海普林在多形红斑和结节性红斑治疗中的应用

多形红斑及结节性红斑是皮肤科的常见病和多发病,为了探讨海普林在其外用治疗中的作用,我们应用随机对照的方法对42例多形红斑和36例结节性红斑患者进行治疗观察,现将结果报告如下:     

多形红斑型药疹40例临床分析

目的　分析多形红斑型药疹增多原因,探讨如何提高疗效及减少发生。方法　对 40例多形红斑型药疹致敏药物、临床表现、实验室检查及治疗进行分析。结果　①致敏药物多为青霉素类、解热镇痛类及中药类;②临床常见,重型较多;③以糖皮质激素为主综合治疗,疗效高。结论　多形红斑型药疹增多与多用、滥用及伪劣药品相关;糖皮质激素为主、全身治疗与局部治疗结合能显著提高疗效;规范用药,加强监管能减少其发生。     

静脉注射人免疫球蛋白联合糖皮质激素治疗重症多形红斑型药疹二例

<正>我科使用大剂量静脉注射人免疫球蛋白(IVIG)联合糖皮质激素治疗重症多形红斑型药疹2例。临床资料例1,男,37岁。因周身红斑、水疱伴痒痛3天入院。患者因"感冒"应用阿奇霉素、阿昔洛韦静脉滴注,第2日躯干出现红斑、丘疹、水疱,自觉瘙痒。随后出现水疱或大疱,部分形成糜烂,口腔黏膜出现糜烂,遂入我院。体格检查:T 39.5℃,P 102次/分,R 20次/分,BP 100/60 mmHg,体重85 kg。神     

热型多形红斑及其中药治疗

<正> 作者根据中医辩证论治原则收集了12例热型多形红斑,并用中药(多形红斑热型方)治疗取得较好疗效。临床资料多形红斑12例,男性2例,女性10例:     

系统性红斑狼疮并发带状疱疹原位复发1例

患者女性，２９岁，因面部红斑、四肢关节痛伴脱发４年余入院，确诊为系统性红斑狼疮，予以泼尼松、雷公藤多甙等治疗。治疗第１２天右侧胸部沿第４～６肋间神经分布区域出现红斑，继发展为簇集性水疱，诊断为带状疱疹，经阿昔洛韦等治疗８天后痊愈。患者５年前在同一部位...     

头孢哌酮舒巴坦钠致重症多形红斑型药疹合并肝损害1例

重症多形红斑是一种严重的大疱性多形红斑,伴有严重的全身反应,并有眼、口、生殖器黏膜损害,大部分与药物有关,现临床报道我院收治的由头孢哌酮舒巴坦钠引起的重症多形红斑型合并肝损害1例。     

带状疱疹并大疱性多形红斑1例

1 临床资料 患者女，56岁。2005年3月30日右侧腰骶部疼痛，且出现红斑、片状匠疱疹、水疱，以“带状疱疹”内服阿昔洛韦片、肌注维生素B。静滴先锋霉素IV（具体方法用量不详）等治疗，皮疹好转，部分结痂。同年4月7日原皮疹尚未痊愈之际，突感全身不适，发热，耶7．6℃，膝踝关节疼痛，相继面部、上眼睑、睑缘及上下口唇出现丘疱疹、小水疱。背部和四肢散在分布水肿性红斑丘疹及大小不一水疱，踝关节周围夹杂有紫癜样皮疹，轻痒，以“多形红斑”收住院。否认药敏史。     

带状疱疹后银屑病同位反应1例及文献回顾

<正>1临床资料患者男,43岁。腰腹部左侧红斑、丘疹伴脱屑1个月。3个月前劳累后腰腹部左侧出现多片群集性红斑、水疱,单侧分布,沿肋间神经走向带状分布,伴针刺样疼痛,当地医院按"带状疱疹"给予"阿昔洛韦片、加巴喷丁胶囊、腺苷辅酶B12片、阿昔洛韦软膏"等治疗7d后疼痛缓解,水疱渐吸收、结痂脱落,3周后痊愈,遗留红褐色斑。1个月前,无明显原因相同部位出现点片状红斑、丘疹,上覆少量灰白色鳞屑,伴轻微瘙痒。当地按"皮     

阿达木单抗联合丙种球蛋白治疗HSV相关性慢性复发性多形红斑一例

本文报道种球蛋白联合阿达木单抗治疗单纯疱疹病毒(HSV)相关的复发性多形红斑1例并复习相关文献。患儿,男,9岁。口唇反复糜烂、渗出15个月,全身反复红斑8个月。皮肤科查体:口唇糜烂,背部、四肢散在暗红色斑片,局部周边可见松弛水疱。病理检查符合多形红斑,单纯疱疹病毒I型IgG滴度444.72 RU/mL。诊断为单纯疱疹病毒感染相关多形红斑,给予伐昔洛韦抗病毒治疗的同时,给予阿达木单抗联合人免疫球蛋白治疗,2周后皮损消退,单纯疱疹病毒I型IgG滴度明显下降。     

单纯疱疹病毒DNA在多形红斑皮损中的表达

应用聚合酶链式反应方法，对26例多形红斑组织中的单纯疱疹病毒DNA进行检测。18例为阳性，阳性率为72％，对照组选择结节性红斑11例，固定性药疹8例，均为阴性。结果对研究单纯疱疹病毒在多形红斑发病中的意义和临床治疗有指导价值。     

Oral acyclovir for the prevention of herpes-associated erythema multiforme

Herpes simplex virus is the single most common precipitator of erythema multiforme. Typically, erythema multiforme lesions appear 10 to 14 days after a recurrent herpes simplex virus infection and attacks can be disabling when they occur at frequent intervals. Prior to the introduction of acyclovir (Zovirax), there was no effective therapy to prevent herpes-associated erythema multiforme. Four patients were treated with a maintenance dose of acyclovir for periods ranging from 10 to 26 months; there were no significant side effects from the drug and only one recurrence of erythema multiforme. Oral acyclovir may become the treatment of choice for herpes-associated erythema multiforme.     

Oral acyclovir prevents herpes simplex virus-associated erythema multiforme

A young woman suffering from recurrent erythema multiforme associated with relapsing gluteal herpes simplex is presented, in whom long-term treatment with oral acyclovir prevented herpes episodes as well as erythema multiforme.     

Identification of herpes simplex virus DNA in lesions of erythema multiforme by the polymerase chain reaction.

An association between erythema multiforme and herpes simplex virus infection has been supported by clinical studies and by the detection by immunofluorescence of herpes viral antigen in sera and skin biopsy specimens of patients with erythema multiforme. In rare cases, the virus has also been isolated in cultures of skin biopsy specimens of erythema multiforme. To investigate further the association between erythema multiforme and herpes simplex virus, we used the polymerase chain reaction for herpes simplex virus to examine skin lesions from patients with erythema multiforme. In this study herpes simplex virus DNA was detected in 11 of 31 biopsy specimens of erythema multiforme; six additional cases showed equivocal amplification results, which is suggestive of low amounts of viral DNA. Seven skin and mucosal biopsy specimens with the histologic changes of herpes virus infection served as positive controls: all were positive for herpes simplex virus DNA. Viral DNA was not detected in control biopsy specimens from skin excised for unrelated conditions. These studies support the association of herpes simplex virus in the pathogenesis of some cases of erythema multiforme. The polymerase chain reaction provides a quick and effective method of detecting herpes simplex virus in lesions of herpes-associated erythema multiforme. Furthermore, the polymerase chain reaction may delineate those cases of erythema multiforme that are etiologically related to herpes virus infection and therefore might be treated with acyclovir to prevent recurrence.     

A Case of Herpes-associated Erythema Multiforme in a Japanese Child

A case of a five-year-old Japanese boy with herpes-associated erythema multiforme (HAEM) was reported. The patient had eleven recurrences of herpes labiaris within one year; four of these recurrences were accompanied by erythema multiforme. A study of the human leukocyte antigens revealed the presence of HLA-DQW3, which has been reported to be significantly frequent in Caucasian patients with HAEM. Oral administration of acyclovir at the onset of herpes labialis was effective in preventing HAEM. Early administration of oral steroids at the onset of HAEM also prevented its exacerbation.     

A double-blind, placebo-controlled trial of continuous acyclovir therapy in recurrent erythema multiforme

Twenty patients who suffered from more than four attacks of erythema multiforme (EM) per year were enrolled in a 6-month double-blind, placebo-controlled trial of acyclovir 400 mg twice daily. Fifteen patients had disease precipitated by recurrent herpes simplex. In the acyclovir-treated group the median number of EM attacks during the treatment period was zero, compared with three in the placebo-treated group (P < 0.0005, Wilcoxon rank sum test). Seven of the 11 patients treated with continuous acyclovir did not have any attacks of EM while taking the drug, and one showed almost complete disease suppression. Following treatment with acyclovir, two patients went into complete remission, whereas all individuals in the placebo group continued to have attacks. In the acyclovir-treated group nine of the 11 patients had herpes simplex-precipitated disease. One of the two patients with idiopathic disease showed complete disease suppression while on acyclovir, lending support to the view that idiopathic recurrent EM may be related to subclinical herpetic infection. In this study, we have shown that continuous acyclovir therapy can completely suppress attacks of recurrent EM and, in some cases, may induce disease remission.     

Persistent Erythema Multiforme Treated with Thalidomide

Erythema multiforme is a common self-limited disorder that predominantly affects younger individuals. It is characterized by typical iris or target lesions on the skin and mucous membranes. Three clinical subgroups of erythema multiforme have been identified: classical erythema multiforme, recurrent erythema multiforme, and persistent erythema multiforme. By definition, persistent erythema multiforme is characterized by the occurrence of continuous typical and atypical lesions without interruption. We report a 15-year-old boy who developed persistent erythema multiforme for 6 months and responded to treatment with thalidomide.     

Erythema multiforme due to Mycoplasma pneumoniae infection in two children

Mycoplasma pneumoniae is an important and highly relevant cause of bullous erythema multiforme, isolated mucositis, and Stevens-Johnson syndrome in children. In this article, we present two children with respiratory Mycoplasma pneumoniae infection and associated cutaneous findings within the spectrum of erythema multiforme. We review the literature associating these three entities with Mycoplasma pneumoniae infection and discuss controversies regarding the classification of erythema multiforme, as well as update reported infectious causes of the bullous form. Many understand the erythema multiforme spectrum to include bullous erythema multiforme, mucositis, and Stevens-Johnson syndrome in the order of increasing severity. We feel that this relationship should be reconsidered to help better understand the prognosis and outcomes. It is our opinion that bullous erythema multiforme is a separate, yet related condition that can occur in the context of Mycoplasma pneumoniae infection. With many similarities to mucositis and Stevens-Johnson syndrome, bullous erythema multiforme can be considered part of a spectrum of disease that includes Stevens-Johnson syndrome. Unlike mucositis and Stevens-Johnson syndrome, bullous erythema multiforme caused by Mycoplasma pneumoniae infection has low morbidity for the child. Mycoplasma pneumoniae-associated mucositis and Stevens-Johnson syndrome seem to occur along a spectrum with separate prognosis and potential pathogenesis compared with bullous erythema multiforme. Making the distinction between these conditions is valuable for predicting the child's prognosis. Patients who develop symptoms consistent with these conditions should be appropriately evaluated for Mycoplasma pneumoniae infection and closely monitored.     

Recurrent and continuous erythema multiforme– a clinical and immunological study

A series of 26 patients with recurrent erythema multiforme was studied. A distinct clinical and immunological subgroup was found called ‘continuous erythema multiforme’ characterized by the presence of atypical lesions in addition to typical lesions, both of which occur continuously and a high level of circulating immune complexes with low levels of haemolytic complement. Herpes labialis preceded erythema multiforme in 17 of the 26 patients (65%) but in no cases could live virus be isolated from the lesions of erythema multiforme. Circulating immune complexes were found in 50 of 129 sera, being found in only 18 % sera between attacks and more commonly in the first 24 h of erythema multiforme lesions (58%). Immunological studies failed to provide conclusive evidence that erythema multiforme is solely immune complex mediated.     

Recurrent erythema multiforme: clinical features and treatment in a large series of patients

Recurrent erythema multiforme is an uncommon disorder. We have reviewed the clinical features and treatment of 65 patients with this condition. The mean number of attacks per year was six (range 2–24). and the mean duration of the disease was 9.5 years (range 2–36) reflecting its chronicity. The majority of patients had oral mucous membrane involvement (69%). In 46 patients (71%) the condition was precipitated by a preceding herpes simplex virus infection. Acyclovir was found to be the most useful first-line treatment, with 55% of patients deriving benefit from either continuous oral acyclovir or a patient-initiated 5-day oral course at the onset of herpes simplex virus infection. Of those failing to respond to acyclovir, a small proportion responded to dapsone. The most resistant patients (11) were treated with azathioprine. with complete disease suppression in all cases.