二期梅毒误诊3例分析

对本院接诊 3例院外误诊的二期梅毒病人情况详细分析 ,以减少误诊。二期梅毒多以玫瑰疹、毛囊疹、丘疹鳞屑、脓疱疹、溃疡疹、肛周及外生殖器扁平湿疣、虫蚀样脱发、口腔粘膜损害等表现。而以多形性红斑、皮肤白斑为首发症状者少见。二期梅毒皮损具有多样性 ,医生对无明显诱因表现为各种皮损的患者 ,应及时做梅毒血清学检查 ,以防误诊     

二期梅毒4例

4例二期梅毒,临床分别表现为为斑疹性梅毒疹,丘疹性梅毒疹,多形红斑性梅毒性疹和脓疱性梅毒疹。3例经肌注苄星青霉素治疗3次,1例静推头孢曲松钠10天。4例均临床治愈。二期梅毒的皮肤及黏膜损害多样,临床上结合病史,仔细检查,减少误诊。     

二期梅毒鼻部损害四例

［摘要］目的：梅毒是一种常见的性传播疾病, 发生于鼻部的二期梅毒少见, 现将2002年至2010年间伴鼻部损害的二期梅毒4例报告如下。方法：4例患者,男3例,女1例,均有不洁性行为史且为异性恋。4例患者均表现为鼻孔缘及鼻前庭不规则浸润斑块和结节,暗铜红色,表面湿润污秽。部分浸润的结节向鼻腔突起,占鼻腔50％。其它改变包括鼻翼两旁可见淡红色环状肉芽肿样浸润,边缘突起,中央退行。鼻尖处直径约1.5cm孤立圆形暗红色斑块。 鼻部以外损害包括口腔黏膜斑、肛周、脐窝及外阴扁平湿疣、手掌特征性斑丘疹、梅毒性脱发。1例患者腹股沟区皮损组织活检病理改变符合梅毒。实验室检查：RPR和TPHA检查均呈阳性,RPR滴度从1:64至1:128不等。结果：4例患者均诊断为二期梅毒。4例患者均予苄星青霉素,240万U,每周一次,共三次。 治疗后4至6周,鼻部及鼻部以外损害同时缩小、变平至消退。结论： 发生于鼻部的二期梅毒损害较少,应该引起重视,减少误诊和漏诊。伴鼻部损害的二期梅毒患者还可伴有其它少见梅毒损害,应认真查体,避免遗漏。     

二期梅毒误诊为湿疹2例

2例均为女性,皮疹以红斑、丘疹、鳞屑为主要表现,曾误诊为湿疹,经梅毒血清学检查确诊为二期梅毒。     

脓疱性梅毒疹1例

正二期梅毒疹形态多样,其中斑疹最常见,其次是丘疹、斑丘疹和丘疹鳞屑性损害。偶可表现为结节样、银屑病样、脓疱性、环状、湿疹样皮损,或表现为脱发、甲病变、口腔黏膜斑等~([1])。我科诊治1例以手掌部脓疱为主要症状的二期梅毒患者,现报告如下。患者男,49岁。因双手掌脓疱1个月余于2015年4月8日来我科就诊。患者1个月前双手掌出现红斑,后红斑基础上出现脓疱,结痂伴脱屑。患者既往体健,     

银屑病样二期梅毒误诊体会（附3例报告）

我科于1997年发现3例银屑病样二期梅毒误诊为银屑病,现报告如下。1 典型病例 例1女,23岁,工人,未婚。全身皮肤出现丘疹、斑丘疹4个月。无自觉症状,有时皮损可自行消退。1月前皮损数量增多并双     

24例早期梅毒被误诊临床分析

目的 了解早期梅毒误诊情况，探讨误诊原因。方法 对误诊的24例早期梅毒进行临床分析，并进行梅毒血清学检查。结果 一期梅毒易误诊为软下疳、生殖器疱疹、脓皮病等，女性还易误诊为急性女阴溃疡；二期梅毒斑疹及斑丘疹皮损易误诊为过敏性皮炎、玫瑰糠疹等；鳞屑性丘疹易误诊为银屑病；扁平湿疣易误诊为尖锐湿疣等。结论 对早期梅毒采用暗视野梅毒螺旋体(TP)检查和快速血浆反应素环状卡片试验(PPR)，可提高诊断质量，降低误诊几率。     

二期梅毒皮肤组织超微结构的研究

二期梅毒组织学改变与临床表现均具有多样性,并且其诊断与临床体征、组织形态学又有密切联系[1]。为进一步探讨梅毒组织形态学变化过程和损伤机制以及协助诊断,我们对二期梅毒皮肤组织超微结构进行了研究。临床资料　取材于1995年～1997年26例二期梅毒患者,男19例,女7例。年龄20～58岁。皮疹类型:斑疹3例,斑丘疹5例,鳞屑性斑丘疹2例,豆状丘疹5例,肥厚丘疹4例,掌跖角化斑疹1例,扁平湿疣6例。患者血清ＲＰＲ(平均滴度1∶19.79)及ＴＰＨＡ试验(滴度1∶80)均阳性,抗ＨＩＶ初筛试验均阴性。方法　常规取冠状沟、包皮、大阴唇、会阴、腹股沟、肛周…     

外阴、肛周扁平湿疣1例

报告1例以外阴、肛周扁平湿疣为主要临床皮肤表现的二期梅毒。患者女,15岁,因"外阴、肛周多发丘疹伴瘙痒10d,阴道流血2d"就诊,本例患者既往有非婚性生活史。实验室检查:梅毒非特异性血清试验(TRUST)阳性(+),滴度1∶32,梅毒螺旋体颗粒凝集试验(TPPA)阳性。最后诊断:二期梅毒。经头孢曲松钠驱梅治疗10d后,皮损大部分消失。     

以口腔黏膜损害为惟一表现的二期梅毒1例

梅毒是由苍白螺旋体引起的一种慢性性传播疾病.临床上多见一期梅毒硬下疳、二期梅毒皮肤黏膜疹,口腔黏膜的损害也常见到,但常并发二期梅毒皮肤损害,现报告1 例以口腔黏膜损害为惟一表现的二期梅毒.     

Miliary pustular syphilid

A case of secondary syphilis is presented in which a dramatic generalized eruption of pustules and an elevated temperature were prominent features. Biopsy of the skin lesions showed dermal granulomata, which are occasionally seen in the papulopustular lesions of secondary syphilis. The classification of pustular syphilids is reviewed.     

Treponema pallidum in leukoderma syphiliticum demonstrated by electron microscopy

Punch biopsies from syphilitic leukoderma lesions and from unaffected skin in 3 patients with secondary syphilis were studies in the transmission electron microscope. In one of the patients the pigment disorder was not preceded by any visible syphilids, and in the biopsy from the leukodermal skin in this patient Treponemata pallidium were demonstrated around vessels and inside nerve fibres in which the myelin sheaths of the axons showed evidence of degeneration. In the other 2 patients the depigmented areas appeared while macular and papular syphilitic lesions were healing. In the biopsies from the leukodermal lesions of these 2 patients and from unaffected skin of all 3 patients, no treponemes were demonstrated. The study indicates that syphilitic leukoderma is not invariably a post-inflammatory phenomenon, but the pigmented skin lesions may themselves represent stigmata of an active syphilitic infection.     

Secondary Syphilis Mimicking Borderline (BL) Leprosy

A young woman with syphilids resembling borderline lepromatous (BL) leprosy is being described. This is yet another addition to its already well-documented manifestations. The high prevalence of leprosy and syphilis augments the epidemiological significance of the case.     

Early varioliform syphilis. A case report.

A 25-year-old man developed a rare form of early syphilis with smallpox-like eruptions, mainly in the groins and axillae. Histological examination of the syphilids showed an unusual structure with an exceptional number of Treponema pallidum within the epidermis.     

Syphilis: uncommon presentations in adults

The clinical manifestations of syphilis are variable in appearance and have been described for centuries. The disease has been arbitrarily divided mainly into three stages. Uncommon presentations of syphilis in adults include (a) primary syphilis—atypical forms of chancre vary in size, shape, morphology, and color. Small ulcus durum is single or multiple, grouped, or herpetiform. Giant necrotic and phagedenic chancres are resolved with scar formation. In intratriginous areas, ulcus durum is rhagadiform, linear, “rocket type,” or bilateral. (b) Secondary syphilids include macular (roseolas, leukomelanoderma), papular (small miliar or lichenoid, or with large size—lenticular or nummular), papulosquamous, syphilis cornee, psoriasiform, annular en cockade, nodular, condylomata lata, malignant syphilis, and others; there are also mucosal lesions, loss of the hairs, and alteration of the nails. (c) Tertiary syphilis occurs decades after infection in three main forms: gummatous, cardiovascular, and neurosyphilis (asymptomatic, meningeal, meningovascular, and parenchymatous—such as general paresis or tabes dorsalis). Early recognition of the clinical manifestations of syphilis is important for the start of treatment, recovery of patients, and the prevention of the spread of disease.     

Literature mapping: association of microscopic skin microflora and biomarkers with macroscopic skin health

Associations between skin microbes or biomarkers and pathological conditions have been reported in the literature. However, there is a lack of clarity on the interaction between the coexistence of common skin microbes with skin physiology and subsequent development of clinical symptoms, and the role of biomarkers in mediating these changes before the development of skin disease. In this review, we aim to identify areas in which extensive research for the studied factors has already been conducted, and which research areas are under‐represented. The SciFinder database was searched for articles containing key words including specific skin microbes, biomarkers, skin physiology and diseases from the beginning of the SciFinder data record to 26 April 2016, and we included an additional relevant recent publication from our group. Among the 8000 + articles selected, the frequency of keyword pairs between two roles [microscopic markers (microflora or biomarkers) and reactions (skin physiology or clinical symptoms, or skin disease)] was investigated. Associated research between the individual factors such as skin microflora or biomarkers (chosen based on our earlier publication) and specific biophysical parameters, symptoms or skin disease was identified. The present research heatmap emphasizes the significance of a structured review of research on concerned factor associations to identify early/subclinical clues that can be used to prevent progression to overt skin disease with the help of precise skin care or early intervention, as indicated by skin microflora, biomarkers and an interactive skin biophysics profile. The findings provide a novel approach to explore such associations and may guide future research directed towards predicting disease from early/subclinical symptoms.     

颜面部皮肤癌手术方式探讨

目的探讨颜面部皮肤恶性肿瘤的手术治疗方法与面部形态及美容的关系。方法从1998年～2003年对69例颜面部恶性肿瘤,根据病灶的部位和范围,扩大切除后行单纯缝合、游离植皮、局部皮瓣 植皮、皮瓣转移等方法修复创面,并辅以放疗或化疗。结果皮瓣全部成活,皮片有3例表皮坏死,其余全部成活,切口愈合良好。随访6个月～3年,术区外形与功能良好。结论颜面部恶性肿瘤宜早期手术扩大切除,选用适宜的修复方式有助于恢复容貌,并取得较满意的外形及预后。     

盐裂皮肤直接和间接免疫荧光联合应用鉴别诊断表皮下大疱病的研究

本文探讨盐裂皮肤ＤＩＦ和盐裂皮肤ＩＩＦ联合应用鉴别诊断表皮下大疱病的价值。２０例两种盐裂皮肤免疫荧光均阳性的病例比较表明，盐裂皮肤ＩＩＦ示抗基底膜带抗体结合表皮侧或真皮侧与盐裂皮肤ＤＩＦ示免疫反应物（ＩｇＧ、ＩｇＡ、Ｃ＿３等）沉积于表皮例或真皮侧的部位基本一致。提示多数情况下盐裂皮肤ＤＩＦ或ＩＩＦ均可单独用于表皮下大疱病诊断，两者对比分析可以提高诊断率。     

Treatment of hyperpigmentation

Hyperpigmentation is a common dermatologic condition that is seen in all skin types but is most prominent in skin of color. In skin of color, any inflammation or injury to skin can almost immediately be accompanied by alterations in pigmentation, either hyperpigmentation or hypopigmentation. Post-inflammatory hyperpigmentation can be observed in many skin conditions including acne, eczema, and contact dermatitis and treatment can be challenging. The goal is to reduce the hyperpigmentation without causing undesirable hypopigmentation or irritation in the surrounding area. This review will discuss current research on treatments for hyperpigmentation and approaches to treating this condition.     

Mast cell density in psoriatic skin. The effect of PUVA and corticosteroid therapy

Summary Numbers and volume fractions of mast cells in nonlesional and chronic lesional skin of psoriatic patients were compared with those of normal control skin. Mast cell densities were similar in psoriatic nonlesional and normal control skin. The superficial dermis of lesional psoriatic skin contained more mast cells than either normal or nonlesional psoriatic skin. Neither PUVA nor corticosteroid treatment for 3–4 weeks significantly reduced mast cell numbers or volume fractions in lesional skin, although both treatments clinically and histologically markedly improved the lesions. The results indicate that the initiation of the healing process in psoriatic plaques is not correlated with the mast cell density. The remaining high mast cell density may be normalized later, or after a longer therapy.