大疱性类天疱疮23例误诊分析

目的分析大疱性类天疱疮的临床特点及误诊原因。方法回顾性分析2015年1月—2020年12月收治的23例误诊为其他疾病的大疱性类天疱疮临床资料。结果本组误诊率为67.6%。23例中误诊为湿疹14例,误诊为天疱疮5例,误诊为多形红斑2例,误诊为丘疹性荨麻疹和脐周炎各1例。误诊时间为3 d~2个月。患者行皮肤组织病理学和免疫荧光检查后,均确诊为大疱性类天疱疮,系统使用糖皮质激素及外用药膏治疗,除1例自动出院外,其余患者症状均明显好转。结论大疱性类天疱疮早期临床症状多样,缺乏特异性,临床医师必须熟悉掌握其临床特征和鉴别诊断,尽早行组织病理学及免疫荧光检查,以提高诊断准确率。

Misdiagnosis Analysis of 23 Patients with Bullous Pemphigoid

Objective To analyze clinical characteristics and misdiagnosed causes of bullous pemphigoid.Methods Clinical data of 23 patients with bullous pemphigoid misdiagnosed as having other diseases between January 2015 and December 2020 was retrospectively analyzed.Results The misdiagnosed rate was 67.6%.Among the 23 misdiagnosed patients,14 were misdiagnosed as having eczema,5 as having pemphigus,2 as having erythema multiforme,1 as having papular urticaria and 1 as having periumbilical inflammation.The misdiagnosed duration was from 3 d to 2 months.All patients were confirmed as having bullous pemphigoid after skin histopathology and immunofluorescence examinations.All patients were treated with glucocorticoid and topical ointment externally.Except one patient who was discharged voluntarily,the other patients showed significant improvement in their symptoms.Conclusion Because the early clinical symptoms of bullous pemphigoid are various and lack of specificity,the clinicians should be familiar with its clinical features and differential diagnosis,and perform histopathology and immunofluorescence examinations as early as possible in order to improve the diagnostic accuracy.