结节性类天疱疮1例

临床资料患者女,76岁。周身起结节1年、疱疹半年伴瘙痒,加重1月就诊。患者1年前开始周身皮肤起丘疹、结节、半年后起水疱,伴有瘙痒,曾就诊于多家医院,考虑为“湿疹、结节性痒疹”,给予治疗（具体不详）,病情时轻时重,近1月皮疹逐渐加重,瘙痒剧烈,影响睡眠,为求进一步诊治,门诊以“类天疱疮”收入院。患者发病以来,无发热,     

红皮病型银屑病合并kaposi水痘样疹1例

临床资料 患者男,46岁.因周身反复起红斑鳞屑疹伴痒30年,弥漫潮红、肿胀、脱屑4天入院.患者30年前双肘部出现红斑鳞屑疹,未诊治,皮疹渐波及周身,在当地医院诊断为“寻常型银屑病”,应用皮炎平等多种外用药,皮疹好转,但反复发作,冬重夏轻,1年前患者周身起脓疱,拟“脓疱型银屑病”入我院,应用地塞米松针治疗,好转后出院.4天前患者无明显诱因周身皮肤弥漫潮红、肿胀、脱屑,痒伴发热,最高达38.5℃,并于面部出现水疱、脓疱,在当地诊所静点头孢类抗生素及口服中药,未见好转,为求系统治疗来诊,门诊拟红皮病型银屑病收入院.     

非霍奇金淋巴瘤伴发多型红斑、红皮病型银屑病1例

患者女,33岁,因“周身起皮疹伴痒10天”为主诉于2002年11月19日入院治疗。患者于三个月前在辽宁省肿瘤医院诊断为非霍奇金淋巴瘤,近3个月间断化疗,前后用药有多种,包括化疗药顺铂、竹叶乙甙、环磷酰胺、长春新碱、平阳霉素以及地塞米松和止吐药格拉斯琼等。     

银屑病合并天疱疮1例

临床资料 患者男，60岁。2004年8月，患者以“周身水疱1月”为主诉入院。患者曾于1997年12月，因染发过敏诱发银屑病加重，周身潮红，肿胀，脱屑，渗出曾住我院。取皮损组织病理诊断“落叶型天疱疮”，给以甲泼尼龙40mg/d，银屑灵40mg/d，环磷酰胺0．2qod，病情控制，治疗1个月后激素减为泼尼松45mg/d出院。半年后当泼尼松减量为15mg/d，病情反复，再次入院，泼尼松30mg/d，控制病情。2004年4月，     

天疱疮合并Busse—Buschke型念珠菌性肉芽肿1例

天疱疮合并念珠菌性肉芽肿者临床上较少见，现报道1例如下。 临床资料 患者女，48岁。以“周身起水疱、大疱5年，右小腿红肿、破溃伴痛痒20天”就诊，门诊拟“天疱疮”收入院。     

银屑病并发外阴鲍恩病1例

<正>患者女,54岁。主因周身反复起红斑、鳞屑20余年于2014年4月23日由门诊以"银屑病"收入院。患者20余年前无明显诱因周身散在起红斑,上覆白色鳞屑,就诊于某诊所,诊断为银屑病,给予药膏外用(具体不详),效果欠佳,皮疹冬重夏轻,未予系统治疗。之后患者曾自行外用曲安奈德新霉素贴膏半年余,二三天更换1次,效果欠佳。外阴皮疹半年余,时有瘙痒等不适,自以为是银屑病皮疹,曾外用糖皮质     

扁平苔藓样药疹1例

临床资料 患者男,67岁。因周身出现蓝紫色斑疹、丘疹、斑块,伴痒4月余,加重2个月,于2011年7月25日就诊我院皮肤科。
　　患者曾因咳嗽、发热20天以“双肺结核病”于2010年10月8日入住我院结核科,入院后给予抗结核治疗24天,病情好转出院。出院后间断服用利福平胶囊、异烟肼片、盐酸左氧氟沙星片、肺泰胶囊、利福喷丁胶囊,抗结核治疗大约4个月后于双前臂出现少量紫色斑,后于其上出现丘疹、斑块,搔抓后渗液,痒感明显。2011年4月在我院门诊诊断为扁平苔藓,未治疗,2个月前皮疹增多,加重,逐渐延及头皮、躯干及四肢,为求进一步诊治,再次就诊我院皮肤科,门诊以扁平苔藓收入院。患者自发病以来无发热流涕,无咳嗽咳痰,无胸闷心悸,无恶心呕吐,饮食、睡眠可,大小便正常,体重无明显改变。     

结节性多动脉炎1例

临床资料 患者男，35岁。因“周身散在结节、破溃8个月”于2009年4月至我科就诊入院。8个月前无明显诱因于左踝部出现一小结节，渐增大、隆起，表面呈紫红色，无痛痒，抓破后不愈合，随之结节多发于全身，以颜面部、左下肢、右前臂为著。入院1个月前就诊于外院，病理诊断为“血管炎”，     

带状疱疹并发腓总神经麻痹1例

临床资料 患者男，75岁。因左腿疼痛半月、左小腿、左足起疱、麻木、行走不便3天，于2005年1月20日来我院诊治。患者半个月前无明显诱因出现周身不适、乏力，随后出现左下肢疼痛，以膝部以下明显，曾按“静脉炎”静滴青霉素，效果不显。3天前左小腿、左足出现水疱，伴疼痛、麻木、左足行走不便而入院。病来无头晕、头痛，二便正常。体检：一般状况好，神清，语利，颅神经（-）。胸腹部检查无异常。皮肤科检查见左小腿外侧、左足外侧皮肤群集米粒大丘疱疹、水疱，基底红色浸润，水疱群之间有正常皮肤，左小腿外侧、左足外侧痛觉减退，深感觉正常，     

红皮病伴下睑外翻和Kaposi水痘样疹1例

患者男，70岁， 因周身皮肤潮红、脱屑3个月，伴双下睑外翻1周入院。患者16年前无明显诱因下面部出现红斑、丘疹，皮疹反复发作，累及躯干、四肢，伴明显皮肤干燥、瘙痒。曾多次住院治疗， 曾考虑“嗜酸细胞增多性皮炎”“泛发性湿疹”。住院期间系统和局部给予糖皮质激素治疗，出院后不规则使用糖皮质激素等外用药膏（具体不详）……     

Nosocomial outbreak of scabies

During the last quarter of 1976, a nosocomial outbreak of scabies occurred in a 558-bed community teaching hospital. There had been scattered reports of scabies throughout Michigan for nearly a year prior to this outbreak. The epidemic spread of scabies from a patient to 38 hospital employees and their families and associates was identified from historical, clinical, and microscopic skin preparation data.     

Risk factors of scabies in psychiatric and long-term care hospitals: A nationwide mail-in survey in Japan

Despite the commonness of scabies in Japanese institutional settings, the nationwide prevalence of scabies has not been elucidated. This study was conducted to assess the prevalence of scabies and control measures in Japanese hospitals. A questionnaire on scabies epidemiology (e.g. number of patients and onsets of outbreak) and preventive measures were sent to psychiatric hospitals and long-term care hospitals nationwide ( n  = 1795) in January 2005. Seven hundred and forty-one hospitals responded (41.3%). Three hundred and thirty-three (44.9%) respondent hospitals had one or more scabies cases in 2004. Among 159 hospitals that had experienced scabies outbreak, only 32 of them reported cases of crusted scabies. Multivariate regression analysis showed that hospitals had a greater number of beds, and that acute- and long-term care wards were more likely to experience scabies onsets. Hospitals that compiled their infection control manuals on scabies, treated suspicious patients with scabicides without confirmed diagnosis, and performed skin checkup of inpatients were more likely to experience scabies cases. Infection control personnel should be aware that unrecognized crusted scabies can cause outbreaks. Higher patient turnover is a risk factor for scabies introduction into a hospital. Preventive measures against scabies, such as patient screening at admission and treating all suspicious patients without confirmed diagnosis, were not effective to avoid scabies introduction.     

Atypical crusted "Norwegian" scabies: report of nosocomial transmission in a community hospital and an approach to control

During August, 1981, a person with an unrecognized case of atypical Norwegian scabies was admitted to a community hospital in Chariton, Iowa. Twenty cases of symptomatic scabies were reported among hospital staff; mites were recovered from four. Subsequent evaluation confirmed scabies transmission to family and friends of this patient before hospitalization; twelve cases of symptomatic scabies, three of them slide positive, were identified in this group. The patient was treated sequentially with 1 percent lindane lotion, 10 percent crotamiton lotion, and 6 percent sulfur ointment to successfully eradicate the infestation. Secondary cases in the hospital and community were treated with 10 percent crotamiton which also was used to prophylactically treat exposed contacts. Control measures and patient management are presented.     

Skabiesepidemie in einer Behindertenwerkstatt – was tun?

Scabies is an infectious parasitic skin disease with a notable rising incidence in Germany. The disease is usually transmitted by close physical contact, but indirect spread e.g. by bedding is also possible. Due to its contagiousness, introduction of scabies into crowding living facilities, such as dormitories or kindergartens, can easily cause an epidemic outbreak. We describe an epidemic of scabies in a workshop for handicapped people in February 1998. A worker with severe scabies reported that numerous colleagues in both workshop and the associated hostel had complained of pruritus for months and that some of them already had undergone scabicide treatment. The number of contacts (staff, colleagues, friends, attendants, family) of our patient and the other already affected people was more than 460. The management of the workshop asked for help in handling the epidemic. We describe the cooperative efforts of the management, as well as hospital and private dermatologists, to evaluate all potential contacts and present a concept of treatment for the termination of such an epidemic outbreak of scabies.     

误诊为湿疹的挪威疥一例

患者，男，24岁。全身皮肤起丘疹伴瘙痒1年余就诊。当地医院曾按“泛发性湿疹”予抗过敏治疗，皮损未见好转。取皮疹鳞屑镜检见疥螨。诊断：挪威疥。经治疗痊愈。     

Bullöse Skabies und durch Skabiesbefall getriggertes bullöses Pemphigoid

Two patients were admitted to our hospital with tense blisters on an erythematous base, typical for bullous pemphigoid. In both patients an infestation with Sarcoptes scabiei was diagnosed by dermatoscopy as well as histological examination. In one patient the clinical diagnosis of bullous pemphigoid could be confirmed by immunofluorescence microscopy, histopathology and a clinical relapse of bullous pemphigoid without scabies infestation. In the other patient no evidence for an autoantibody-mediated autoimmune blistering disease was found.We postulate that bullous scabies could develop after long persistency of the parasites leading to a specific immune response with activation of T helper type 2 (Th2) cells causing high levels of the cytokine interleukin 5 and then consecutively eosinophilia. Secretion of proteolytic enzymes near the basal membrane zone might explain the development of intraepidermal, often suprabasal blisters. In contrast, in the first patient the scabies infestation might have triggered a flare up of the underlying autoimmune disease. Comparison of our two patients demonstrates two entities: bullous pemphigoid triggered by scabies as a Koebner phenomenon and a bullous subtype of scabies mimicking bullous pemphigoid.Therefore both, scabies infestation triggering bullous pemphigoid and bullous pemphigoid-like scabies should be included in the differential diagnosis of vesicles, tense blisters and erythema, especially at an early clinical stage.     

Risk factors for recurrence of scabies: a retrospective study of scabies patients in a long-term care hospital

A considerable number of patients suffer recurrence of scabies. To elucidate risk factors for recurrence of scabies, we compared patients who experienced scabies recurrence and those who suffered scabies only once. We conducted a retrospective review of medical records of all scabies patients in a long-term care hospital for the elderly (300 beds; six wards) for a period of 42 months to determine frequency of scabies onsets, underlying diseases, history of treatment, and demographic data such as age and sex. One hundred and forty-eight patients and five hospital staff members suffered scabies during the 42-month study period. All staff members and 98 patients had no recurrence, while 50 patients experienced at least one recurrence of scabies. The cumulative number of scabies diagnoses was 228. The rates of scabies onset and recurrence were considerably different among wards. The dementia unit showed the highest rate of onset and recurrence. In addition to frequent exposure to infectious sources, problematic behavior, such as lying in other patients beds, might cause the high recurrence rate in dementia units. Higher serum total lymphocyte count and topical use of γ-benzene hexachloride were associated with lower risk of scabies recurrence. Recurrence of scabies is not uncommon among elderly patients in institutional settings. Impaired immunity may be a risk factor for recurrence of scabies. Groups with a high onset rate of scabies pose a high likelihood of recurrence. Problematic behavior of demented patients may increase the risk of recurrence. Use of effective topical treatment may effectively prevent recurrence.     

Crusted ("Norwegian") scabies in a specialist HIV unit: successful use of ivermectin and failure to prevent nosocomial transmission.

A nosocomial outbreak of scabies in a specialist inpatient HIV unit resulted from a patient admitted with crusted scabies. Treatment of his infestation with topical scabicides alone failed and he remained infectious for several weeks. His infestation was then eradicated with combined topical treatment and oral ivermectin. In total, 14 (88%) out of 19 ward staff became symptomatic, and 4 (21%) had evidence of scabies on potassium hydroxide examination of skin scrapings. The ward infection control policy was changed to distinguish patients with crusted scabies from those with ordinary scabies. A second patient with crusted scabies was treated with combined oral and topical therapy early in his admission and nursed with more stringent isolation procedures. No nosocomial transmission occurred and his infestation responded rapidly to treatment. Patients with crusted scabies require strict barrier nursing if nosocomial transmission is to be avoided. Ivermectin combined with topical scabicides may be a more efficacious treatment than topical scabicides alone in such patients.     

Crusted Norwegian scabies in an adult with Langerhans cell histiocytosis: mishaps leading to systemic chemotherapy

BACKGROUND: Crusted Norwegian scabies is a rare hyperkeratotic variant of scabies infestation. We report herein a case of crusted scabies in a woman with underlying Langerhans cell histiocytosis (LCH). OBSERVATIONS: A 49-year-old woman with LCH was hospitalized owing to marked thrombocytopenia. Her hyperkeratotic skin eruption was thought to be secondary to LCH because several years earlier, she had positive biopsy findings and had been diagnosed as having LCH. After a 1-month hospital stay, her laboratory values improved despite worsening of her skin lesions. CONCLUSION: Analysis of skin scrapings confirmed the presence of scabies, and resolution was achieved with a 1-dose ivermectin treatment.     

Norwegian scabies. A new complication of immunosuppressive therapy

The second reported case of Norwegian scabies in an immunosuppressed patient is presented. This uncommon fulminant form of scabies is difficult to diagnose and may give rise to numerous secondary cases of routine scabies. Because of the current widespread use of immunosuppressive medication, it is believed that an increasing number of cases of Norwegian scabies will be seen and that an increased awareness on the part of clinicians will be necessary in order to diagnose such cases early in their course before numerous hospital personnel are infested.