临床结合疱顶表皮病理鉴别诊断葡萄球菌性烫伤样皮肤综合征

目的 探讨鉴别葡萄球菌性烫伤样皮肤综合征及中毒性表皮坏死松解症的可靠方法.方法 观察并比较12例葡萄球菌性烫伤样皮肤综合征患者及6例中毒性表皮坏死松解症患者的临床表现和治疗情况,并利用患者皮损的疱顶表皮切片染色,了解其组织学表现.结果 葡萄球菌性烫伤样皮肤综合征的疱顶表皮组织病理均表现为由角质层和小部分残余颗粒层细胞组成.均未见表皮其他层次细胞.中毒性表皮坏死松解症患者的疱顶表皮组织病理均表现为疱顶表皮由表皮全层组成.角质形成细胞呈明显嗜酸性变性坏死;两组患者的疱顶表皮组织病理表现差异显著,临床诊断与疱顶表皮组织病理表现完全一致.结论 疱顶表皮组织病理检查可作为鉴别葡萄球菌性烫伤样皮肤综合征和中毒性表皮坏死松斛症的方法之一.

Differential diagnosis of staphylococcal scalded-skin syndrome and toxic epidermal necrolysis by clinical features and histopathological sections of blister roof

Objective To explore a reliable method to differentiate staphylococcal scaled skin syndrome （SSSS） from toxic epidermal necrolysis （TEN）. Methods Clinical manifestations and management were compared between 12 patients with SSSS and 6 patients with TEN. Blister roofs were obtained from all the patients, then subjected to histological section and HE staining. Results Histopathologically, blister roofs in SSSS were composed of stratum corneum and vestiges of stratum granulosum without any other strata involved. On the other hand, all epidermal strata were included in the blister roof of TEN with apparent eosinophilic necrosis of keratinocytes in the epidermis. Significant difference was observed between SSSS and TEN cases in the histopathological findings of blister roof, and all the histopathological diagnosis was consistent with clinical diagnosis of these patients. Conclusion Our results suggest that histopathological examination of blister roofs may be regarded as a reliable method to differentiate SSSS from TEN