伴有谷蛋白敏感性肠病的疱疹样皮炎一例

疱疹样皮炎是一种与谷蛋白敏感性有关的慢性、自身免疫性水疱性疾病,是腹腔疾病的一种皮肤表现。本文报道了一例伴谷蛋白敏感性肠病的疱疹样皮炎患者,严格控制无谷蛋白饮食和氨苯砜治疗后皮损明显好转。     

Rheumatoid neutrophilic dermatosis with tense blister formation: A case report and review of the literature

We report a 78‐year‐old woman with rheumatoid neutrophilic dermatosis (RND) presenting with tense blisters; an extremely rare manifestation of this condition. Systemic corticosteroid was of limited efficacy, while dapsone was effective. A literature review of four similar cases showed that tense blisters in this type of RND tended to appear on the lower extremities of aged, female rheumatoid arthritis patients. Of note, half of the cases were resistant to corticosteroids, as anti‐neutrophil agents are reported to be effective. Accordingly, it is important to recognise this unusual manifestation for the timely initiation of appropriate therapy.     

Expression of eotaxin, interleukin 13 and tumour necrosis factor-alpha in dermatitis herpetiformis

BACKGROUND: The dermal and perivascular infiltrate in dermatitis herpetiformis (DH), which is mainly composed of CD4+ lymphocytes, neutrophils and eosinophils, is believed to play an important part in the pathogenesis of the disease. Previous studies suggest that cytokines such as interleukin (IL) -8, granulocyte-macrophage colony-stimulating factor, IL-4 and IL-5 could be involved in the pathogenesis of DH. These cytokines appear to drive tissue infiltration and maturation of eosinophils. Part of the effect of T-helper (Th) 2-type cytokines (IL-4, IL-5) on eosinophils could be mediated by eotaxin, which is a highly specific chemotactic protein induced by various cytokines [IL-4, IL-13, tumour necrosis factor (TNF) -alpha and interferon-gamma]. OBJECTIVES: To evaluate the expression of eotaxin and its inducers, IL-13 and TNF-alpha, in DH. METHODS We examined lesions collected from 10 DH patients with active disease. Sections from each specimen were incubated with anti-IL-13, anti-TNF-alpha and anti-eotaxin antibodies. Chloroacetyl esterase reaction was performed to show mast cell infiltration. RESULTS: Eotaxin was mainly expressed at the tips of the dermal papillae, within the microabscesses. Positivity was also found in the lymphomonocytic infiltrate in the dermis. IL-13 was expressed in the dermal infiltrate and TNF-alpha was found in the inflammatory infiltrate and in dermal vascular cells. CONCLUSIONS: These findings confirm the importance of the lymphomonocytic infiltrate and of Th2 cytokines in the pathogenesis of this disease, suggesting that tissue infiltration in DH is mediated by cell-specific chemokines such as eotaxin and not only by non-specific chemokines such as IL-8.     

Sulfasalazine‐induced generalized vitiligo in a patient with dermatitis herpetiformis and celiac disease

Vitiligo is an acquired idiopathic pigmentary skin disorder characterized by the development of white macules and patches due to the loss of functioning melanocytes. In this report, we describe a case of a patient with a longstanding history of dermatitis herpetiformis (DH) and celiac disease that developed rapidly progressing, biopsy‐confirmed generalized vitiligo after 11 months of treatment with anti‐inflammatory medication sulfasalazine, prescribed for the patient's DH. To the best of our knowledge, this is the first case report which has demonstrated the possible biochemical pathways, triggered by sulfasalazine, in the development of vitiligo.     

Immunoelectron microscopy of linear dermatitis herpetiformis: report of a case.

Linear deposits of both IgA and C3 were found along the BMZ (by direct IF), and band-like IgA deposits directly below the basal lamina (by HRP-anti-HRP electron microscopy), in a case of clinically typical DH. No circulating antibodies could be detected.     

The occurrence of type 1 diabetes in patients with dermatitis herpetiformis and their first-degree relatives

BACKGROUND: The increased prevalence of type 1 diabetes (T1D) is well documented in patients with coeliac disease, whereas evidence is scanty in patients with dermatitis herpetiformis (DH). OBJECTIVES: To assess the prevalence of T1D in patients with DH and their first-degree relatives, and to study how DH patients with associated T1D respond to a gluten-free diet (GFD) treatment. METHODS: A series of 1104 consecutive patients with DH was recorded and a specific questionnaire sent to 341 of these for familial disease surveillance. Sex- and age-matched patients with isolated DH served as controls in the diet treatment analysis. RESULTS: Twenty-five (2.3%) patients with DH were affected by T1D and three (3.0%) of their first-degree relatives also were affected by T1D, the frequencies being significantly higher than in the general population. Most DH patients with T1D and with isolated DH could adhere strictly to the GFD. The response was good or moderate in 84% of the DH patients with T1D and in 94% of the patients with isolated DH. CONCLUSIONS: The prevalence of T1D is increased in patients with DH and their first-degree relatives. The rash in DH patients with T1D responds to a GFD in a way similar to that seen in patients with isolated DH.     

Palmar petechiae in dermatitis herpetiformis: a case report and clinical review

Palmar petechiae or purpura is an unusual finding in dermatitis herpetiformis (DH) that occurs in children but is only rarely reported in adults. We describe a 46-year-old man with DH who presented with the classic pruritic papulovesicular eruption and associated volar finger and palmar petechiae. We discuss recent advances in the pathogenesis and treatment of DH.     

Childhood dermatitis herpetiformis: a case report and review of the literature

Dermatitis herpetiformis (DH) is a chronic pruritic cutaneous eruption associated with gluten-sensitive enteropathy (celiac disease [CD]) and immunoglobulin A (IgA) deposition in the skin. While the disease is not uncommon among adolescents, DH is rarely seen in prepubertal patients. Children with DH present similarly to adults; however, uncommon skin findings have been reported. Because of an increased risk for autoimmune diseases and lymphoma, accurate diagnosis and treatment are imperative. We present a case of DH in a 6-year-old Latino boy previously diagnosed with atopic dermatitis and recurrent urticaria. Our aim is to highlight the various cutaneous presentations of DH and encourage clinicians to consider this diagnosis in young patients with recalcitrant atypical skin disease.     

中国疱疹样皮炎特征分析：1958—2018年文献回顾

【摘要】 目的 总结我国疱疹样皮炎患者的疾病特征。方法 检索中国知网、万方和Pubmed数据库中公开发表的中国人疱疹样皮炎相关文献,根据纳入及排除标准对临床表现、普通病理、免疫病理特点进行筛选,分析符合诊断标准患者的疾病特征。结果 纳入55例疱疹样皮炎患者,发病年龄（44.9 ± 18.5）岁,男女比例约2.5∶1,平均诊断延迟4.1年。皮损主要表现为红斑基础上的紧张性水疱,分布在臀区、肘部、背部、膝部等部位。39例描述组织病理表现,37例可见表皮下疱,17例存在中性粒细胞浸润。33例描述皮损周围组织直接免疫荧光表现,31例可见IgA颗粒状沉积,23例沉积部位为真皮乳头。39例描述了治疗情况,其中25例使用氨苯砜或氨苯砜联合无谷胶饮食治疗,治疗效果明显,皮损多在1个月内消退。结论 中国疱疹样皮炎主要表现为红斑基础上的紧张性水疱,直接免疫荧光主要表现为IgA颗粒状沉积,病因可能具有遗传学特点,氨苯砜治疗效果良好。     

类风湿性嗜中性皮炎一例并文献复习

报道1例类风湿性嗜中性皮炎并复习相关文献。患者,女,60岁。四肢红斑、丘疹、结节痛1年余,加重伴水疱、脓疱1周。患者确诊类风湿关节炎3年余,类风湿因子阳性。三次组织病理示表皮表现不一,真皮浅中层均可见较多弥漫中性粒细胞浸润,可见核尘,并可见少量淋巴细胞浸润,血管内皮肿胀伴红细胞外溢,未见血管炎改变。DIF阴性。诊断：类风湿性嗜中性皮炎。结合病例及相关文献,对此病发病机制、临床及病理、治疗等进行综合分析。     

Eyelid discoid lupus erythematosus and contact dermatitis: a case report

We report a patient with discoid lupus erythematosus (DLE) and associated allergic contact dermatitis (ACD) in the eyelids. In women, ACD caused by nail varnish is frequent and often seen in the eyelids. ACD caused by drugs (e.g. neomycin) is also frequent in this region. However, DLE with periorbital presentation without evidence of systemic or other cutaneous involvement is rare.     

氨苯砜单疗治疗类风湿性嗜中性皮炎一例

类风湿性嗜中性皮炎是一种严重类风湿关节炎的特异性皮肤表现,本文报道一例并复习相关文献。患者,男,60岁。躯干、四肢泛发暗红色丘疹、水疱1个月,类风湿关节炎病史7年。实验室检查及组织病理符合类风湿性嗜中性皮炎。患者因类风湿关节炎病史曾使用免疫抑制剂和糖皮质激素,本次选择氨苯砜单疗,治疗2周后实验室检查异常项目恢复正常,皮损明显消退。     

栅栏状中性粒细胞肉芽肿性皮炎合并强直性脊柱炎一例

患者,男,55岁。四肢暗红色斑块、脱屑5年。既往有强直性脊柱炎病史。皮损组织病理学检查示真皮内上皮细胞肉芽肿改变,部分区域上皮细胞呈栅栏状排列,局部伴有中性粒细胞、淋巴细胞浸润。实验室检查抗核抗体、SSA、SSB、抗双链DNA等为阴性,HLA-B27为阳性。诊断：栅栏状中性粒细胞肉芽肿性皮炎合并强直性脊柱炎。     

Allergic contact dermatitis associated with reactive dyes in a dark garment: a case report

In this study, we present a case of a patient who has not been occupationally exposed to reactive dyes, but did present with a dermatitis from wearing a dark cotton garment. The patient experienced reactivation of his dermatitis when rewearing a new unwashed dark T-shirt made of 100% cotton (in fact, the patient reported that it had to be washed at least 3 times before the skin reaction disappeared). He presented positive patch tests to 6 reactive dyes from Chemotechnique textile series. The clothing could not be proved as the true cause of the dermatitis, but resolution occurred upon removal of the suspected garment. This suggests that contact allergy to the reactive dyes (he did not react to any other dyes and his garment was a natural fabric) was likely responsible. With this report, we would like to emphasize that reactive dyes, as a class, should be considered as potential allergens, both occupationally and from non-occupational exposure such as garments. If garments containing reactive dyes are not properly rinsed in the manufacturing process, we believe that excess of dye can be retained that may cause allergic contact dermatitis (ACD). As the reactive dyes and their hydrolysis products are very water-soluble, they can be easily washed off to prevent ACD.