1例全身多处溃烂的坏疽性脓皮病的护理

坏疽性脓皮病(pyoderma gangrenosum,PG)是一种病因不明的慢性复发性溃疡性皮肤病,其发病年龄多在25～40岁,儿童也可见[1],女性更易发病[2]。美国发病率每年约十万分之一,其中30%的患者有创伤和外伤史[3]。我院于2004年11月19日收治1例坏疽性脓皮病的患者,经积极治疗和有效护理,于2周后好转出院。现将护理体会报告如下。1病例介绍患者,女,40岁,因全身多关节肌肉疼痛3年余,皮肤多处破溃5月入院。于3年前右小指外伤后肿痛,当地诊所行切开取异物治疗。后近端指间关节疼痛未见缓解。其后肩关节、指间关节疼痛,即用强的松治疗,3年来从未间断。5…     

Clinical analysis of leg ulcers and gangrene in rheumatoid arthritis

Leg ulcers are often complicated in patients with rheumatoid arthritis (RA), however, the etiology is multifactorial. We examined the cases of leg ulceration or gangrene in seven RA patients who were hospitalized over the past 3 years. One patient was diagnosed as having pyoderma gangrenosum. Although vasculitis was suspected in three patients, no histological evidence was obtained from the skin specimens. In these patients, angiography revealed the stenosis or occlusion of digital arteries. In the remaining three patients, leg ulcers were considered to be due to venous insufficiency. Treatment should be chosen depending on the causes of leg ulcers.     

Superficial granulomatous pyoderma: a case report of two Japanese patients and clinical comparison with foreign patients

Superficial granulomatous pyoderma (SGP) is an unusual variant type of pyoderma gangrenosum characterized by a benign course and specific histological features; it is quite a rare cutaneous disorder in Japan. We reported two Japanese cases of SGP and compared the clinical features of 13 Japanese cases with those of 42 foreign cases. Case 1 was a 53-year-old female who presented with three indolent and ulcerative plaques with elevated edges on the back and the posterior portion of the left thigh. Case 2 was a 74-year-old female who presented with crusted and vegetative erythematous plaques on the left shoulder and left upper arm. Histological examinations revealed a characteristic three-layer granuloma in each case. Laboratory and physical examinations found no abnormalities. Topical corticosteroid, oral administration of minocycline, and/or additional supplementation with corticosteroid were effective. In comparison with foreign cases, Japanese cases show a possible differentiation in the ratio of sex and distribution of the ulcer. Females have a high incidence and the extremities are frequently involved area in Japanese cases. Up to now, 11 cases of SGP have been reported in Japan. To our best knowledge, our patients are the first Japanese cases described in the English literature.     

Rosacea fulminans in pregnancy

Rosacea fulminans is a rare condition with a female preponderance and unknown aetiology, characterized by the abrupt onset of papules, pustules and erythema affecting the face. Corticosteroids and isotretinoin are regarded as the two main therapeutic agents. We report a case associated with pregnancy, and discuss the therapeutic implications. This is the first published report of rosacea fulminans in pregnancy complicated by stillbirth.     

Behçet's syndrome with pyoderma-gangrenosum-like lesions treated successfully with dapsone monotherapy

Behçet's syndrome (BS) is a rare multisystem disorder belonging to a group of neutrophilic dermatoses. We report a 65‐year‐old male patient who had suffered from recurrent painful orogenital ulcers for 50 years from the age of 15 and started developing pustular and bullous lesions evolving into non‐healing ulcers similar to those seen in pyoderma gangrenosum (PG) two months prior to presenting to us. There was no evidence of systemic disease or malignancy. Routine baseline investigations were within normal limits. The patient was treated successfully with dapsone, antibiotics, and local wound care.     

Pyoderma gangrenosum in a patient with autoimmune haemolytic anaemia and complement deficiency

About 50% of cases of pyoderma gangrenosum (PG) are associated with a variety of systemic diseases. We describe a patient with severe PG on both legs who suffered from an autoimmune haemolytic anaemia in association with a congenital deficiency of complement factors C2 and C4. To the best of our knowledge, this constellation has not been previously reported.     

Treatment of pyoderma gangrenosum with oral Tripterygium wilfordii multiglycoside

Two patients with refractory pyoderma gangrenosum (PG) were treated with oral Tripterygium wilfordii multiglycoside (TWG). TWG is a Chinese medicine extracted from a medicinal herb, Tripterygium wilfordii Hook F, and has potent anti-inflammatory and immunosuppressive effects. The effect of TWG on PG was demonstrated by clinical findings. Improvement of the lesions occurred within two weeks, and the ulcers healed about a month. Mild side effects such as gastrointestinal disturbances were observed in both patients. These side effects were patient-acceptable, and there was no need to stop the treatment. Transient elevation of serum ALT was observed in one patient; the serum ALT returned completely to normal after the discontinuation of TWG. These results suggest that TWG may be an effective alternative for refractory PG and that careful monitoring of liver function during TWG treatment is necessary.     

Scabies and pyodermas – diagnosis and treatment

Scabies and pyodermas are two of the commonest skin infections in tropical settings. They affect large numbers of people, particularly children, and account for a large burden of disease for peripheral health care teams. Despite this there have been significant advances in our knowledge of these diseases, their impact and their management. However there is a need to evaluate these developments in this specific setting, tropical health and in the context of communities with limited resources. This section will describe these advances and the challenges that remain.