白塞病78例临床分析

目的了解白塞病的临床特点。方法回顾性分析78例白塞病患者的诱因、起病类型、初发部位、临床表现、实验室和病理检查情况及其治疗方法。结果白塞病多见于女性,男:女=1:1.44,好发于青壮年(20~45岁),多为慢性起病,27例急性型发病诱因以上呼吸道感染为主(19例,占70.37%),最常见症状依次是口腔溃疡(96.15%)、皮肤损害(78.21%)、生殖器溃疡(42.31%)、眼部损害(37.18%),其余症状相对较少;实验室检查和病理检查无特异性,皮肤针刺反应阳性率52.56%。结论白塞病的诊断主要依靠临床症状,针刺反应有辅助诊断意义。     

美容注射术后皮肤脓肿分枝杆菌感染临床分析

对2018年12月至2019年12月我院确诊的7例皮肤脓肿分枝杆菌感染患者的临床资料进行回顾性分析。本文患者均在非正规医院行美容注射术,术后注射部位都发生脓肿分枝杆菌感染。7例患者均为多发皮损,且为美容注射后发病,表现为红斑、结节、脓肿、溃疡。病理呈感染性肉芽肿改变。6例皮损组织脓液培养结果为脓肿分枝杆菌,1例行组织PCR扩增提示脓肿分枝杆菌感染。诊断为皮肤脓肿分枝杆菌感染。给予克拉霉素、利福平、左氧氟沙星治疗,皮损均消退,随访半年无复发。     

20例鱼刺伤肉芽肿临床、病理及分子生物学检测分析

目的:分析鱼刺伤肉芽肿患者的临床特点、病理及分子生物学检测情况。方法:对我院门诊确诊的20例鱼刺伤肉芽肿患者临床资料进行回顾性分析。结果:20例患者中16例(80%)患者发病前有外伤史且与水产品或水有接触,4例(20%)无明显诱因;所有患者皮损发生于上肢,17例患者单侧发病,3例双侧发病;临床表现以原发皮疹、浅表破溃或多发结节为主。20例患者病理组织检查者均提示感染性肉芽肿;TB-IGRA阳性率为70%。17例(85%)患者于治疗后6个月内痊愈,1例治疗10个月后痊愈,2例正在随访中。结论:本文中患者海分枝杆菌感染多与日常接触水产品有关;临床以单侧发病为主;TB-IGRA阳性检出率高。     

HIV感染者皮肤黏膜表现的回顾性临床分析

目的:对HIV感染者皮肤黏膜表现展开回顾性临床分析,旨在为临床HIV感染者的临床表现与诊断提供有利依据。方法:对2011年12月至2013年12月期间两家医院收治的100例HIV感染者表现进行回顾性分析,并研究其一般资料与临床资料。结果:100例研究对象中,有皮肤黏膜表现患者68例(68.0%),其中男性65例(95.6%),女性3例(4.4%);大部分患者年龄20~50岁;未婚人数超过患者总人数一半35例,(51.4%);患者职业以农民为主,25例(36.8%);性接触传播61例(89.7%);有皮肤黏膜表现组相比于无皮肤黏膜表现组,CD4+细胞不足50个/μI者有皮肤黏膜损害的例数对比例数超过200个/μI者显著提升,即皮肤黏膜损害与低CD4+细胞间存在统计学相关性(P<0.05);有皮肤黏膜表现组出现艾滋定义性疾病患者例数显著高于无皮肤黏膜表现组,数据差异具有统计学意义(P<0.05);100例感染者的皮肤黏膜损害涉及4个种类,主要为真菌感染,合计24例(35.3%);病毒感染,合计13例(12.9%);呈现出其他皮肤病者,合计18例(26.5%);合并2种(含2种)以上皮肤黏膜疾病者,合计13例(19.1%)。结论:HIV感染者皮肤黏膜损害多见为真菌、感染,性传播途径为HIV感染重要途径之一,频发的皮肤黏膜病变以及合并性病感染可作为临床诊断HIV感染的重要依据。     

15例隆突性皮肤纤维肉瘤临床及病理分析

目的:分析15例隆突性皮肤纤维肉瘤(DFSP)患者的临床、病理表现。方法:对我院近20年来明确诊断的15例隆突性皮肤纤维肉瘤患者资料进行回顾性分析,分析其临床和病理组织学特点及治疗情况。结果:15例DFSP中男∶女为13∶2,平均年龄38.4岁,肿瘤为单发或多发性结节。最基本的组织学特点是病变在真皮,皮下组织内浸润性生长,瘤细胞形成典型的席纹状结构;免疫组化标记示vimentin阳性率100%(15/15)、CD34阳性率100%(15/15)、肿瘤细胞Ki-67阳性率大于10%比率为60%(9/15),CK、S-100、FVⅢa、CD68均阴性。其中12例行局部切除术,3例行扩大切除加植皮或转移皮瓣修补术。全组病例复发8例(53.3%),均为行局部切除术者。结论:DFSP是一种好发于真皮的低度恶性软组织肿瘤,免疫组化标记有助于明确诊断,外科手术是其主要的治疗方法,但局部切除常易复发。     

皮肤平滑肌瘤43例临床及组织病理分析

目的:探讨皮肤平滑肌瘤的临床及组织病理特点。方法:回顾性分析该科1989年6月—2019年6月经组织病理确诊的43例皮肤平滑肌瘤患者的临床及组织病理特征。结果:43例患者中男17例,女26例,其中25～60岁者最多见,占79.1%;病程20年者8例(18.6%);皮损位于下肢者最多见;伴疼痛者21例(48.8%)。所有样本中毛发平滑肌瘤16例(37.2%),血管平滑肌瘤22例(51.2%),生殖器平滑肌瘤5例(11.6%),术前正确诊断率为25.6%。结论:皮肤平滑肌瘤常见于中青年女性,多发者常见于躯干,单发者常见于下肢,误诊率高,皮损组织病理检查是唯一确诊手段。多发性皮肤平滑肌瘤可作为诊断潜在恶性肿瘤的线索。     

细菌性阴道病与生殖道支原体感染的相关性分析

目的初步探讨细菌性阴道病(bacterial vaginosis,BV)合并生殖道支原体感染的相关性。方法根据Amsel的BV诊断标准选择95名BV患者,同时选择91名非BV患者,以及84名健康体检者做为对照组,取宫颈分泌物做支原体培养。结果 95例BV患者支原体感染阳性55例,阳性率57.89%;非BV患者支原体感染30例,阳性率32.97%;健康体检者支原体感染18例,阳性率21.43%,BV患者支原体感染明显高于其他两者,具有非常显著差异(P0.01)。BV患者感染以人型支原体为主,其余两组以解脲脲原体为主。结论细菌性阴道病与生殖道支原体感染有一定的相关性,可能是支原体感染的诱因之一,临床诊治时应该注意。     

反射式共聚焦显微镜在头皮银屑病早期诊断中的应用

目的:探讨头皮银屑病的反射式共聚焦显微镜(RCM,简称皮肤CT)图像特征,分析皮肤CT在其诊治中的临床意义。方法:选取临床拟诊为头皮银屑病患者55例,分别行皮肤CT扫描检查和组织病理检查,分析皮肤CT对头皮银屑病的特征表现及诊断准确度。结果:头皮银屑病皮肤CT的主要特征为角化不全,Munro微脓肿,真皮乳头上顶、真皮乳头密度增加、规则排列,真皮乳头内明显迂曲扩张充血的血管。皮肤CT诊断银屑病47例(85.5%),通过病理检查确诊银屑病49例(89.1%),以病理检查为金标准,皮肤CT检查诊断的灵敏度为91.8%(45/49),特异度为66.7%(4/6),准确度89.1%(49/55),误诊率33.3%(2/6),漏诊率8.2%(4/49),Youden指数为0.585,Kappa值为0.510(P<0.05)。结论:RCM(皮肤CT)扫描检查对头皮银屑病具有辅助诊断及提供鉴别诊断线索的作用,值得临床推广。     

皮肤病护理

951417 116例SLE诱因分析与临床护理/张惠萍…//山西护理杂志。-1994,8(6).-165～166 首发症状的诱因为寒冷9例,妊娠分娩8例,日光照射7例,感冒7例,劳累4例,感染3例,饮食不当3例,精神刺激2例,油漆过敏2例,外伤、饮酒各1例,无明显诱因69例。患者初次发病无明显诱因者居多,占59.48％,而在病程中症状加重者大多有明显诱因,无诱因者占33.33％,二者间有显著性差异(P<0.     

成人过敏性紫癜28例临床分析

目的:了解成人过敏性紫癜的临床特点。方法:回顾性分析2005年5月至2010年6月在我院诊治的28例成人过敏性紫癜患者的临床和实验室资料。结果:本组病人以青壮年男性为主,冬、春季好发,上呼吸道感染为主要诱因,多数患者以皮肤紫癜为首发表现,双下肢为皮疹最易出现的部位,有关节损害者4例(14.3%),有胃肠道损害者5例(17.9%),有肾脏损害者7例(25.0%)。结论:成人过敏性紫癜除有皮疹表现外,可累及关节、胃肠道及肾脏。     

The prevalence of "high-risk" HPV types in penile condyloma-like lesions: correlation between HPV type and morphology.

OBJECTIVE--To evaluate the prevalence of "high-risk" human papilloma virus (HPV) types in penile condyloma-like lesions and to correlate HPV types with clinical and histological features. DESIGN--The study included 94 male patients with signs of penile HPV infection. From acuminate, papular and macular lesions, specimens were collected for HPV DNA hybridisation, using the dot blot and Southern blot techniques. Biopsy specimens from 51 cases were examined by light microscopy for signs of koilocytosis and dysplasia. SETTING--The STD outpatient clinic of the Department of Dermatovenereology of Sahlgrenska Hospital, Göteborg, Sweden. RESULTS--In 79 (90%) of 88 patients HPV DNA was detected by dot blot. Of 51 cases examined by histology 88% disclosed an evident koilocytosis. "High-risk" HPV types (16, 18, 31, 33, 35) were demonstrated in 8% of acuminate, 24% of papular and 56% of macular lesions. In 29% of 51 lesions examined histologically moderate to severe dysplasia was observed. There was a significant correlation between "high-risk" HPV types and dysplasia. CONCLUSION--"High-risk" HPV types are prevalent in papular and especially macular penile condyloma-like lesions. The histological finding of koilocytosis concomitant with dysplasia strongly indicates infection with a "high-risk" HPV type. Although the risk of penile cancer is low, it is from an epidemiological point of view important to diagnose these lesions. Until simple tests for HPV typing are available, biopsy for light microscopy (histology) should be obtained liberally from papular and macular condyloma-like lesions. In atypical cases of balanoposthitis HPV aetiology should also be considered.     

聚合酶链反应及转印杂交对尖锐湿疣复发的病因学研究

用通用引物介导的聚合酶链反应及其产物斑点杂交技术，对１５例复发及相应的原发尖锐湿疣（ＣＡ）皮损中人乳头瘤病毒相关序列进行了检测和分型；同时还对３５例原发ＣＡ周围外观正常皮肤组织ＤＮＡ作了转印杂交分析。结果表明隐性感染是ＣＡ复发的非常重要原因，再感染也是ＣＡ复发不容忽视的原因。     

Clinical features and outcomes of Sweet's syndrome associated with non‐tuberculous mycobacterial infection and other associated diseases

Sweet's syndrome (SS) is associated with various diseases including non‐tuberculous mycobacterial infection (NTM). Recent reports have shown that SS associated with NTM is increasing. Clinical features of SS associated with NTM may be different from SS associated with other associated diseases. The aim of the present study was to compare clinical parameters and treatment outcomes of SS associated with NTM and other associated diseases. Patients from January 2004 to April 2014 diagnosed with SS were retrospectively enrolled. Clinical variables were compared between SS patients with and without NTM infection. There were 51 SS patients during the study period; 36 patients (70.59%) had NTM. Clinical variables between the NTM and other associated diseases were comparable: age, sex, and pattern and locations of skin lesions. Five laboratory factors were significantly different between the groups including white blood cell counts (NTM 25 800 vs 12 850 cells/mm³), lymphocyte percentages (13.0% vs 18.7%), monocytes (3.0% vs 7.2%), blood urea nitrogen (BUN) (11.7 vs 8.1 mg/dL) and serum creatinine (Cr) (1.0 vs 0.7 mg/dL). The presence of markedly high white blood cell counts, a low percentage of mononuclear cells and high BUN/Cr levels in SS may be a clinical clue to recognize the association with NTM infections; particularly in dissemination.     

178例艾滋病皮肤表现的临床分析

目的:探讨艾滋病皮肤粘膜疾病的病种分布、临床表现特点。方法:回顾分析178例艾滋病患者住院期间皮肤粘膜疾病的种类、特征及实验室指标。结果:艾滋病皮肤粘膜损害复杂,以真菌、病毒感染为主,分别为165例(92.7%)、120例(67.4%),疾病种类依次为口腔念珠菌病、口腔毛状粘膜白斑、马内青霉病、带状疱疹等23种。有2种以上皮肤粘膜疾病者128例(71.9%)。91.6%的艾滋病患者皮肤粘膜疾病发生于CD4 T淋巴细胞小于200 cells/μL时,其中发生于小于50 cells/μL占74.7%。结论:艾滋病皮肤粘膜损害以真菌、病毒感染为主,皮损的镜检、真菌培养可作为艾滋病皮损常规检查之一,皮肤马内青霉感染是诊断艾滋病的重要线索,部分皮肤粘膜病变可作为诊断疾病进入艾滋病期的依据之一。     

Warty dyskeratoma--"follicular dyskeratoma": analysis of clinicopathologic features of a distinctive follicular adnexal neoplasm

BACKGROUND: The clinicopathologic spectrum of warty dyskeratoma (WD) is not well characterized and the pathogenesis of this unusual lesion is still unclear. OBJECTIVE: We reviewed the clinical and histopathologic spectrum of WD and investigated a possible involvement of human papillomavirus (HPV) infection in onset of this lesion. METHODS: A total of 46 cases of WD were analyzed clinically and histopathologically. Polymerase chain reaction (PCR) analysis for HPV-DNA was performed in 13 lesions of WD. RESULTS: A total of 46 lesions of WD from 45 patients (M/F ratio, 1:1.8; mean age 59.8 years, median 61 years, age range 3-88 years) presented as solitary papules or small nodules on the head and neck (32 cases), trunk (9 cases), lower extremities (4 cases), and upper extremities (1 case). One patient had 2 lesions. No patient had clinical signs of Darier's or Grover's disease. Histopathologically on scanning magnification, lesions showed mainly 3 architectural patterns, namely, cup-shaped (29 cases), cystic (6 cases), and nodular (2 cases). In 9 cases, a combination of two of these morphologic patterns was observed. Characteristically, the epithelial component in all WDs displayed foci of acantholytic dyskeratosis. Variable features suggestive of follicular differentiation toward the infundibular portion of a normal hair follicle were also observed, including a focal contiguity to pilosebaceous units in most cases (63%), and the presence of small infundibular cystic structures in a subset of lesions (46%). The majority of lesions (83%) also revealed a hyalinized or fibrous stroma with intrastromal clefts. PCR analysis for HPV-DNA performed in 13 cases inclusive of all representative architectural patterns was negative. CONCLUSION: We conclude that WD shows a wider spectrum of morphologic features than previously recognized. Despite some histopathologic similarities to viral warts, WD is not a manifestation of HPV infection. On the other hand, the majority of these lesions display overall histopathologic features consistent with a follicular adnexal neoplasm. On the basis of this finding, we propose the alternative term follicular dyskeratoma to better reflect the distinctive features of this peculiar lesion.     

Plexiform and other unusual variants of palisaded encapsulated neuroma

Palisaded, encapsulated neuroma (PEN) has been described as a predominantly solitary, nodular tumor; plexiform or multinodular growth patterns have not been reported in detail. We reviewed 55 PEN in order to evaluate: 1) the predominant growth patterns: 2) features that may indicate previous trauma; and 3) association with acne-like changes. Sixteen cases (29%) had growth patterns other than the solitary, nodular type. These patterns were: a) plexiform (7/16), b) multinodular (5/16), and c) fungating (4/16). Other unusual features included evidence of trauma, i.e., fibrosis, myxoid change, chronic inflammation (5/16), partially incomplete capsule (6/16), and association with acne-like features (13/16). These results suggest that: 1) plexiform or multinodular growth patterns occur relatively often in PEN; 2) some changes indicate a possible histogenetic relation to traumatic neuroma, probably via secondary traumatization; 3) a high frequency of association with acne-like changes which could imply, but does not prove, an acne-induced histogenesis; and 4) the differential diagnosis of cutaneous plexiform lesions should include PEN.     

Cutaneous non‐tuberculous Mycobacterial infections: a clinical and histopathological study of 17 cases from Lebanon

Background Only a few studies characterized cutaneous non‐tuberculous Mycobacterium (NTM) infections in this region of the world . Objective The aim of this study was to describe the epidemiological, clinical and histological findings of cutaneous NTM infections in Lebanon. Patients/Methods Retrospective study of 17 patients (19 histological specimens) diagnosed with cutaneous NTM infections and confirmed by culture‐based partial sequencing of the 16S rRNA gene at the American University of Beirut Medical Center between 2005 and 2008. Results Of 17 cases, 14 were caused by Mycobacterium marinum. All patients were immunocompetent except for one. Clinically, the most common presentation was multiple sporotrichoid lesions over an extremity (8/17). Many patients had peculiar presentations including bruise‐like patches, herpetiform lesions, annular ulcerated plaques, symmetrical nodules over the buttocks and locally disseminated lesions with surrounding pale halo. Almost all patients cleared their infection on either minocycline or clarithromycin monotherapies. Histologically, a dermal small vessel proliferation with mixed inflammation (granulation tissue‐like changes) was identified in 58% of specimens. The most common type of granulomatous inflammation was the suppurative (47%) followed by the tuberculoid (30%), sarcoidal (11%), and palisading (5%) types. Lichenoid granulomatous dermatitis was noted in 42% of cases. Special staining highlighted mycobacteria in only two specimens. Conclusions The incidence of cutaneous NTM infections is high in our area. Many patients had peculiar clinical presentations. Our study is the second to report the common presence of granulation tissue‐like changes as a good histological indicator of cutaneous NTM infections. Minocycline and clarithromycin remain the drugs of choice in our area.     

Rapid identification of cutaneous infections by nontubercular mycobacteria by polymerase chain reaction-restriction analysis length polymorphism of the hsp65 gene

BACKGROUND: Nontubercular mycobacteria (NTM) may cause cutaneous infections which are difficult to interpret due to the variability of the clinical manifestations. This study involved eight patients (four men and four women) with primary cutaneous infections caused by NTM; the skin lesions included dermo-hypodermal abscesses, suppurative granulomas, and papulonodules localized on the legs, arms, hands, and face. The general condition of the patients was relatively good and they were not immunosuppressed. METHODS: All samples were processed with standard methods and the isolates were identified by pattern restriction analysis after polymerase chain reaction (PCR-PCA) amplification of the heat shock protein of 65 kDa. RESULTS: In this way, we were able to identify three Mycobacterium chelonae strains, two Mycobacterium marinum, two Mycobacterium fortuitum, and one Mycobacterium avium. The lesions disappeared in 3 or 4 weeks after treatment with two or more antimicrobials. CONCLUSIONS: For a correct diagnosis of cutaneous infection by NTM, demonstrating the presence of mycobacteria is essential; routinely available techniques lack sensitivity and are extremely tedious; often mycobacteria are not seen after acid-fast stain. We used PCR-PCA to identify mycobacteria grown in liquid media; the time of identification of mycobacteria was shortened relative to conventional methods.     

皮肤非结核分枝杆菌感染2例报告

背景：非结核分枝杆菌的培养比较困难，国内关于确诊非结核分枝杆菌感染的报告很少，目的：探讨非结核分枝杆菌感染的实验室诊断方法及非结核分枝杆菌感染的治疗措施。方法：应用聚合酶链反应和ELISA技术进行实验室诊断，并以联合疗法分别治疗之。结果：2例非结核分枝杆菌感染患者经联合疗法治疗有显著疗效。结论：所用的聚合酶链反应和ELISA有助于诊断非结核分枝杆菌感染，氟嗪酸、利福平、氨苯砜联合疗法治疗有显著疗效。