　急性泛发性发疹性脓疱病为急性起病,皮损广泛,有特征性的非毛囊性脓疱,糖皮质激素治疗敏感.     

无菌性脓疱类皮肤病167例临床分析

目的了解无菌性脓疱类皮肤病的临床特点,为该类疾病的预防、诊治等提供借鉴。方法回顾性分析167例无菌性脓疱类皮肤病患者的一般资料、临床表现、实验室检查结果及治疗方法等。结果脓疱型银屑病发病男女接近,疱疹样脓疱病、连续性肢端皮炎发病以女性为多,其诱因各不相同。三种疾病均伴有发热,而且疱疹样脓疱病与脓疱型银屑病相比高热及发热时间长短差异无统计学意义。该三种疾病可致不同比例的甲或舌损害。各疾病可致不同程度实验室检查指标异常。脓疱型银屑病经免疫抑制剂,阿维A单独或联合其他两种药物治疗,好转较快;连续性指端皮炎经激素单独或联合其他两种治疗方法治疗,好转较快。结论无菌性脓疱类皮肤病临床特征各不相同,需要兼顾患者的个体化差异。     

昆明山海棠片联合甲砜霉素治疗掌跖脓疱病34例临床观察

目的观察昆明山海棠片联合甲砜霉素治疗掌跖脓疱病的临床疗效。方法将入选的98例掌跖脓疱病患者随机分成三组。治疗组（34例）予口服昆明山海棠片0．72g和甲砜霉素0．25g,均3次／d,同时外搽氯倍他索乳膏2次／d;对照1组（32例）予昆明山海棠片口服联合氯倍他索乳膏外搽;对照2组（32例）予甲砜霉素口服联合氯倍他索乳膏外搽。三组患者均治疗6周后判定疗效。结果治疗组、对照1组和对照2组的有效率分别为72．73％,40．43％和34．38％,治疗组有效率显著高于其他两组（P均〈0．05）。三组均出现轻度不良反应,患者可耐受,未影响治疗,差异无统计学意义（P均〉0．05）。结论口服昆明山海棠片和甲砜霉素并同期外用氯倍他索乳膏治疗掌跖脓疱病的疗效好,安性高,值得临床选用。     

窄波UVB联合阿维A治愈疱疹样脓疱病1例

疱疹样脓疱病是一种少见的难治性复发性脓疱性皮肤病，可见于儿童，无特效疗法，糖皮质激素，免疫抑制剂对部分病例有效，但不能防止复发，并且长期应用对儿童生长发育有较大影响。我们用窄波UVB联合阿维A（商品名：新体卡松）治愈1例顽固性疱疹样脓疱病患儿，报道如下。     

脓疱性银屑病76例临床分析

目的：分析脓疱性银屑病的临床特征。方法：对76例脓疱性银屑病患者按照国际上通行的分类方法进行诊断和分类，并对其病史资料、临床特征和治疗经过进行分析。结果：该76例脓疱性银屑病在同期就诊的银屑病患者中占8．6%，其中以局限性居多．占71．0％．主要累及掌跖部位；泛发性病例中5种临床亚型均各有2～6例患者，表现为程度不一的红斑、脓疱和鳞屑根据不同的皮疹特点给予窄谱中波紫外线(NB-UVB)、长波紫外线(UVA）、维A酸等综合治疗取得较为满意的效果，有效率为49．2％结论：脓疱性银屑病的临床表现和治疗反应在不同患者间差异较大。新的分类方法对指导临床实践具有积极意义。     

Alterations of surface receptors on intralesional neutrophils in pustular psoriasis and palmo-plantar pustulosis

Alterations of binding capacity of surface IgG-Fc and complement receptors were demonstrated in polymorphonuclear neutrophils (PMNs) obtained from the pustular lesions of psoriasis. A marked decrease of C3 receptors, but not of IgG-Fc, was found in PMNs from the lesions of palmo-plantar pustulosis (PPP) and bacterial pustules. PMNs from pustular lesions of psoriasis exhibited only a slight decrease in the number of C3 receptors. No significant decrease in membrane receptors was noted in circulating PMNs from psoriatic patients. We suggest that mechanisms of formation of aseptic subcorneal pustules, mediated by PMN membrane receptors for C3 fragments, are different in pustular psoriasis and PPP.     

Levels of proelafin peptides in the sera of the patients with generalized pustular psoriasis and pustulosis palmoplantaris

The levels of proelafin peptides in the sera of patients with pustulosis palmoplantaris, a unique type of localized pustular psoriasis, and generalized pustular psoriasis were determined by competitive enzyme-linked immunosorbent assays using antibodies against synthetic proelafin polypeptides corresponding to the elastase inhibitor (elafin) and transglutaminase substrate domains. The sera of patients with pustulosis palmoplantaris (9 cases) exhibited a normal range of proelafin peptide levels. The sera of patients with generalized pustular psoriasis (3 cases) showed high titres of proelafin peptide. There were no large differences in the titres between the 2 antibodies. The antibodies for 2 different domains of proelafin showed a similar immunoreactivity for the non-pustular region of the epidermis in all pustulosis palmoplantaris tested. The results indicate that serum proelafin peptides in pustular psoriasis may depend on the extent of the involved area, and that proelafin peptide level in pustulosis palmoplantaris remains normal despite enhanced local expression in the lesional skin. Since the skin lesions of patients with pustulosis palmoplantaris are limited to the palms and soles, enhanced expression of proelafin in the lesional skin may not lead to elevation of proelafin peptides in the serum.     

Acute generalised exanthematous pustulosis

Acute generalised exanthernatous pustulosis (AGEP) is a condition characterised by sudden onset of non-follicular aseptic pustules all over the body. It is distinct from pustular psoriasis with characteristic morphology, histopathology and evolution.     

HL-A antigens in pustular psoriasis.

HL-A typing was performed on 97 patients with pustular psoriasis. HLA-B27 was found increased for the combined three subgroups: localized psoriasis of palms and soles, acrodermatitis continua and generalized pustular psoriasis, who were associated with a high incidence of arthritis. These subgroups have this in common with Reiter's disease indicating a link between the entities. In persistent palmo-plantar pustulosis an increased incidence of HLA-Bw35 was found. HLA-B13, HLA-B17 and HLA-Bw37 which are found markedly increased in psoriasis vulgaris were in acrodermatitis continua, generalized pustular psoriasis and persistent palmo-plantar pustulosis either absent or not increased as compared with the control population. 7 of 30 patients with localized psoriasis of palms and soles had one of these antigens. Our findings confirm that psoriasis vulgaris and pustular psoriasis as such, seem to be different aetiological entities. Some patients with localized psoriasis of palms and soles may be true psoriatics which besides their psoriasis have a tendency to develop a pustular reaction in their palms and soles similar to persistent palmo-plantar pustulosis.     

泛发性脓疱型银屑病44例临床分析

目的：探讨脓疱型银屑病临床表现及治疗效果。方法：对44例脓疱型银屑病患者进行临床回顾。结果：多种因素可导致脓疱型银屑病发病，感染和滥用糖皮质激素是其主要诱因；发热和血象升高是其主要系统性临床表现；糖皮质激素联合第二代维A酸治疗脓疱型银屑病明显优于其他两组治疗效果。结论：系统应用糖皮质激素联合维A酸药物可作为泛发性脓疱型银屑病治疗的首选方案。     

Pustulosis acuta generalisata is a post-streptococcal disease and is distinct from acute generalized exanthematous pustulosis

Generalized pustular eruptions with fever present a diagnostic and therapeutic problem. Based on a case of pustulosis acuta generalisata and a review of the literature, this entity can be regarded as an exclusively post-streptococcal disorder with an elevated antistreptolysin litre. It has a distinct clinical presentation of isolated pustules on normal skin, predominantly in an acral location. We propose criteria for the clear separation of this disease from acute generalized exanthematous pustulosis and from pustular psoriasis.     

Manifestation of palmoplantar pustulosis during or after infliximab therapy for plaque-type psoriasis: report on five cases

Infliximab is a monoclonal antibody directed against TNF-α. It has been approved for use in rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease, psoriatic arthritis and plaque-type psoriasis. In case reports, positive effects on pustular variants of psoriasis have also been reported. However, paradoxically, manifestation of pustular psoriasis and plaque-type psoriasis has been reported in patients treated with TNF antagonists including infliximab for other indications. Here, we report on 5 patients with chronic plaque-type psoriasis who developed palmoplantar pustulosis during or after discontinuation of infliximab therapy. In two of the five cases, manifestation of palmoplantar pustulosis was not accompanied by worsening of plaque-type psoriasis. Possibly, site-specific factors or a differential contribution of immunological processes modulated by TNF inhibitors to palmoplantar pustulosis and plaque-type psoriasis may have played a role.     

The profile and outcome of pustular psoriasis in Singapore: a report of 28 cases

Background Pustular psoriasis is a rare form of psoriasis that can be divided into generalized and localized forms. The aim of this study is to describe the patient profile and outcome of pustular psoriasis seen at a tertiary referral skin center in a tropical country. Methods The records of all patients with pustular psoriasis during the 4 years from 1989 to 1993 were reviewed. Diagnostic criteria for selection included at least one episode of either generalized or localized macroscopic noninfective pustulation. Results There were 28 patients with pustular psoriasis, with an age range of 4–77 years. Nineteen patients had generalized pustular psoriasis: Von Zumbusch (seven), annular form (two), juvenile form (six), pustular psoriasis of pregnancy (one), and the localized form of generalized pustular psoriasis (three). Nine patients had localized pustular psoriasis: palmoplantar pustulosis (five) and acrodermatitis continua (four). Patients with the acute Von Zumbusch pattern had recalcitrant disease with multiple flares and significant morbidity and mortality. Patients with the annular form had a subacute onset and a chronic course. In patients with the juvenile form of generalized pustular psoriasis, two patterns could be recognized: Zumbusch form (four) and annular form (two). Despite significant morbidity, each of our young patients had a relatively benign course with no deaths and an excellent response to etretinate therapy. Our nine patients with localized pustular psoriasis all had a chronic course: the average duration of disease was 6 years for patients with palmoplantar pustulosis and 12 years for patients with acrodermatitis continua. Conclusions The pattern of pustular psoriasis seen in Singapore is similar to that reported in the Western literature. Using these categories we can provide guidelines for treatment and prognosis.