疱疹样脓疱病1例

疱疹样脓疱病１例张丽①患者女，２７岁，已婚。因周身红斑、脓疱反复发作２年，于１９９５年１１月１５日入院。该患者于２年前妊娠３个月时双腋下出现红斑和脓疱，逐渐蔓延至颈和腹股沟部，１个月后自愈。足月顺产一健康女婴。７个月前疾病复发，但未妊娠，发病与第１次...     

疱疹样脓疱病并发妊娠期肝内胆汁淤积症1例

报告1例疱疹脓疱病并发妊娠期肝内胆汁淤积症。患者女，26岁，妊娠34^4周，躯干和四肢出现红斑，脓疱伴瘙痒和疼痛5个月，加重1个月，近期出现黄疸，入院时血清丙氨酸转氨酶，天冬氨酸转氨酶，血清胆红素和胆汁酸均升高，皮损组织病理改变符合疱疹样脓疱病，行剖宫产术，给予糖皮质激素，局部抗感染及对症支持等治疗后皮损痊愈。     

CTX治疗疱疹样脓疱病1例

患者女 ,４２岁 ,１９７５年妊娠８个月时发病 ,全身泛发红斑基础上出现脓疱 ,伴发热。Ｔ３８．０～３９．０℃。顺产一男婴后皮疹消退。曾反复发作５次。１９９９年５月１日 ,皮疹再发 ,全身皮肤疼痛 ,并有发热、畏寒。最高３９．８℃ ,否认家族中有银屑病患者。皮肤科情况 :面部、躯干、四肢弥漫红斑 ,其上密集分布粟粒样红色疱疹 ,口腔粘膜未破溃。实验室检查 :血钙２．２５ｍｍｏｌ／Ｌ ,血沉５５ｍｍ／ｌｈ ,ＷＢＣ１８．５×１０９／Ｌ。脓疱细菌、真菌及血培养均阴性。皮肤组织病理变化符合疱疹样脓疱病。经泼民松、雷公藤等治疗 ,效…     

阿维A加糖皮质激素治疗疱疹样脓疱病2例

疱疹样脓疱病多见于孕妇，呈慢性经过，易反复发作，预后不良，我科采用阿维A(acitretin)加糖皮质激素治疗疱疹样脓疱病2例，效果较好，现将临床观察结果报告如下。     

疱疹样脓疱病1例

疱疹样脓疱病为少见皮肤病,作者发现1例,现报道如下。1病例资料患者女,21岁。因双腋下、腹股沟及腹部脓疱三周余入院。患者04年10月孕8月时于双腋下、腹股沟等皮肤皱折处起红斑,继而在红斑上发出粟粒或绿豆大小脓疱,稍痒。外院以“湿疹”予外用药治疗(具体不详),病情反复。在2005年1月12日产后4天双腋下、腹股沟等皮肤皱折处及手术切口周围脓疱大量出现,自觉疼痒,我院门诊诊断为“疱疹样脓疱病”,先后予0·5%新霉素液外用、强的松(每次10 mg,每日3次)等治疗,皮疹反复。为进一步诊治,收入住院。病程中无呕吐、腹泻,睡眠差,饮食和两便正常。既…     

增殖型天疱疮1例误诊分析

患者女,29岁。全身散在至泛发水疱、渗出、红斑、脓疱、增殖等,先后诊断为单纯疱疹、传染性湿疹样皮炎、多形红斑、无菌性脓疱病、IgA天疱疮,直至出现增殖样皮损,组织病理证实为增殖型天疱疮,予以足量系统糖皮质激素治疗后好转,随访至今无复发。增殖型天疱疮的早期皮损表现多样,增殖可在晚期出现,组织病理及免疫荧光有助于诊断。     

无寻常性银屑病的疱疹样脓疱病、泛发性脓疱型银屑病1例及其家系IL-36RN基因的突变检测

目的检测1例无寻常性银屑病的中国汉族女性疱疹样脓疱病、泛发性脓疱型银屑病患者及其家系的IL-36RN基因突变情况。方法 1例42岁无寻常性银屑病病史的泛发性脓疱型银屑病女性患者,16年前曾患疱疹样脓疱病住院治疗。其父亲患寻常性银屑病30年。采集该家系6名成员和13名健康对照的血样,提取基因组DNA,PCR扩增IL-36RN基因的全部外显子编码区及其侧翼序列,并直接测序。结果泛发性脓疱型银屑病患者IL-36RN基因c.115+6TC位点检测到纯合突变,其父亲、母亲、女儿IL-36RN基因c.115+6TC位点均检测到杂合突变,健康对照、其弟弟和丈夫的相同基因位点未检测到突变。结论 IL-36RN基因c.115+6TC位点的纯合突变可能是该例泛发性脓疱型银屑病和疱疹样脓疱病的共同发病基础。本研究为国内首次报告的疱疹样脓疱病患者中检测到IL-36RN基因c.115+6TC位点纯合突变,进一步支持疱疹样脓疱病与不伴寻常性银屑病的泛发性脓疱型银屑病是由IL-36RN基因突变所致的相同疾病。     

疱疹样脓疱病5例临床分析

目的探讨疱疹样脓疱病的临床特点。方法回顾性分析5例疱疹样脓疱病患者的发病情况、临床表现、治疗及妊娠结局。结果应用抗炎药物加糖皮质激素治疗,适当补充钙剂有一定效果。分娩或终止妊娠后,脓疱会消退缓解。结论疱疹样脓疱病治疗应用抗炎药物、糖皮质激素及钙剂。治疗效果不佳者,孕早期可人为终止妊娠,晚期应密切观察,防止早产。患过该病的妇女,尽量避免再次妊娠。     

羊痘疮一例

患者,女,53岁。双上肢靶样丘疱疹15天。发病前5天被羊咬伤后手背出现丘疱疹,后发展为水疱、脓疱。给予夫西地酸和咪喹莫特乳膏外用,联合盐酸多西环素口服,局部夫西地酸乳膏预防及治疗继发感染,15天皮损完全消退。     

疱疹样脓疱病1例

病例资料　患者 ,女 ,2 1岁。因皮肤起针头大小脓疱 1月 ,加重 1周 ,于 1999年 2月 2 5日来我院就诊。 1月前 ,颈部皮肤出现针头大小脓疱 ,向周围扩展 ,在当地医院就诊 ,按皮肤“感染”治疗 ,静滴青霉素 5 6 0万Ｕ ,地塞米松 5ｍｇ ,1次 日 ,5天后 ,症状缓解。 2周后 ,皮损再次增多 ,面积扩大 ,部分皮损相互融合呈片状 ,在外院按“疱疹样脓疱病”治疗 ,具体用药不详 ,皮损面积不断扩大 ,躯干及四肢均出现同样皮损。近 1周患者发热 ,皮损相互融合成“脓湖状”。前来我院就诊 ,患者既往无特殊病史 ,家族中无类似病史。查体 :神志清 ,精神可 ,…     

Infliximab for the treatment of recalcitrant generalized pustular psoriasis of pregnancy: Report of a challenging case

Pustular psoriasis of pregnancy (PPP), also known as impetigo herpetiformis, is a rare gestational dermatosis that may induce life‐threatening complications for both the mother and fetus. Treatment of recalcitrant generalized PPP may be challenging as available therapeutic options are limited. We herein present a 24‐year‐old pregnant woman with generalized PPP accompanied by high fever, fatigue, leukocytosis, and elevated levels of serum acute phase reactants. The patient was resistant to a combination treatment of high‐dose cyclosporine (7.5 mg/kg/d, peroral), systemic methylprednisolone (1 mg/kg/d, intramuscular), and empirical antibiotherapy. However, she dramatically improved with infliximab (5 mg/kg, intravenous infusion), which was introduced at week 28 of pregnancy. Even within 24 hours after the first infusion of infliximab, pustular lesions began to regress with a rapid decline in fever. Following the third infusion, clearance of pustular lesions with a slight erythema was observed. Serum levels of leukocytes and acute phase reactants returned to normal. There were no adverse events related to infliximab therapy. At 40 weeks, the patient gave birth to a healthy baby. Our experience reported herein suggests that infliximab may serve as a rapidly acting, highly effective, and well‐tolerated “rescue” therapy in recalcitrant generalized PPP, which poses a big therapeutic challenge for clinicians.     

Polyarthritis with atypical keratotic nodular dermatosis or polyarthritis with multiple keratoacanthoma. A case report

We report an interesting case of generalized papular and nodular lesions with central keratinous plugs and severe hyperkeratotic-acanthotic histopathology with arthritis in a 19-year-old male patient who had suffered from a similar disease 2 years earlier. Papules and nodules erupted a few days after the arthritis and this was noticed during both episodes. On healing, nodules fell spontaneously leaving behind insignificant hyperpigmented scars.     

Generalized bullous impetigo in a neonate

Generalized bullous impetigo is uncommon in healthy and term neonates. It must be differentiated from staphylococcal scalded skin syndrome and other commonly encountered vesiculopustular lesions. We report generalized bullous impetigo in an otherwise healthy neonate.     

TNF-α拮抗剂治疗复发性疱疹样脓疱病一例

患者,女,31岁。妊娠期反复脓疱加重1个月。患者8年前妊娠期曾全身出现红斑、脓疱,产后皮损自行消失。根据患者既往病史、症状、体征及辅助检查,诊断“疱疹样脓疱病”,入院后予TNF-α拮抗剂皮下注射,辅以复方甘草酸苷、阿奇霉素抗炎及外用药治疗,1周后患者皮疹明显好转出院。     

Impetigo herpetiformis

We report the case of a 30-year-old patient who had impetigo herpetiformis during hormonal contraception and during two successive pregnancies. The diagnostic features of impetigo herpetiformis are reviewed. An association with HLA-Cw 6 is recognized. A large post-traumatic spleen cyst probably influenced the course of the disease. Postpartum therapy with oral glucocorticosteroids and etretinate was successful.     

Acrodermatitis enteropathica

A case of acrodermatitis enteropathica belatedly recognized in a pregnant 23-year-old woman is reported. The condition was not specifically diagnosed during childhood. It cleared at puberty but recurred during two of three pregnancies in the form of pustular, vesiculobullous, and psoriasiform lesions. There were no associated signs or symptoms in other organs. Initial diagnoses upon the recurrence during the third pregnancy were herpes gestationis and impetigo herpetiformis. A markedly decreased serum zinc level (18 micrograms/dl) was found. Treatment with zinc sulfate was instituted, and within 3 days the cutaneous lesions began to clear. Two months after the birth of a healthy child, and without further therapy, all lesions had resolved and the serum zinc level was nearly normal. Acrodermatitis enteropathica should be considered in the differential diagnosis of unresponsive bullous dermatoses occurring during pregnancy.     

Confocal laser scanning microscopic observation of glycocalyx production by Staphylococcus aureus in skin lesions of bullous impetigo,atopic dermatitis and pemphigus foliaceus

BACKGROUND: Glycocalyx collapses during dehydration to produce electron-dense accretions. Confocal laser scanning microscopy (CLSM) may be used to visualize fully hydrated microbial biofilms. OBJECTIVES: Using CLSM, to analyse glycocalyx production by Staphylococcus aureus cells in skin lesions of bullous impetigo, atopic dermatitis and pemphigus foliaceus. A second objective was to compare numbers of S. aureus cells in tissue sections prepared by different methods for routine light microscopy. METHODS: S. aureus cells in skin lesions of impetigo, atopic dermatitis and pemphigus were stained with safranin, and positive staining with fluorescein isothiocyanate-conjugated concanavalin A was considered to indicate the presence of glycocalyx. RESULTS: All S. aureus cells tested in skin lesions of impetigo, atopic dermatitis and pemphigus were covered with glycocalyx and formed microcolonies. The numbers of S. aureus cells in a routine light microscopy section were significantly lower than those in a frozen section that had not been dehydrated with ethanol. CONCLUSIONS: S. aureus cells generally produce glycocalyx in skin lesions of bullous impetigo, atopic dermatitis and pemphigus foliaceus, which accounts for the difficulty of removing S. aureus cells from these skin lesions. The glycocalyx may collapse during dehydration and most of the S. aureus cells may be carried away during preparation of routine light microscope sections.     

Impetigo in epidemic and nonepidemic phases: an incidence study over 4(1/2) years in a general population

BACKGROUND: Little is known about incidence and natural variation of impetigo in general populations. OBJECTIVES: To investigate the natural course of impetigo in a well-defined population, and to study the resistance pattern of the causal bacteria over time. METHODS: This is a population-based incidence study in Austevoll, an island community of 4457 inhabitants in Norway, in the years 2001-2005. Incidence rates are given as events per person-year. Epidemic periods were identified by statistical process-control analyses. RESULTS: The incidence rate of impetigo for the whole study period was 0.017 events per person-year, corresponding to a total of 334 cases. The incidence rates were 0.009, 0.026, 0.019, 0.016 and 0.009 in the years 2001, 2002, 2003, 2004 and 2005, respectively. Three epidemics were identified, starting in August of 2002, 2003 and 2004, lasting for 11, 11 and 5 weeks, respectively. Incidence rates in these epidemic periods were 0.099, 0.045 and 0.074, respectively. In epidemic periods, Staphylococcus aureus was the causal bacterium in 89% (117/132) of cases, while this proportion was 68% (84/123) in nonepidemic periods (P < 0.01). Staphylococcus aureus was resistant to fusidic acid in 84% (98/117) and 64% (54/84) of impetigo cases in epidemic and nonepidemic periods, respectively (P < 0.01). When investigating all types of infections caused by S. aureus in the study period, the proportion of fusidic acid resistance in impetigo cases (152/201, 76%) differed significantly from fusidic acid resistance in other infections (18/116, 16%) (P < 0.01). CONCLUSIONS: Distinctive epidemic outbreaks occurred during the summer of three of the five follow-up years. In outbreaks, S. aureus was more frequently the causal agent and the sensitivity to fusidic acid decreased significantly.     

An epidemicity of Paederus species in Cukurova region

Two hundred four patients (117 females, 87 males; age range: 3-80 y) were admitted to our facility between May 1995 and June 1997 and studied to determine the endemicity of the Paederus species, which has been increasing for the last 6 years (especially in May and June) in the Cukurova region of southern Turkey. Clinically, infection with the Paederus species mimics contact dermatitis, herpes zoster, bullous impetigo, and phytophotodermatitis. Definitive diagnosis is made by historical and clinical findings. To determine the main histopathologic features of this infestation, biopsy specimens were obtained from 9 patients and stained with hematoxylin and eosin (H&E). In most patients, the skin lesions were located on the exposed parts of the body. Clinically, these lesions were linear, vesicular, bullous, and/or pustular on erythematous bases and resembled either phytophotodermatitis, herpes zoster, or impetigo rather than classic insect bites. Pederin, which is released from the Paederus species, may cause these lesions. The number of cases has increased markedly during the last 5 years. In the coming years, we expect this number to increase significantly.     

Generalized pustular psoriasis provoked by propranolol

An 80-year-old man who had had plaque-type psoriasis for 40 years experienced a rapid onset of generalized pustular psoriasis three days after initiation of propranolol hydrochloride therapy. Trial therapy with propranolol on two occasions resulted in similar episodes. The skin lesions and systemic symptoms resolved after the discontinuation of propranolol therapy and administration of methotrexate sodium. This case study documents propranolol--a beta-blocker--as another causal factor for pustular psoriasis.