5例糖尿病性皮肤病的临床分析

５例糖尿病性皮肤病的临床分析周湘兰（上海医科大学附属金山医院内分泌科２００５４０）糖尿病是一组全身性的内分泌疾患，可累及包括皮肤在内的任何组织和器官。Ｇｉｌｇｏｒ和Ｌａｚａｒｕｓ（１９８１）〔１〕报告约有３０％的糖尿病患者伴发皮肤病变，在这些皮肤病变...     

糖尿病伴发皮肤病28例分析

糖尿病常伴有多种皮肤损害,且皮肤损害的程度多与糖尿病病程,病情关系密切。如果仅考虑微循环代谢障碍及其对皮肤胶原蛋白的影响,几乎所有糖尿病患者均有皮肤受累。在糖尿病确诊前,不少人以皮肤病就诊,认识糖尿病合并皮肤病的特点,可为早期诊断糖尿病提供线素,现将我们诊治的糖尿病伴发皮肤病28例分析如下:1临床资料1.1一般资料28例患者均按诊断标准确诊为Ⅱ型糖尿病,其中:男12例,女16例,年龄30~70岁,病程6m—35ye,30~50岁8例,50岁~70岁20例,空腹血糖7.6~18.5mmol/L,餐后2h血糖10.8~22.5mmol/L,糖化血红蛋白(HbAlc)7.5%~14%,其中3例并糖尿…     

78例糖尿病皮肤病变临床分析

糖尿病皮肤病变近年来国内外已有一些报道[1～4],皮肤病变比较直观可为糖尿病早期诊断提供线索。现对我们见到的78例糖尿病皮肤病变分析报告如下。临床资料　本组患者为本院内分泌科和皮肤科门诊及住院病人,糖尿病诊断符合ＷＨＯ1981年诊断标准。其中男49例,女29例,年龄30～89岁,平均59.5岁。皮肤病变发病时糖尿病病程<5年37例,5～9年20例,10～14年8例,≥15年13例。皮损表现　见附表。78例中真菌感染发病率最高,占19.23%,女性多见,多为白念珠菌感染。大疱症均在有严重并发症时发生,5例中2例死亡。　　讨论　本组中真菌感染发病率最高,与陈锡…     

196例糖尿病患者皮肤病的临床浅析

皮肤损害不仅是皮肤病主要临床表现,也是一些全身性疾病的外在反映。就糖尿病而言,皮肤损害为多种多样。我们在1989年3月—1990年3月,对196例临床确诊为糖尿病的患者进行了皮肤病学检查及有关资料的收集,现报告如下:     

162例2型糖尿病合并皮肤病临床分析

目的：进一步认识2型糖尿病合并皮肤病变类型及特点,以早期发现及诊断糖尿病,减少漏诊。方法：对我院门诊250例2型糖尿病患者进行皮肤病变调查,对其中162例合并皮肤病变者进行临床分析。结果：糖尿病患者中合并皮肤病变者占64．8％,其中感染性皮肤病居首位,各种皮肤病变中位居前三的为甲真菌病38.9％,湿疹19.7％,瘙痒症14.8％。42．5％患者合并多种皮肤病变。结论：糖尿病患者易发生合并皮肤病变。经久不愈、反复发作的皮肤病患者应注意监测血糖,做到对糖尿病的早发现、早诊断、早治疗,提高患者的生活质量。     

阴囊瘙痒性皮肤病578例临床分析

本文对我科于2004年1月~2006年6月,诊治的578例阴囊瘙痒性皮肤病患者的临床资料进行回顾性分析,现报道如下。1临床资料与方法1.1临床资料所有的病例均来源于我科门诊及住院患者,共578例,发病年龄从出生10天~82岁,平均(32.31±17.15)岁,其中<1岁者94例(16.26%),1~20岁143例(占24     

糖尿病性皮肤病1例

患者男,80岁.双下肢出现水疱近1个月.患者10余年前自觉多饮多食,半年内体重下降5 kg左右,查空腹血糖8.4 mmol/L(正常值3.61～6.11 mmol/L,以下同),餐后2 h血糖14mmol/L,诊断为2型糖尿病,予以阿卡波糖(每次50 mg,每日3次)治疗,空腹血糖波动在8～10 mmol/L.近1个月来,患者血糖最高值达12 mmol/L,双足跖、小腿陆续出现大小不等的水疱,发病部位无烫伤及外伤史.高血压病史20余年,冠心病、阵发性房颤、心功能Ⅲ级10余年,脑梗死、老年性痴呆8年.2005年11月20日曾因"慢性支气管炎急性发作、阻塞性肺气肿"入住我院.     

新生儿皮肤病1042例临床分析

新生儿时期 ,是皮肤病的高发病期。在许多方面有特殊的临床表现。为了了解新生儿皮肤病的特点 ,提高对新生儿皮肤病的预防和诊治水平 ,防止或减少新生儿皮肤病的发生。现将我院新生儿病房在 1995年 10月～ 1999年 10月期间收治的患儿所患皮肤病的情况分析如下 :1　临床资料1 1　一般资料　本院新生儿病房于 1996年～ 1999年期间收住患儿 1182例 ,患有皮肤病或患有儿科疾病伴发皮肤病的新生儿 10 42例。其中男 5 5 8例 ,女 484例 ,男女之比为 1∶1 2。年龄最大为出生后 2 8天 ,最小为出生后 3小时。足月产 96 0例、非足月产 82例。1 2　统计…     

化妆品皮肤病153例临床分析

近年来 ,随着化妆品的广泛应用 ,由化妆品引起的不良反应报道日渐增多 ,本文对近三年来我科诊治的由化妆品引起的皮肤病 15 3例进行临床分析 ,现将资料报道如下 :1　临床资料1 1　性别与年龄分布　 15 3例中女性 114例 ,男性 39例 ,年龄 14～ 71岁 ,14～ 2 0岁 18例 ,2 1～ 30岁 42例 ,31～ 40岁 39例 ,41～ 5 0岁 2 3例 ,5 1～ 6 0岁 2 7例 ,6 1～ 71岁 3例。1 2　临床类型　 15 3例化妆品皮肤病中表现为急性、亚急性皮炎的有 132例 ,霜膏类及纹眉引起的皮炎常局限于用药部位。染发皮炎往往除头皮部红斑、丘疹、水疱外 ,耳后、颈部、面部均…     

Cryoglobulinemic syndrome: presentation of four cases with skin involvement

Cryoglobulins are serum immunoglobulins that precipitate reversibly when the serum is cooled below 371 degrees C. In cryoglobulinemic syndrome, a multitude of organs can be involved, but many patients suffer from a moderate, chronic disease consisting of palpable purpura, arthralgia and fatigue. Skin involvement is especially useful in aiding early recognition of this entity. We present four patients with cryoglobulinemic syndrome and skin lesions, in whom it was not possible to find an etiological or associated factor. We discuss the etiopathogenesis, clinical and pathological findings, treatment and prognosis of this entity.     

Lichenoid folliculitis of the scalp in four patients with ichthyosiform skin disorders and cicatricial alopecia

Ichthyosis is a heterogeneous group of inherited skin disorders characterized by a defect of keratinization. Patients diagnosed with lamellar ichthyosis (LI) and some ichthyosiform syndromes, such as the Conradi‐Hünermann‐Happle syndrome (CHHS), usually present with hair loss. Even though only few dermatologic complaints carry as many emotional overtones as hair loss, there are very few data available in the literature regarding scalp histopathological features in ichthyosis. A better understanding of scalp changes in such context may result in new therapeutic strategies that in turn would enhance patients' self‐esteem and quality of life. The aim of this paper is to describe the scalp histopathological findings of four young patients with cicatricial alopecia: three diagnosed as having LI and the fourth with CHHS.     

The lymphocytic infiltrates in the ear-Lobe skin of diabetics

Summary In 1953 Jessner and Kanoff described a special type of infiltration of the skin. Later, similar findings were described as an accompanying phenomenon in different diseases and as a reaction to variable factors. There are as yet no data about these infiltrates in connection with diabetes.In this investigation the material from 117 human ear-lobes (26 healthy and 91 diabetics, all aged between 20–45 years) was histologically analyzed. It was established that lymphocytic infiltrates were present in 2/3 of the diabetic patients and less than half of the healthy persons. The difference between these groups of persons was statistically significant.Accordingly it can be said, that a sort of Jessner-Kanoff infiltrate can also be seen in the ear-lobe skin of diabetics, and that this method could be applicable as an additional method for diagnosing diabetes.

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Zusammenfassung 1953 beschrieben Jessner und Kanoff bekanntlich eine besondere Form von Hautinfiltration, die später auch als Begleiterscheinung bei verschiedenen Erkrankungen und als Reaktion auf verschiedene Ursachen gesehen wurde. Beobachtungen über eine Verbindung mit Diabetes mellitus liegen bislang nicht vor.In der jetzigen Studie wurde Excisionsmaterial von 117 menschlichen Ohrläppchen (26 gesunde Personen und 91 Patienten mit Diabetes mellitus, Gesamtalter 20–45 Jahre) histologisch untersucht. Lymphocytäre Infiltrationen lagen bei zwei Drittel der Diabetes-Patienten und in weniger als der Hälfte der gesunden Kontrollpersonen vor. Der Unterschied zwischen den beiden Gruppen ist statistisch signifikant.Es zeigt sich damit, daß Jessner-Kanoff'sche Infiltrate auch in den Ohrläppchen von Patienten mit Diabetes mellitus gefunden werden können und daß diese Beobachtung als ein weiteres Hilfsmittel für die Diagnostik eines Diabetes mellitus herangezogen werden kann.

     

Peeling skin syndrome in eight cases of four different families from India and Bangladesh

Peeling skin syndrome (PSS) is a rare recessively inherited ichthyosiform genodermatoses characterized by superficial skin peeling. This has 2 subtypes, acral (APSS; OMIM 609796) and generalized form (OMIM 270300). The later has been subdivided into type A (non-inflammatory) and type B (inflammatory). Eight cases of peeling skin syndrome in 4 families were recorded over a period of 5 years. They were diagnosed clinically and confirmed histopathologically. Disease onset ranged from birth to childhood age (mean 5.25 ± 4.528 years) and age at presentation ranged from 7-35 years (mean 23.25 ± 10.471 years). Males outnumbered females (M:F - 5:3). All had non-inflammatory generalized disease of type-A PSS variety, except one who had type-B PSS. Two Muslim families (1 st and 2 nd family, total 5 patients) came from nearby country Bangladesh, and the 2 Hindu families were Indian. Higher severity over acral areas in generalized type, possible autosomal dominant pattern of inheritance and improvement with age as found in this series were new manifestations and possibly unreported previously. The disease was found to be poorly responsive to oral retinoids. Prevalence of the disease may be higher than expected. Importance of mutational analysis was also highlighted.     

Twenty MHz B-scan sonography for visualization and skin thickness measurement of human skin

As a non-invasive method, ultrasound is a suitable diagnostic procedure for routine in vivo examination of the human skin in dermatology. In this study 40 healthy test subjects were examined with a 20-MHz ultrasound scanner in order to determine the thickness and morphology of normal skin at 51 different sites. B-mode ultrasonography permits us to measure both the individual layers of the skin and deeper structures and to assess their definition and echogenicity. In both sexes the greatest skin thicknesses were found on: the shoulder-blade (mean thicknesses (mm), males 3.07/ females 2.47); the upper back (m, 3.04/f, 2.85); the chin (m, 3.04/f, 2.69); the lower lip (m, 2.66/f,2.50) and in the region of the lower back (m, 2.64/f, 2.39). Particularly thin skin was found on: the upper eyelid (m, 0.59/f, 0.64); the lower eyelid (m, 0.99/f, 0.86); in the groin (m. 0.97/f, 0.90); in the armpit (m, 1.01/f, 1.09) and on the forearm (m, 1.13/f. 1.00 mm). Knowledge of differences in the characteristic reflex patterns depending on the sex and age of the subject and the site of the skin examined forms the basis for assessment of pathological sonograms.     

Suicide risk in skin disorders

Suicide accounts for about 1,000,000 deaths worldwide every year and is among the leading causes of death in young adults. Reports of high prevalence of suicidal ideation and increased suicide risk in several skin diseases raised concerns about deliberate self-harm in dermatological patients. The literature consistently points to an increased suicide risk in patients with psoriasis, atopic dermatitis, and acne, with higher risk in patients in whom the skin condition is associated with clinically significant emotional distress, changes in body image, difficulties in close relationships, and impaired daily activities. Other risk factors for suicide include a history of suicide attempts, severe mental or physical disorders, alcoholism, unemployment, bereavement or divorce, and access to firearms or other lethal means. Dermatologists may play an important role in recognizing suicidal ideation and preventing fatal self-harm in their patients. Increasing dermatologists' awareness of the issue of suicide and developing mental health consultation-liaison services within dermatology settings would be instrumental in contributing to suicide prevention in this population.     

Mechanisms in allergic skin disorders

Background Allergic skin disorders are initiated and maintained through the action and interaction between resident tissue cells, infiltrating leucocytes and mediators. Review The major cellular components of the skin immune system are keratinocytes, dendritic cells such as epidermal Langerhans cells (LCs) and dermal dendritic cells, mast cells and fibroblasts. Following an allergenic stimulus, inflammatory and immunocompetent cells accumulate in the epidermis and dermis, giving rise to specific clinical and histological manifestations. Leucocytes which accumulate in the inflammatory focus attract more leucocytes and stimulate the resident cell population. Primary mediators, released by resident cells upon stimulation, play a vital role in initiating and controlling inflammation. The mediators induce vascular endothelial cells to express adhesion molecules, which mediate migration of leucocytes into the dermis, where chemotactic factors attract them to the inflammatory focus. Activation of trapped T-lymphocytes by antigen-presenting cells (APCs) is followed by the release of inflammatory cytokines. Allergic contact dermatitis (ACD) depends on the activation of specifically sensitised T-cells, and epidermal LCs are the primary APCs. Most contact allergens are small, chemically reactive moleculed and CD4⁺ Th1 type T-cells are the target cells. Atopic dermatitis is a chronic eczematous condition, involving antibody IgE, LCs and dermal dendritic cells as the APCs, with Th2 T-lymphocytes as the target cells. Urticaria comprises a heterogeneous group of conditions, characterised by a wheal and flare reaction. Mast cells are the principal source of mediators involved and histamine is the most important of these.