皮肤假性血管炎

皮肤假性血管炎以血栓形成和血管壁损伤为主,没有免疫反应参与.该文简述该病的概念、分类和治疗情况.     

以皮肤假性血管炎为突出表现的SLE一例

患者女,49岁,因四肢关节疼痛12年、脱发12个月、下肢青斑8个月、疼痛1个月于2010年12月来本院就诊.患者12年前无明显诱因出现四肢关节疼痛,对称性分布,累及大关节,有时有近端指间关节和膝关节肿胀,伴晨僵,约半小时可自行缓解,关节肿痛及晨僵持续时间不超过6周.当地医院考虑类风湿性关节炎,治疗情况不详,关节仍时有疼痛.12个月前出现弥漫性脱发,头皮无油屑.     

皮肤假性血管炎北大核心CSCD

血管炎是指组织病理学上血管壁及其周围组织的炎症性改变,主要的病理学特征包括血管内皮肿胀、红细胞外溢、血管壁及其周围有纤维蛋白样物质沉积及炎细胞浸润,严重者有血栓形成甚至整个血管的破坏。     

皮肤坏死性血管炎

皮肤坏死性血管炎是由一大组皮肤损害所组成的系列临床病变。一些偶然因素可能是本病的病因,它可以与系统性疾病伴发,但有50％病因不明。主要表现为可触及的紫癜及其它的皮肤损害,呈急性、亚急性或慢性病程。组织学上有两种表现:白细胞碎裂型和淋巴细胞型。提示了两种不同的发病机理:免疫复合物介导的和细胞介导的免疫反应机理。一些因素与发病机理有关:粘附因子、纤维蛋白溶解系统、神经肽、血管紧张性、免疫因子及γ/δT细胞。实验室检查的目的在于明确诊断和明确致病因素,治疗时应尽可能消除致病因素。     

以皮肤假性血管炎为突出表现的SLE一例北大核心CSCD

患者女,49岁,因四肢关节疼痛12年、脱发12个月、下肢青斑8个月、疼痛1个月于2010年12月来本院就诊。患者12年前无明显诱因出现四肢关节疼痛．对称性分布,累及大关节,有时有近端指间关节和膝关节肿胀,     

原发性皮肤小血管炎

皮肤白细胞碎裂性血管炎（LCV）在病理上表现为毛细血管后小静脉周围中性粒细胞浸润、血管壁及其周围纤维素沉积、内皮肿胀及红细胞外溢。大多数LCV与系统性炎症性疾病、恶性肿瘤、感染及药物过敏有关，但有30％～60％的皮肤LCV患者仅出现皮肤损害而无其他器官病变，称之为原发性皮肤小血管炎（primary cutaneous small vessel vasculitis，PCSVV）。这是一种病理概念，而非临床诊断，指累及毛细血管后小静脉的白细胞碎裂性血管炎，损害仅限于皮肤，而无皮肤外器官受累，这组疾病包括单纯型过敏性紫癜、持久隆起红斑、坏疽性脓皮病、原发性月乍肝炎病毒C相关性混合性冷球蛋白血症、正常补体性荨麻疹性血管炎、过敏性血管炎、幼儿急性出血性水肿。     

皮肤坏死性血管炎

皮肤坏死性血管剡由一大组皮肤损害所组成的系列临床病变。一些偶然因素可能是本病的病因，它可以与系统性疾病伴发，但有５０％病因不明，主要表现为可触及的紫癜及其它的皮肤损害，呈急性、亚急性或慢性病程。组织学上有两种表现；白细胞型和淋巴细胞型。提示了两种不同的发病机理；免疫复合物介导的和细胞介导的免疫反应机理。一些因素与发病机理有关；粘附因子、纤维蛋白溶解系统、神经肽、血管紧张性、免疫历子及γ／δＴ细胞。     

皮肤血管炎治疗现状

及时去除病因,如停用可疑的药物,治疗相关疾病,消除感染病灶。急性和亚急性过敏性血管炎的病因治疗有相当重要价值,如一些病例在成功地去除牙周脓肿后,紫癜和坏死性损害迅速消退。多数血管炎还应注意保暖和休息,过敏性紫癜并无特别的治疗方法,最好的方法就是休息。     

皮肤假性淋巴瘤

报告皮肤假性淋巴瘤1例。患者女,51岁。左上臂电疗仪治疗后局部出现丘疹、结节,并迅速增大,皮损组织病理检查提示淋巴细胞浸润,滤泡生发中心增殖,伴大量组织细胞反应及浆细胞浸润。免疫组化染色结果示滤泡中心CD20、CD79α阳性,滤泡外周CD45RO、CD3阳性。诊断:皮肤假性淋巴瘤。     

皮肤血管炎的病因学

皮肤血管炎的病因学比较复杂，受累血管的大小不同其病因也不一样。1主要累及小血管的血管炎包括皮肤白细胞碎裂性血管炎、过敏性紫癜、荨麻疹性血管炎、持久性隆起性红斑等。其中最常见是白细胞碎裂性血管炎，此为病理学诊断名称，即为皮肤小血管炎。本病是一组由多种因素（感染、药物及伴随的免疫损伤和疾病等）引起的以中性粒细胞为主、以白细胞碎裂为特征的小血管性血管炎，主要侵犯皮肤小静脉。诱发本病的因素有：①感染，包括病毒（如甲、乙、丙型肝炎病毒、单纯疱疹病毒和流感病毒）、细菌（如溶血性链球菌、金黄色葡萄球菌、麻风杆菌、结核杆菌等）、白念珠菌、支原体、衣原体等，约占15％-20％。②药物，包括胰岛素、青霉素、磺胺、喹诺酮类药物、非甾体类抗炎药、避孕药、抗流感疫苗等，约占10％～15％。③全身炎症性皮肤病，包括系统性红斑狼疮、类风湿性关节炎、干燥综合征、炎症性肠病等，约占15％～20％。④恶性肿瘤，如淋巴增生性疾病及内脏实质性肿瘤等，约占2％～5％。其余原因不明者为特发性，约占45％～55％。     

Cutaneous pseudovasculitis

Cutaneous pseudovasculitis represents a heterogeneous collection of disorders that are capable of simulating cutaneous vasculitis and can be broadly classified into diseases that produce hemorrhage (petechiae, purpura, and ecchymoses) or vessel occlusion with resultant livedo, cyanosis, ulcers, digital necrosis, and/or gangrene. Overlap is not uncommon, but if present, one mechanism dominates. Hemorrhagic pseudovasculitis is due to vessel wall dysfunction (incompetence), which can be related to diverse factors that include vessel wall deposition of metabolic substances (amyloid, calcium), nutritional deficiencies (scurvy), nonvasculitic inflammatory purpura (pigmented purpuric dermatitis, arthropod, viral and drug reactions), degeneration of the vessel wall and supporting stroma (senile/solar purpura), direct vessel wall invasion of infective organisms, coagulation-fibrinolytic disorders (eg, thrombocytopenia), and vessel wall trauma. Cyanotic-infarctive pseudovasculitis is due vaso-occlusion by emboli, thrombi, or fibrointimal hyperplasia (endarteritis obliterans) and includes varied conditions such as purpura fulminans, Coumadin necrosis, antiphospholipid antibody syndrome, cardiac myxoma, cholesterol embolization, calciphylaxis, and radiation arteritis. Delayed and inappropriate diagnosis of pseudovasculitis leads to incorrect management and exposure to potentially deleterious treatment modalities such as corticosteroids and cytotoxic agents. The diagnosis of a pseudovasculitic disorder requires a high index of suspicion and should always be part of the differential diagnosis of vasculitis. Skin biopsy is a crucial step in differentiating pseudovasculitis from authentic vasculitis; absence of histologic evidence of vasculitis, particularly after multiple biopsies, should direct evaluation and diagnosis towards pseudovasculitis.     

Cutaneous Melanoma

Cutaneous melanoma is an enigmatic cancer with good survival rates with management at an early stage, i.e. thin superficial lesions localized to the primary site. However, once it becomes deeply invasive with evidence of metastasis, it is one of the most aggressive and lethal cancers. Many investigations have been done and are being conducted in the areas of prevention, (identification and removal of precursor lesions, sun avoidance and use of sun screen preparations), diagnosis (monoclonal antibodies, tumour markers) and therapy (immunotherapy, hyperthermic perfusion and randomized clinical trials. From the Royal Victoria Hospital, Montreal, Quebec, personal experiences with the use of a Levamisole/Placebo — double blind randomized clinical trial for Stage I Melanoma patients is presented. The results of another trial of combination chemoimmunotherapy utilizing BCG/DTIC and/or CCNU for Stage II patients is discussed. Experimental studies into the lymphocytic reaction of lymph nodes draining a primary melanoma site have been initiated and changes in the number of T cells and B cells in the lymph nodes have been noted, reflecting some systemic changes in the host. A prospective randomized surgical protocal on cutaneous melanoma of intermediate thickness (1 to 4 mm) is underway to determine whether a conservative local excision is sufficient and whether involved regional nodes are an indicator and not an instigator of further disease (Intergroup Melanoma Study). Hyperthermic limb perfusion as a therapeutic modality has still to be proven as a useful procedure in the management of melanoma. A clinical trial is urgently required. Increasing public and professional awareness coupled with pertinent clinical and basic research into various aspects of this disease make the future of the patient with melanoma not as black as it seems!     

皮肤血管肉瘤

皮肤血管肉瘤是一种来源于血管或淋巴管内皮细胞的恶性软组织肉瘤.该病罕见,常发生于老年人头面部,其他部位则多与放疗或慢性淋巴水肿有关.该病临床表现和组织学形态多变,容易误诊.治疗方面,该病具有高度侵袭性,容易复发和转移,且发病机制不清,目前尚缺乏有效的治疗方式.对于早期患者,手术联合放疗为主要的治疗方式.对于局部进展和发生转移的患者,目前多采用细胞毒化疗.然而,患者的长期预后依然不理想.近年来,有部分学者开始研究该病的分子机制,并探索相关的靶向治疗.     

皮肤假性淋巴瘤的研究进展

皮肤假性淋巴瘤系指临床表现或组织病理类似恶性淋巴瘤,但又不满足恶性淋巴瘤诊断标准的一组淋巴细胞增生性病变.根据皮损中浸润淋巴细胞的主要类型,可分为皮肤B细胞假性淋巴瘤和皮肤T细胞假性淋巴瘤.临床表现多样,通常为红色斑块、丘疹或结节,头颈部多见.部分皮损有自愈性和复发性.组织学上可见淋巴细胞浸润,一般呈多克隆增生,但易与其他恶性疾病混淆.皮肤假性淋巴瘤尚无特效治疗方法,目前的治疗包括手术切除、光动力疗法、干扰素等,但可能复发.本病预后良好,但有转变为恶性淋巴瘤的可能,需要长期随访.     

Cutaneous ectoparasites

Parasites inhabit many places in the world. Some of these can inhabit the human skin or body. Many of these have been eradicated in the developed countries but persist in some tropical environments that are fun places to visit. Visitors can bring such parasites home with them such as scabies, cutaneous larva migrans, tungiasis and myiasis. Their clinical manifestations and treatment are presented for physicians evaluating and treating travelers from exotic places.     

皮肤结核病研究进展

【摘要】 皮肤结核病由结核杆菌复合群引起,临床表现因感染途径、宿主免疫力等因素差异而呈多样性。传统的实验室诊断方法如抗酸染色直接镜检、培养、病理检查等在皮肤结核诊断和治疗中起重要作用,近年来以核酸扩增技术为代表的系列检测技术的发展为其临床精准诊断和治疗提供了重要保障。本文将综述皮肤结核病的病因与发病机制、临床表现、实验室检查和治疗进展。     

Cutaneous melioidosis

Melioidosis is an infection caused by the gram-negative bacterium Burkholderia pseudomallei. This disease is endemic in Southeast Asia and North Australia with sporadic occurrence in temperate countries, mostly imported from travellers. Any organ can be involved in melioidosis whereby Burkholderia pseudomallei causes an acute inflammatory reaction with rapid development of small abcesses which tend to coalesce to form larger abscesses. Cutaneous manifestations vary greatly. We report a man with systemic melioidosis who presented with cutaneous lesions.