过量甲氨蝶呤中毒引起的皮肤损害1例

 报告1例过量甲氨蝶呤中毒引起的皮肤损害。患者女,74岁,全身红斑脱屑伴疼痛8 d。入院前连续10 d口服MTX 5 mg/d,累积剂量50 mg,服药第3天全身出现红斑脱屑。皮肤科检查：口腔黏膜糜烂,躯干四肢弥漫分布红斑,表面脱屑,部分可见糜烂渗出,以四肢受累为主。完善相关实验检查提示白细胞及血小板减少,转氨酶升高。诊断：甲氨蝶呤中毒。治疗：口服亚叶酸钙解毒,加强水化,碱化尿液,促进血小板及白细胞升高,护肝,外用药物及对症支持治疗,2周后好转出院。目前病情平稳,正在随访中。     

Acral erythema in children receiving high-dose methotrexate

Scant information is available concerning the occurrence and evolution of chemotherapy-induced acral erythema in children receiving intravenous high-dose methotrexate (MTX). Among 50 children with acute lymphoblastic leukemia or lymphoblastic lymphoma receiving a total of 203 courses of high-dose MTX (3-8 g/m2), 3 cases of acral erythema were observed. Painful erythema of finger and toe pads was noted in three children 3 days to 2 weeks after MTX infusion. The lesions resolved completely after blister formation and desquamation. These patients subsequently received high-dose MTX therapy without cutaneous problems. The present work points out that the chemotherapeutic schedule need not be modified in selected patients who develop acral erythema following high-dose MTX infusion.     

Chemotherapy-induced acral erythema in patients receiving bone marrow transplantation

Chemotherapy-induced acral erythema is an uncommon and distinctive syndrome of intense macular erythema of the palms and fingers seen in patients treated with high-dose chemotherapy. It is painful, may form bullae, and heals uneventfully with desquamation. The incidence (35%) of this complication in patients receiving bone marrow transplantation at our institution is quite high and probably reflects the exceptional doses of chemotherapy and concomitant total body irradiation these patients receive. Biopsy specimens showed vacuolar change, spongiosis, necrotic keratinocytes, and epidermal atypia. These findings probably result from direct toxic effect and mimic those of acute graft-vs-host disease. Awareness of chemotherapy-induced acral erythema is important to avoid its misdiagnosis as a cutaneous sign of acute graft-vs-host disease. This distinction can usually be made on clinical grounds. If necessary, serial skin biopsy specimens are helpful.     

Penile Involvement with Hand-Foot Syndrome

Hand-foot syndrome, or palmar plantar erythrodysesthesia, is a chemotherapy-induced cutaneous reaction typically characterized by painful erythema of the palms and soles followed by desquamation and exfoliation in those areas. This report represents the first case of hand-foot syndrome associated with penile erythema, pain, and desquamation in addition to the classic hand and sole findings.     

大剂量丙种球蛋白静脉滴注联合甲泼尼龙治疗重症多形红斑型药疹1例

报告1例别嘌醇引起的重症多形红斑型药疹伴外周血红细胞、白细胞和血小板降低，经甲泼尼龙60mg／d同时加用大剂量免疫球蛋白静脉冲击疗法(HDIVID)成功治愈，并且缩短了疗程。     

A case of docetaxel-induced erythrodysesthesia

Chemotherapy-induced acral erythema (CIAE) is a rare cutaneous reaction to high-dose chemotherapy, clinically featuring painful erythema on the palms and soles. Docetaxel (Taxotere), an anticancer agent, is known to cause various reactions, including CIAE. We experienced a case of docetaxel-induced acral erythema with facial edematous erythema that coincidentally emerged and regressed with appearance and disappearance of the acral lesions. Docetaxel-induced acral erythema exhibits a widespread distribution and intense sensations of intolerable pain and numbness. Therefore, some authors use the term erythrodysesthesia instead of acral erythema. We speculated that the facial erythema might be part of the spectrum of erythrodysesthesia. Our case was finally diagnosed as decetaxel-induced erythrodysesthesia. Although CIAE is self-limiting, the patients frequently require treatment because of intolerable pain. Reported treatments for CIAE include topical or systemic steroids, elevation of the legs, and application of cold compression to the lesion. In our case, application of a steroid ointment with the occlusive dressing technique (ODT) alleviated the clinical manifestations and was also prophylactic for the erythrodysesthesia.     

Erythema nodosum induced by the synergism of acupuncture therapy and flu-like infection

A 32-year-old female patient developed erythema nodosum-like lesions at needle prick sites after acupuncture therapy. Over the next few days, she developed similar new lesions over the extremities, trunk and face along with flu-like symptoms. There were neither genital ulcerations nor eye lesions. A skin biopsy specimen from an extremity lesion showed the characteristic findings of erythema nodosum. Treatment with oral potassium iodide at a dose of 750 mg/day was effective, and there has not been any recurrence to date. We diagnosed this case as erythema nodosum induced by a synergism between acupuncture therapy and a flu-like infection.     

腹部复发性疼痛性红斑一例

患者,女,72岁。腹部皮肤反复起红斑伴疼痛11年。皮肤科查体：腹部片状红斑及黄褐色色素沉着斑,境界清楚,表面稍粗糙,无脱屑、糜烂、渗出,皮损之间可见正常皮肤,皮温稍高,有明显触痛及摩擦痛。组织病理示：表皮轻度角化过度,局灶增厚伴上皮脚延长、融合,基底层色素颗粒增多,真皮浅层血管旁见少许淋巴细胞浸润。诊断：复发性疼痛性红斑。     

A case of erythema elevatum diutinum associated with peripheral ulcerative keratitis

A young woman with recurrent painful lesions on the dorsal aspects of her hands associated with arthralgia presented with pain and redness of both eyes. After extensive investigations, a diagnosis of erythema elevatum diutinum accompanied by peripheral ulcerative keratitis was made. The patient was treated with dapsone 50 mg, t.i.d., and responded well.     

Case of severe bullous erythema including intertrigo‐like eruptions with angioedema induced by pegylated liposomal doxorubicin

Pegylated liposomal doxorubicin (PLD) is an anthracycline anticancer agent used in ovarian cancer and a form of doxorubicin enclosed in pegylated liposomes. There are only a few reports on intertrigo‐like eruptions caused by PLD. We describe the first case of severe bullous erythema, including intertrigo‐like eruptions with angioedema, induced by PLD in Japan. We present the case of a 53‐year‐old woman who was diagnosed with stage IIIC ovarian cancer. After receiving three cycles of PLD, the patient developed swelling of the upper lip and painful erythema with blisters and erosions on the axilla, upper back, flank and wrists. The patient was diagnosed with angioedema and severe skin lesions, including intertrigo‐like eruptions induced by PLD. Although treatment with oral prednisolone and topical steroids was effective against these eruptions, the administration of PLD was discontinued because of its ineffectiveness against the primary disease. Several risk factors, such as obesity, perspiration and racial differences, may contribute toward a severe manifestation such as that seen in our patient. Moreover, our case was the first accompanied by angioedema. The mechanism of coexistence of intertrigo‐like eruptions and angioedema is not clear; further studies are required to clarify the pathological mechanism of intertrigo‐like eruptions.     

Erythema nodosum induced by kerion celsi of the scalp

A 5-year-old girl presented with a 2-week history of a sharply demarcated, inflammatory, granulomatous lesion on the right side of her scalp. Shortly afterward, painful, subcutaneous nodules developed on her shins and thighs. Trichophyton mentagrophytes was isolated from the scalp lesion and a diagnosis of erythema nodosum induced by kerion of the scalp was made. The patient was started on oral therapy with 18 mg/kg/day griseofulvin, associated with topical crystal violet. Her erythema nodosum regressed in 10 days, while the kerion healed 6 weeks later, leaving residual scarring alopecia. Erythema nodosum represents a reaction pattern to a wide variety of inflammatory stimuli. The interest of this case lies in the unusual association of kerion erythema nodosum, of which only nine cases have been reported in the international literature.     

发生于特瑞普利单抗长期治疗后的大疱性类天疱疮二例

例1女,63岁,全身皮疹2个月伴瘙痒,表现为红斑基础上水疱大疱。2年前因直肠肛管恶性黑素瘤行肠周淋巴结清扫术,静脉注射特瑞普利单抗预防性治疗1年,停药后2周出现全身皮疹。上肢红斑处皮损直接免疫荧光示,IgG沿基底膜带沉积;血清盐裂间接免疫荧光,IgG沿表皮侧线状沉积。血清酶联免疫吸附试验示,BP180 > 200 U/...     

Treatment of perforating collagenosis of diabetes and renal failure with allopurinol

We present a case of widespread reactive perforating collagenosis in a 63-year-old woman undergoing haemodialysis after diabetic nephropathy, who was treated successfully with allopurinol. The patient responded well and rapidly to a dose of 100 mg allopurinol daily. It is suggested that more patients with reactive perforating collagenosis may benefit from allopurinol therapy.     

Chemotherapy-induced acral erythema: report of a case and immunohistochemical findings

Chemotherapy-induced acral erythema (CAE) is an uncommon and distinct reaction seen in patients receiving high-dose chemotherapy. The exact pathogenic mechanisms of this disorder are still unknown. We report a 27-year-old woman who presented with red, swollen and painful macules on both palms, clinically consistent with this disease. Histological examination demonstrated vacuolar degeneration of the basal cell layer and spongiotic blisters in the epidermis, especially in the atrophied eccrine ducts and papillary oedema with mild perivascular infiltration of mononuclear and hypersegmented neutrophils. Immunohistochemistry showed that the infiltrating mononuclear cells were CD3-CD16+CD56+ leucocyte function antigen-1+, possibly natural killer cells. The eccrine ducts expressed HLA-DR and intracellular adhesion molecule-1 (ICAM-1). Our findings suggest that cell-to-cell interaction between NK cells and keratinocytes in the eccrine apparatus may induce CAE and may be involved in the pathogenesis of the skin reaction in our patient and possibly in this disease.     

Boric acid poisoning

The skin manifestations associated with boric acid intoxication are particularly striking. We present a case report of a 44-year-old black woman who, following a suicide attempt, demonstrated the classic features of acute boric acid poisoning. She developed generalized erythema creating a "boiled lobster" appearance with massive areas of desquamation. A discussion of the history of the use of boric acid by the medical profession follows the patient presentation.     

Febrile perianal streptococcal dermatitis

We describe a child with an unusual presentation of perianal streptococcal dermatitis which included fever, acral scarletiniform desquamation, and extension of erythema to involve the genitalia and proximal thighs, as well as the commonly seen well-defined erythema of the perianal area. We suggest that isolated group A beta-hemolytic streptococci (GAS) in our patient produced a pyrogenic exotoxin similar to that which appears in scarlet fever.     

Massive isotretinoin intoxication

We report a case of acute intoxication due to a massive overdose of isotrerinoin. A 29-year-old male patient ingested 900 mg of isotretinoin corresponding to 12·5mg (kg/day) or 30 times the prescribed dosage and 1 day later the patient experienced mild headache. Forty-eight hours later, cheilitis, diffuse cutaneous xerosis and desquamation of the forehead and of the external auditory meatus occurred; cutaneous xerosis and cheilitis resolved spontaneously. We determined the serum level of isotretinoin and of 4-oxo-isotretinoin, its natural metabolite in sera taken 4, 5, 6 and 11 days following ingestion. The side-effects were mild and represented only exacerbations of some common isotretinoin side-effects. To date, three other cases of isotretinoin overdosage have been reported. There was a low toxicity of isotreitnoin overdose.     

Pustular acral erythema in a patient with acute graft-versus-host disease

Acral erythema is a well-known side-effect of chemotherapy treatment but it is not common in patients undergoing bone marrow transplant. We report a post-transplant patient with clinical and histological acute graft-versus-host disease (GVHD) who concurrently developed acral erythema presenting as painful, well-defined and self-limiting palmar erythema with pustules. A skin biopsy from the palm showed abnormal keratinocyte maturation and eccrine squamous syringometaplasia. This case illustrates the difficulties in establishing the differential diagnosis of cutaneous eruptions in patients undergoing bone marrow transplant.     

Low-dose acitretin is associated with fewer adverse events than high-dose acitretin in the treatment of psoriasis

OBJECTIVE: In practice, lower dose acitretin therapy (25 mg/d) seems to be better tolerated and associated with fewer abnormalities found after laboratory testing. Here we revisit the original phase 3 trials for acitretin to evaluate the evidence for low-dose therapy producing fewer adverse effects than the 50 mg/d dosage. DESIGN: We retrospectively analyzed pooled data from 2 large pivotal trials, each including a randomized, placebo-controlled, 8-week double-blind phase followed by a 16-week open-label phase. SETTING: Multicenter pivotal trial of subjects in referral centers and private practice. PARTICIPANTS: Subjects with severe psoriasis requiring systemic therapy were recruited according to inclusion/exclusion criteria. INTERVENTION: During the double-blind phase, subjects received placebo or one of several fixed acitretin doses. Dose adjustment was allowed during the open-label phase, during which high-dose treatment was defined as a mean dosage of 50 mg/d and low-dose treatment was defined as a mean dosage of 25 mg/d. MAIN OUTCOME MEASURES: The frequency of anomalies found after laboratory testing and clinical adverse events were the outcomes of interest. RESULTS: Common adverse effects (dry skin, alopecia, rhinitis, etc) were 2 to 3 times more frequent in subjects receiving 50-mg/d acitretin than in those receiving 25 mg/d. Increases in hepatic enzymes and triglycerides in subjects receiving low-dose therapy were minimal compared with levels in those receiving high-dose therapy. CONCLUSIONS: We have shown low-dose therapy (25 mg/d) to be an effective strategy for substantially reducing acitretin-associated adverse effects. Many adverse effects associated with acitretin therapy are dose dependent and can limit the usefulness of this potentially beneficial therapy.     

Palmoplantar pustulosis treated with itraconazole: a single, active-arm pilot study

Pustulosis palmoplantaris (PPP; synonyms: pustulosis palmaris et plantaris, palmoplantar amicrobic pustulosis) is a common chronic, relapsing, pustular eruption affecting the palms and soles. The authors report the successful treatment of six therapy-experienced patients with histologically confirmed PPP with oral itraconazole (100 mg/day for 1 month, followed by a month of 100 mg/day every other day). Three of six patients showed complete clearance of pustules, significant reduction of erythema, and unnoticeable desquamation, whereas the other three patients had no new pustules appearing and had modest reduction of erythema and desquamation. All patients experienced relapses within a month of therapy cessation. Two of the three complete responders reinitiated itraconazole therapy at 100 mg/day for another 2 weeks, followed by a maintenance dose of 50 mg/day until achieving remission. As complete responses are not commonly observed in placebo treatments in placebo-controlled trials for PPP, the authors believe that the present study shows that itraconazole is an effective treatment for treatment-resistant PPP.