成人银屑病皮炎1例报告及文献复习

报告1例银屑病皮炎。患者男,36岁。因全身反复红斑及丘疹伴瘙痒6年余,加重2个月余就诊。皮肤科检查：头皮可见较多白色鳞屑,枕后可见红色斑块;面部弥漫性红色斑片,上覆白色鳞屑,双耳可见散在痂壳;躯干及四肢散在红色斑块,部分上覆白色鳞屑,指甲部分可见点状凹陷及甲板变形。多次皮损组织病理检查均提示银屑病特征性改变。根据临床表现及皮损组织病理检查结果,最终诊断为银屑病皮炎。     

反向性银屑病二例

<正>临床资料例1,患者,女,48岁。7年前,患者头皮出现红色丘疹、斑块伴银白色鳞屑,轻度瘙痒,院外诊断为"银屑病",给予药物治疗(具体药物不详)后皮损消退,此后皮疹反复出现。3个月前,患者头皮再次出现大量银白色鳞屑,并出现双侧腋下、会阴部境界清楚的红斑。患者无高血压、糖尿病、心脏病等病史,家族中无类似疾病史。查体:一般情况好,系统检查未见明显异常。皮肤科情况:头皮大量银白色鳞屑,可见束状发。双侧腋下、会阴部境界清楚的红斑,未见明显鳞屑(图     

银屑病并发光泽苔藓

报告1例银屑病并发光泽苔藓。患者男,29岁。头皮、双肘伸侧红斑、鳞屑5年,左上臂、骶尾部丘疹1年。头皮、双肘部皮损典型,诊断为银屑病;骶尾部皮损组织病理检查:符合光泽苔藓。治疗:糠酸莫米松软膏外用于左上臂及骶尾部丘疹,卡泊三醇软膏外用于头皮及双肘部皮损。     

儿童屈侧银屑病一例

男性10岁患儿,颈部、腋窝、腹股沟反复红斑、丘疹、鳞屑1年。皮肤科情况:颈周及腋窝散在鳞屑性红色斑丘疹,部分融合成片;双侧腹股沟区可见境界相对清楚的大片红斑,表面相对湿润,鳞屑不明显,其中腹股沟内侧皱褶处局部浸渍,腹股沟区红斑周围、股内侧散在鳞屑性红色丘疹;头皮、躯干及四肢无类似皮损;指(趾)甲未见异常。组织病理示:表皮角化过度伴角化不全,可见Munro微脓肿,棘层肥厚,表皮突向下延伸,真皮乳头处小血管增生,部分区域充血,真皮上部血管周围单一核细胞浸润。最后诊断:屈侧银屑病。     

寻常型天疱疮并发疱疹样天疱疮

报告1例寻常型天疱疮并发疱疹样天疱疮。患者女,45岁。因头皮红斑、水疱1年,泛发全身伴瘙痒2个月就诊。皮肤科检查:头皮散在黑色厚痂,双侧腋下甲盖大糜烂面,尼氏征(+);躯干、四肢屈侧泛发环状红斑,其上较多黄豆大的紧张性水疱,尼氏征(-)。皮损组织病理及直接免疫荧光检查分别符合寻常型天疱疮和疱疹样天疱疮。诊断:寻常型天疱疮,疱疹样天疱疮。     

以掌跖角皮症为首发表现的银屑病

报告1例以掌跖角皮症为首发表现的银屑病。患者男,19岁。手足红斑伴鳞屑40 d,加重10 d。皮肤科检查:头皮、口周、肛周、阴囊、腋下、背部及手足大片浸润性斑片,其上见成层鳞屑,Auspitz征阳性,部分鳞屑呈蛎壳样,掌跖部皮损融合成片,呈疣状增生,指、趾甲浑浊增厚。手掌部皮损组织病理检查:表皮角化过度伴角化不全,棘层肥厚,表皮突延长,颗粒层消失,真皮浅层血管周围淋巴细胞浸润。诊断:银屑病。治疗:予口服阿维A,治疗20 d后皮损基本消退。     

疱疹样脓疱病1例

患者女,21岁。全身红斑、脓疱伴疼痛3个月,于2014年7月入院。患者3个月前妊娠后无明显诱因出现脐周红斑,后红斑渐累及头皮、面部、躯干、四肢近端及腋下,并在红斑基础上成批出现环状排列的群集性脓疱,针头大,对称分布,部分融合成脓湖,伴疼痛及紧绷感,无发热、抽搐及乏力;1个月前至当地医院就诊,予红霉素软膏外用,无好转;1周前自用有机碳粉(具体不详)外敷,皮损加重。门诊拟"角层下脓疱病"收入院。患者怀孕17周,既往有银屑病史2年。     

银屑病合并落叶型天疱疮一例

患者男,34岁,因全身红斑、水疱伴疼痛1周,于2016年11月24日于广东省中医院皮肤科就诊.诉11月17日左手大拇指因磁铁被夹伤,伤口0.4 cm × 0.2 cm,当时有渗血,自行外用创口贴贴敷,当天伤口处曾触及甲苯.18日双手及腋下散发透明小水疱,部分融合为大水疱,破溃后渗液明显,伴有疼痛,当时未予以重视,未行任何治疗.随后皮疹渐增多,双手臂、双侧腋下、胸腹部、背部多处片状红斑,水疱已破溃,局部可见痂皮,少许渗液;颜面部红肿,眼周、嘴唇等多处红斑、水疱,融合成片,破溃后渗液明显,局部可见黄褐色痂皮;双下肢小腿处片状鳞屑性暗红斑,瘙痒剧烈.患者自诉皮损处疼痛明显,有异味,精神状态尚可.既往有寻常性银屑病病史10余年,近1年来口服中药及中成药,银屑病病情控制尚可,否认药物食物过敏史.     

颗粒状角化不全一例

患者女,31岁,左腋窝红斑、糜烂、痒23年.体检:左腋下可见近环形红色斑片,约8 cm×10 cm,皮损中央淡紫红色粟粒大棘状丘疹,不完全融合形成斑块,皮损外周红斑表面轻度糜烂、渗液,散在少量米粒大脓疱,部分区域可见瘢痕;全身其他间擦部位未见任何皮损.皮损表面分泌物真菌镜检阴性.组织病理:角质层增厚,角化过度并显著角化不全,角质层大多数细胞保留细胞核,包含大量嗜碱性颗粒.角化不全下方颗粒层仍然保留,其中少部分细胞胞质呈空泡状.表皮呈银屑病样增生,真皮内血管周围以淋巴细胞为主的混合炎症浸润,并可见明显血管扩张.诊断:颗粒状角化不全.     

银屑病并发克罗恩病

报告1例银屑病并发克罗恩病。患者男,53岁。四肢红斑及鳞屑3年余,加重20 d。皮肤科检查:四肢散在甲盖至钱币大红斑,其上覆有层状银白色鳞屑。皮损组织病理检查:角质层增厚,角化不全,颗粒层变薄,棘层增厚,表皮突延长,末端较宽,部分与临近的表皮突相结合;真皮上部淋巴细胞浸润。肠镜示回肠末端多发不规则溃疡。回肠末端溃疡组织病理检查:小肠黏膜溃疡表面炎性坏死渗出,其下各层组织内可见淋巴细胞、单核细胞和浆细胞浸润,可见上皮样肉芽肿。诊断:银屑病并发克罗恩病。     

Investigation of the hair of patients with scalp psoriasis using atomic force microscopy

Background. Psoriasis affects not only the soft keratin of the skin, but also hard keratin, such as nails and hair. However, few studies have described the changes induced in the hair of patients with psoriasis. Aim. Using atomic force microscopy (AFM), we investigated the morphological property of hair samples taken from the scalp of patients with psoriasis. Methods. Lesional and nonlesional hairs taken from 15 patients with scalp psoriasis were investigated. Hairs from 15 healthy adults were also examined as controls. Using AFM, surface images were taken of an area of 20 × 20 μm², with 512 × 512 pixels and a scan speed of 0.8 lines/s. Results. Pits were frequently seen in the hair shafts of patients with psoriasis, similar to those seen in their nail plates. Macropit number, scale thickness and surface roughness were all significantly increased in lesional hairs compared with both nonlesional and control hairs, and macropits and scale thickness were also increased in nonlesional hairs compared with control hairs. Conclusions. The hair shafts of patients with scalp psoriasis exhibited the same macropits seen in their nails. Both lesional and nonlesional hairs had similar changes in morphological structure compared with controls. This supports the generalized nature of psoriasis, with changes in hair structure being analogous to the changes seen in skin and nails.     

4种真菌引起儿童全身广泛感染1例

报告1例由4种真菌引起的儿童全身广泛性感染。患儿男,13岁。全身出现脱屑性红斑、斑块、脱发、灰甲及甲变形10年。头部皮损真菌学鉴定为许兰毛癣菌,臀部皮损培养见紫色毛癣菌生长,指甲刮屑培养出絮状皮癣菌,踝周鳞屑和趾甲屑培养为污染菌,舌部系白念珠菌感染,经伊曲康唑0.1g/d口服,治疗6周完全治愈。     

Videodermoscopy scalp psoriasis severity index (VSCAPSI): a useful tool for evaluation of scalp psoriasis

The standard methods used to diagnose scalp psoriasis vary in sensitivity, reproducibility, and invasiveness. Videodermoscopy can be used to explore microcirculatory modifications in skin diseases. Psoriasis presents three pathognomonic vascular patterns: red dots, hairpin vessels and red globular rings. Our aim was to create a videodermoscopy scalp psoriasis severity index (VSCAPSI) for evaluation of scalp psoriasis, especially mild and moderate forms that often are not clinically appreciable. VSCAPSI takes into account the area of the scalp affected by psoriasis, the presence and morphology of vascular patterns, the erythema and desquamation. Videodermoscopy images obtained between November 2009 to June 2010 from 900 participants with various scalp and hair disorders were reviewed for distinguishing features. During the 2010 Italian congress on psoriasis, in order to assess the reproducibility and efficacy of the VSCAPSI, 146 dermatologists were asked to evaluate 16 videodermoscopy images of scalp psoriasis using the VSCAPSI. Of the 900 patients, 85 new cases of scalp psoriasis were diagnosed. The other 815 patients were found to be suffering from different scalp and hair diseases. Of 146 dermatologists, 28 did not recognize erythema, 15 desquamation and 7 the vascular patterns. The VSCAPSI provides important evidence for early diagnosis, differential diagnosis, for follow-up and screening.     

Dermoscopic features of psoriasis of the skin,scalp and nails – a systematic review

Dermoscopy is a non‐invasive in‐office method, which enables the diagnosis of many dermatoses and reduces the need for performing biopsies. To date, no systematic review about the diagnostic usability of dermoscopy in psoriasis has been available. The objective of this article was to summarize and critically analyse literature data on the dermoscopy of skin, scalp and nail changes in psoriasis. A systematic search of three medical databases was performed. A total of 45 articles were included into the analysis. Cutaneous psoriatic lesions assessed in all studies at a low magnification showed regularly distributed red dots. At a 50‐fold or higher magnification capillary bushes (glomerular vessels) with a diameter range of 50–146 μm were observed. The background colour was described as reddish or pinkish with white or yellowish scales. The most frequent dermoscopic (trichoscopic) feature of scalp psoriasis was the presence of red dots/globules and twisted red loops. Typical dermoscopic (onychoscopic) signs of nail psoriasis were onycholysis, salmon patches and splinter haemorrhages. There is an accumulating body of evidence that dermoscopy (both handheld and videodermoscopy) is a useful tool in differential diagnosis in doubtful cases of psoriasis of the skin, scalp, nails, palms, soles and genital regions.     

Ⅰ型先天性厚甲症1例

患者男,32岁。指/趾甲增厚、变形和变色32年。皮肤科情况:手足20甲的甲板均明显增厚、变形和变色,右足第4趾背侧见一蚕豆大厚壁大疱,双侧掌跖角化,双侧肘部、臀部见数个角化性丘疹;黏膜、毛发未见异常,未见多发性脂囊瘤和表皮囊肿损害。诊断:I型先天性厚甲症。     

A Topical Treatment Program for Psoriasis with Low Anthralin Concentrations

A treatment program for psoriasis in which 0.01--0.05% anthralin was used has been clinically evaluated. In such low concentrations it is possible to use anthralin if one simultaneously avoids exposing the skin to unnecessary external mechanical trauma, including the mechanical removal of the scales from the lesions. Applied in this fashion, anthralin then also becomes most suitable for use in ambulatory therapy. In these low concentrations it does not irritate either the involved or the non-involved psoriatic skin. No discoloration of the clothes, the skin, the hair or the nails was observed.     

银屑病患者指甲和鳞屑的蛋白质SDS-电泳图谱和转谷氨酰胺酶活性探讨

目的:探讨银屑病患者指甲和鳞屑蛋白质十二烷基硫酸钠(SDS)-电泳图谱和转谷氨酰胺(transglutaminase 1,TGase1)酶的活性.方法:各取5例银屑病患者的指甲和鳞屑与5例健康人的指甲和鳞屑,分别提取蛋白质进行SDS-聚丙烯酰胺凝胶电泳(SDS-PAGE).应用辣根过氧化物酶(HRP)-单丹酰尸胺结合物对鳞屑铺片标本检测TCase 1酶活性.结果:健康人指甲和鳞屑的SDS-PAGE图谱皆呈现4条主带:63 ku、54 ku、48 ku及38 ku,银屑病患者指甲及鳞屑的SDS-PAGE图谱也呈现此4条主带,但多数主带扫描数值的水平较高,P<0.01.健康人的鳞屑铺片标本TGase 1酶活性呈现为棕黄色细颗粒定位于角质深层角质形成细胞(KC)的周缘;相比之下银屑病患者的TGase 1酶活性缺乏.结论:指甲及鳞屑的SDS-PAGE主带相似,前者图谱更清晰可能与其蛋白较稳定有关.银屑病患者比健康人的SDS-PAGE图谱主带表达水平升高,提示其KC可能呈增生状态,表达产物较多;患者TGase 1酶活性的缺如提示其表皮屏障功能有缺陷,可能与其参与代偿性增生有关.     

Adalimumab‐induced scalp psoriasis with severe alopecia

In recent years, with the increase usage of tumor necrosis factor (TNF) inhibitors, more side effects have revealed. The incidence of paradoxical psoriasis (psoriasis vulgaris, palmoplantar pustulosis, scalp psoriasis, or their combinations) ranges from 1 to 5%; however alopecia due to anti‐TNF‐α‐induced scalp psoriasis, rarely reported in the literature. We report a 37‐year‐old woman who developed palmoplantar pustulosis and scalp psoriasis with severe alopecia after 2 months of treatment with adalimumab for chronic plaque psoriasis. Biopsies from the palmar and scalp lesions showed psoriasiform changes. Adalimumab treatment was discontinued, and methotrexate was started (15 mg/weekly, subcutaneously) with topical adjuvant agents. A dramatic improvement was seen in both the skin and scalp with complete hair regrowth in 1 month. We conclude that, in anti‐TNF‐α‐induced scalp psoriasis, suspension of anti‐TNF‐α agent and systemic and topical treatments should be considered to avoid scarring alopecia.     

发疹型扁平苔藓1例

  报告1例发疹型扁平苔藓。患者男,69岁。全身暗红斑、丘疹伴瘙痒5个月。血糖升高9年余。皮肤专科检查：头面部、躯干及四肢可见暗红斑,部分融合成片,部分苔藓样肥厚明显,伴扁平丘疹及斑块,上覆细薄鳞屑,头部皮肤脱屑明显,未见束状发。口腔颊黏膜可见Wickham纹,生殖器黏膜见白色斑疹。皮损组织病理：表皮缺损,真皮浅层见带状的淋巴组织浸润,见色素失禁。PAS染色阴性。诊断:发疹型扁平苔藓;2型糖尿病。予小剂量激素联合羟氯喹治疗1个月后,遗留色素沉着斑,无新发皮疹。     

Long-term treatment of psoriasis with calcipotriol scalp solution and cream

The efficacy and safety of long-term concurrent twice-daily treatment of scalp and body psoriasis with calcipotriol scalp solution (50 mcg/ml) and calcipotriol cream (50 mcg/g) were evaluated in a prospective, multi-centre, open-label, non-controlled evaluation over 52 weeks in 202 patients. Safety and efficacy as measured by total sign score (scalp psoriasis), modified PASI (body psoriasis) and patient self-assessment were assessed at week 2, 6 and 10 and thereafter every six weeks. By week 28, mean total sign score for scalp psoriasis had reduced from 5.9 to 2.5 (p<0.001). No further reduction was seen. By week 34, mean PASI for body psoriasis had reduced from 6.8 to 2.6 (p<0.001). No further reduction was seen. At week 52, the percentage of patients assessing their psoriasis as moderate or severe had decreased from 72 to 21% for scalp psoriasis and from 62 to 19% for body psoriasis. Facial irritation was the most frequent adverse event (91/276 events) with the highest incidence occurring at week 2 and few new reports at subsequent visits. There were no significant changes in mean serum calcium, parathormone or urinary calcium/creatinine ratio. Combined treatment with calcipotriol scalp solution and cream was effective and safe for long-term treatment of scalp and body psoriasis.