糖皮质激素联合免疫球蛋白治疗中毒性表皮坏死松解症15例疗效观察

目的:探讨糖皮质激素联合静脉注射免疫球蛋白(IVIG)治疗中毒性表皮坏死松解症(TEN)的临床疗效、不良反应和转归。方法:回顾性分析15例TEN患者采用糖皮质激素联合免疫球蛋白治疗的临床资料。结果:15例TEN患者均伴有黏膜糜烂,皮损(表皮已剥脱或即将剥脱)面积占体表面积的(19.40±6.51)％;糖皮质激素用量(以泼尼松为标准量):(1.5～2.0)mg/(kg·d);IVIG用量:(0.2～0.4)g/(kg·d),连续用药(6.0±1.3)d。联合用药第(3.0±1.3)天开始起效,痊愈9例,共治疗(23.60±5.49)d;基本痊愈5例,共治疗(16.70±3.14)d;死亡1例。所有患者均可耐受IVIG治疗。结论:糖皮质激素联合IVIG治疗TEN具有协同作用,可明显提高疗效和减少死亡,减少糖皮质激素引起的不良反应。     

静脉注射丙种球蛋白辅助治疗系统性红斑狼疮6例

目的观察静脉注射丙种球蛋白(IVIG)辅助治疗系统性红斑狼疮(SLE)疗效。方法应用皮质类固醇激素为强的松当量1~2mg/(kg·d),同时给予IVIG,400mg/(kg·d),第1次连续3~5天给药,以后每月1次,连续5个月,比较治疗前后临床症状及缓解时间、化验指标改善等情况。结果IVIG辅助治疗SLE,与对照组比较,疗后SLEDAI积分明显下降,且迅速缓解临床症状。长期随诊观察,IVIG治疗有利于激素平稳减量,并且对于激素治疗后病情复发者再次应用有效。结论采用IVIG辅助治疗SLE6例效果较好,临床症状及化验指标改善较快。     

半标准大剂量静脉注射用人免疫球蛋白治疗皮肤病13例临床疗效观察

目的:探讨半标准大剂量静脉注射用人免疫球蛋白(IVIG)疗法治疗皮肤病的疗效和安全性。方法:对13例大疱性皮病、重症药疹及重症皮肌炎患者采用糖皮质激素和免疫抑制剂治疗病情改善不明显时,给予(IVIG)0.2g/(kg·d),连续应用3～5d,疗效不满意者,再用同样剂量治疗3～5d。结果:12例患者获得满意疗效,治疗中未见不良反应。结论:半标准大剂量IVIG治疗皮肤病安全有效。     

表皮坏死型药疹住院患者50例临床分析

目的探讨表皮坏死型药疹的临床特点,为科学防治提供借鉴。方法对确诊为表皮坏死型药疹的50例患者临床资料进行回顾性分析。结果 50例患者中,致敏药物包括卡马西平、别嘌呤醇和拉莫三嗪、解热镇痛类药物、抗菌药物、某些中药制剂,以及三氯乙烯和醋甲唑胺等;卡马西平、别嘌呤醇、拉莫三嗪、三氯乙烯诱发的表皮坏死型药疹,其潜伏期相对较长;36例既往没有明确的药敏史;32例患者有不同程度发热,13例有浅表淋巴结肿大;入院时20例皮损表现是Stevens-Johnson综合征(SJS),20例是中毒性表皮坏死松解症(TEN),10例入院后由SJS发展为TEN,16例有肝损,10例有肾损,6例出现血液嗜酸性粒细胞(EOS)增多;48例均及早使用大剂量皮质类固醇激素控制病情,36例在入院早期即同时使用了大剂量静脉用免疫球蛋白(IVIG)。50例病情均得到有效控制,但病程反复迁延不一,15例出现严重的二重感染,住院时间4~51d,平均19.78d。结论表皮坏死型药疹虽然危重,但是只要早期确诊、及时停用致敏药物,积极有效救治,包括早期足量大剂量皮质类固醇激素,必要时辅助大剂量IVIG、防治可能的二重感染等措施,本型药疹是可以得到有效控制的。     

细菌性皮肤病

20120806免疫球蛋白治疗中毒性表皮坏死松解症疗效分析/付文静(滨州医学院附院皮肤性病科),张莉,金德蕙…∥中国麻风皮肤病杂志.-2011,27(2).-138～139回顾性分析12例中毒性表皮坏死松解症(TEN)患者临床资料,从发病之日至应用免疫球蛋白(IVIG)时间为3～30d,仅2例患者中途停止。分析结果认     

25例中毒性表皮坏死松解症住院患者治疗的回顾与分析

目的介绍中毒性表皮坏死松解症(TEN)这种高死亡率药疹的临床表现和治疗方法。方法分析2008年8月—2012年10月本科收入院治疗的25例TEN患者的临床特征、预后因素及治疗。结果所有病例都由药物引起。抗生素为最常见的原因,其他有抗癫痫类药物、卡马西平、别嘌呤醇和非甾体抗炎药物。败血症是最常见的并发症,其次是肝和肾功能损伤。入院后均给予糖皮质激素治疗(以强的松计算)1~1.5 mg/(kg·d),并给予静脉注射用人免疫球蛋白(IVIG)600~800 mg/(kg·d)静脉滴注4~7 d。血浆置换术联合激素治疗伴有肿瘤的2例患者。除了SCORTEN评分较高的患者死亡,其他患者均治愈。结论 TEN患者的预后与其SCORTEN评分有关。新的治疗方法对今后TEN的治疗有很大的帮助。     

注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白联合甲泼尼龙治疗中毒性表皮坏死松解症5例

目的探讨注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白联合甲泼尼龙在中毒性表皮坏死松解症(TEN)治疗中的作用。方法回顾性分析本科收住院的5例药物引起的TEN患者的临床资料,分析其采用注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白联合甲泼尼龙治疗的效果及预后。结果 5例患者均痊愈。例1先静脉滴注甲泼尼龙80 mg/d,皮疹仍加重,第3天皮下注射注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白50 mg,皮疹渐好转;例2先皮下注射50 mg注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白1次,皮疹仍进展,第2天静脉滴注甲泼尼龙250 mg/d,皮疹渐好转;例3、4、5皮下注射注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白50 mg,2次/周(共3次),前3 d联合静脉滴注甲泼尼龙250 mg/d,后甲泼尼龙快速减量,皮损明显好转。结论单独应用注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白或甲泼尼龙治疗TEN疗效不佳时,联合用药有助于控制病情,治疗早期联合用药可能有助于增强治疗效果。     

人免疫球蛋白和重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗中毒性表皮坏死松解症的对比研究

目的:评价静脉注射人免疫球蛋白（IVIG）及重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白（rhTNFR：Fc）治疗中毒性表皮坏死松解症（TEN）的疗效。方法:收集2013—2019年武汉市第一医院使用IVIG及rhTNFR：Fc治疗的TEN患者资料。IVIG组11例,男3例,女8例,年龄25 ~ 72岁,中位TEN疾病严重...     

康复新液治疗中毒性表皮坏死松解型药疹17例临床分析

目的探讨康复新液对中毒性表皮坏死松解型药疹(TEN)患者的有效性及安全性。方法收集2014年11月—2018年12月铜川市人民医院皮肤科收治的TEN患者17例,在常规治疗基础上,加用康复新液10 mL,3次/d口服,并使用康复新液对皮肤黏膜糜烂面进行外敷,3次/d,治疗至皮损干燥、结痂。观察临床疗效及不良反应。结果经上述治疗后患者皮肤及黏膜皮损恢复较好,所有患者未发现不良反应。结论康复新液治疗TEN,疗效显著,安全性好。     

中毒性表皮坏死松解症与复方新诺明

本文报告2例死于中毒性表皮坏死松解症(TEN)的老年病例,其TEN发生于短期用复方新诺明治疗后。例1男,79岁,因术后尿路感染服用复方新诺明。服2次(4片)后出现发热及泛发性红斑,接着发生严重的水疱(TEN)。皮损累及体表面积的50％。首次服药后第10天患者死亡。18年前患者曾用复方新诺明治疗过顽固性前列腺炎,无不良反应。例2男,86岁,因慢性支气管炎加剧入院。由于对青霉素过敏,用红霉素疗效欠佳而改服复方新诺明。服药3次(6片)后,发生泛     

Dermatology in private practice in France in 2000

OBJECTIVES: Data regarding French dermatological practice are scarce. Our objective was to identify the skin disorders most commonly diagnosed by office-based dermatologists. We also documented the severity of these skin disorders, as reflected by the repercussions on patient's everyday life, and the way physicians managed patients. DESIGN: We carried out a one-day survey of visits to a randomly selected sample of 900 French office-based dermatologists. The randomization was stratified according to the five French different dialing area codes. RESULTS: Office-based dermatologists saw 6411 patients with 7839 skin disorders during the survey. The daily number of visits to French dermatologists was estimated at 47 000 and the annual number between 12 and 14 millions. Office-based dermatologists mostly managed warts, acne, nevus, dermatitis, malignancies and pre-malignancies, fungal infection and psoriasis. Repercussions on patients'everyday life were assessed by physicians as important or very important in 28 p. 100 of cases. Half of the patients received topical treatment, 20.5 p. 100 a systemic drug and 40 p. 100 a minor surgical procedure (including cryotherapy). CONCLUSION: Although dermatologists frequently see benign skin disorders such as warts or nevus, more severe diseases represent an important part of their activity.     

Decrease in neutrophils observed in vivo in psoriatics after PUVA therapy

Summary In 56 patients leucocyte and differential counts were done before and at weekly intervals during PUVA treatment of chronic recalcitrant psoriasis. A statistical significant (P<0.01) decrease in the percentage of neutrophils was observed during the first week of the PUVA therapy. This observation could be closely related to the clinical clearing of psoriasis (P=0.02).The effect of PUVA therapy in psoriasis may be due to a decrease in the number of immunocompetent neutrophils demonstrated in psoriatic lesions.     

37例麻风患者的家庭集聚性调查分析

目的:明确麻风家庭感染者的发病情况。方法:利用全国麻风病防治信息管理系统(LEPMIS)数据库,描述性分析麻风家庭感染者的发病情况。结果:符合条件的共17户家庭37例麻风患者,其中多菌型患者33例,少菌型4例;密切接触5年内发病4例(10.81%),5~10年发病者11例(29.73%),超过10年发病者13例(35.14%),不明时间者9例(24.32%);其中因父母子女关系感染17例(45.95%)、祖孙关系5例(13.51%)、兄弟关系2例(5.41%)。结论:多菌型麻风是家庭传染者的主要传染源。     

Progress in Malassezia Research in Korea

Yeasts of the genus Malassezia are part of the normal flora of human skin. However, they are also associated with various skin diseases. Since the introduction of Malassezia to the Korean Dermatologic Society two decades ago, remarkable progress has been made in our knowledge of this genus. In this paper, we review recent developments in Malassezia research, including taxonomy and methods for species identification, recent genome analyses, Malassezia species distribution in healthy conditions and in specific skin diseases, trials investigating the mechanisms underlying Malassezia-related diseases, as well as therapeutic options. This review will enhance our understanding of Malassezia yeasts and related skin diseases in Korea.     

Hard cornification in reptilian epidermis in comparison to cornification in mammalian epidermis

The structure of reptilian hard (beta)-keratins, their nucleotide and amino acid sequence, and the organization of their genes are presented. These 13-19 kDa proteins are basic, rich in glycine, proline and serine, and different from cytokeratins. Their mRNAs are expressed in beta-cells. The central part of beta-keratins (this region has been previously termed 'core-box' and is peculiar of all sauropsid proteins) is composed of two beta-folded regions and shows a high identity with avian beta-keratins. This central part present in all beta-keratins, including feather keratins, is the site of polymerization to build the framework of beta-keratin filaments. Beta-keratins appear cytokeratin-associated proteins. Their central region might have originated in an ancestral glycine-rich protein present in stem reptiles from which beta-keratins evolved and diversified into reptiles and birds. Stem reptiles of the Carboniferous period might have possessed glycine-rich proteins derived from exons/domains corresponding to the variable, glycine-rich region of cytokeratins. Beta-keratins might have derived from a gene coding for small glycine-rich keratin-associated proteins. The glycine-rich regions evolved differently in the lineage leading to modern reptiles and birds versus that leading to mammals. In the reptilian lineage some amino acid regions produced by point mutations and amino acid changes might have given rise to originate the central beta-pleated region. The latter allowed the formation of filamentous proteins (beta-keratins) associated with intermediate filament keratins and replaced them in beta-keratin cells. In the mammalian lineage no beta-pleated region was generated in their matrix proteins, the glycine-rich keratin-associated proteins. The latter evolved as glycine-tyrosine-rich, sulphur-rich, and ultra-sulphur-rich proteins that are used for building hairs, horns and nails.     

Experimental approaches to lymphocyte migration in dermatology in vitro and in vivo

Lymphocyte trafficking through the dermal compartment is part of the physiological surveillance process of the adaptive immune system. On the other hand, persistent or recurrent lymphocyte infiltrates are hallmarks of both types of chronic inflammatory skin diseases, Th1-type such as psoriasis or Th2/allergic-type like atopic dermatitis. A better understanding of the mechanisms underlying lymphocyte movements is one of the key prerequisites for developing more effective therapies. In this review, we introduce a range of simple-to-sophisticated experimental in vitro and in vivo approaches to analyze lymphocyte migration. These methods start from static in vitro adhesion and chemotaxis assays, include dynamic endothelial flow chamber, intravital dual photon, and transcutaneous live-video microscopy, and finally encompass specific genetically deficient or engineered animal models. Discussing pros and cons of these assay systems hopefully generates both state-of-the-art knowledge about the factors involved in most common chronic skin diseases as well as an improved understanding of the limitations and chances of new biologic pharmaceuticals that are currently introduced into clinical practice.     

Dermatoses in cement workers in southern Taiwan

Construction workers are known to have occupational dermatoses. The prevalence of such dermatoses was unknown in Taiwanese construction workers. The objective of this study was to determine the work exposure, prevalence of skin manifestations, and sensitivity to common contact allergens in cement workers of southern Taiwan. A total of 1147 current regular cement workers were telephone-interviewed about skin problems during the past 12 months, work exposure, and personal protection. Among those interviewed, 166 were examined and patch tested with common contact allergens. A high % of cement workers reported skin problems in the past 12 months. More men (13.9%) reported skin problems possibly related to work than women (5.4%). Prevalence was associated with lower use of gloves, duration of work as cement worker, and more time in jobs involving direct manual handling of cement, especially tiling. A high % of dermatitis was noted in the 166 workers examined, which correlated with reported skin problems. On patch testing, construction workers had a high frequency of sensitivity to chromate. Sensitivity to chromate or cobalt was associated with reported skin problems, or dorsal hand dermatitis on examination. These workers'dermatitis was under-diagnosed and inadequately managed. It is concluded that cement workers in southern Taiwan had a high prevalence of skin problems related to cement use. Protective measures, work practice, and physician education should be improved to prevent or manage such problems.