痤疮型SAPHO综合征一例诊治分析及文献复习

SAPHO综合征是一组罕见的以皮肤和/或骨与关节炎性病变为主要临床表现的异质性疾病，其典型皮肤表现包括无菌性脓疱病及重度痤疮，此外还涉及化脓性汗腺炎、寻常型银屑病等，部分患者皮肤表现也可缺失。现代医学对本病的亚型分类尚未得到公认，各种亚型在治疗上是否应区别对待也未达成共识。既往中医药诊治SAPHO综合征的病例报道极少，尤其缺乏对痤疮型病例的治疗探讨。本文报道1例患者以“面部炎性丘疹、结节、囊肿3年，右臀区、右髋疼痛2周”为主诉于2017-04-27入住中国中医科学院西苑医院风湿病科，诊断为痤疮型SAPHO综合征，采用中医药治疗有效，揭示本型以湿热毒瘀为本，筋脉拘挛为标，临证应注意清热解毒药物、解痉止痛药物、入心经药物及藤类药物的使用，并结合文献研究探讨本病亚型分类的必要性与可行性。

Diagnosis and Treatment of SAPHO Syndrome with Severe Acne: a Case Report and Literature Review

SAPHO syndrome is a rare heterogeneous disease mainly characterized by inflammatory lesions of the skin and/or bone and joint.Its typical skin manifestations include aseptic pustulosis and severe acne.In addition，it also involves suppurative hyperhidrosis，psoriasis vulgaris and so on，while the skin disorder may also be absent.The subtypes of SAPHO syndrome have not been recognized，and there is no consensus on whether the various subtypes should be treated differently.So far，few cases of SAPHO syndrome treated by TCM have been reported，especially those with severe acne.A case of SAPHO syndrome with severe acne is reported in this paper，who was admitted to Rheumatology Department，Xiyuan Hospital，China Academy of Chinese Medical Sciences on April 27，2017 with a chief complaint of a three-year history of facial inflammatory papules，nodules，and cysts，and a two-week history of pain in the right gluteal region and right hip.He was diagnosed with SAPHO syndrome with severe acne and his conditions were improved significantly by TCM treatment，revealing that the subtype is mainly developed due to the stasis of dampness，heat and toxin in essence with tendon clonus as external manifestation，so the priority of treatment should be given to the use of heat-clearing and detoxifying drugs，antispasmodic and analgesic drugs，heart-entering meridian drugs and rattan drugs，while discussing the necessity and feasibility of SAPHO syndrome subtype classification based on a literature review.