摘要
目的:探讨分析泛发性脓疱型银屑病的诱发或加重因素、临床表现、各种相关的实验室检查以及五种不同的治疗方法。方法:通过收集了1993年～2006年我科收治的33例泛发性脓疱型银屑病患者的病例,回顾分析了泛发性脓疱型银屑的多种诱发或加重因素及各种诱因或加重因素所占的比例,临床表现尤其是所伴发的全身症状的不同表现,各种实验室相关检查及五种不同的治疗方案的对比。结果:本组33例泛发性脓疱型银屑病病例中,找不到诱发或加重因素的居多,其余多种诱发或加重因素中最常见的为感染及皮质类固醇的使用不当。临床表现除典型的针尖至粟粒大小的无菌性脓疱的皮损外,常伴有多种全身症状的表现,其中以发热最为常见。各项相关的实验室检查中以血常规中的白细胞及中性粒细胞的升高、红细胞及血红蛋白的下降、低白蛋白血症、低钙血症最为常见。五种治疗方法的选用应根据患者病情轻重而选择不同的治疗方法。结论:泛发性脓疱型银屑病诱发或加重因素多种,临床表现除典型皮损外多伴有全身症状,有多种实验室检查的异常,根据患者病情轻重选择不同的治疗方法,糖皮质激素慎用。
Objective: To discuss and analyse generalized pustular psoriasis patients' causitive factors, clinical manifestations, some relative laboratory examinations and five kind of different treatments. Methods: Through collecting 33 cases of generalized pustular psoriasis patients who lived in my dermatological department from 1993 to 2006, retrospective analysis of generalized pustular psoriasis' variable causitive factors and their percents, clinical manifestations, especially accompanied with systemic symptoms, some relative laboratory examinations and the comparation of five kind of different treatments. Results: In our patients, the most of them have no causitive factor, except for it, the inflammation and the improper use of corticosteriod are very common. In clinical manifest -ations, except for characteristic clinical manifestations that are aseptic pustulars from pinpoint to millet, it is frequently accompanied with systemic symptoms, espicially fever. In the relative laboratory examinations, the increase of leucocyte and neutrophils, the decrease of red blood cell, albumin and calcium is the most common. Five kind of treatments should be selected according to the severity of disease. Conclusions: Causitive factors of generalized pustular psoriasis are variable; its systemic symptoms are very common, except for its characteristic eruption; its results of several kind of laboratory examinations are abnormal; its treatments should be choosed according to the severity of disease, the use of corticosteriod should be cautious.
引文
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[1] Ohkawara A, Yasuda H, Kobayashi H et al.Generalized pustular psoriasis in Japan :two distinct groups formed by differences in symptoms and genetic background. Acta Derm Venereol,Jan 1996, 76(1):68-71
[2] Davison S. C, Allen M. H, Mallon E, Barker J. N. Contrasting patterns of streptococcal superantigen-induced T-cell proliferation in guttate vs. chronic plaque psoriasis. Br J Dermatol, 2001, 145(2): 245-251
[3] Rola Ajib, Lori Janbazian, Elias Rahal, Ghassan M, et al. HLA allele associations and V-beta T-lymphocyte expansions in patients with psoriasis, harboring toxin-producing staphylococcus aureus. J Biomed Biotechnol,2005, 2005(4): 310-315
[4] Hajime Iizuka, Hidetoshi Takahashi ,Akemi Ishida-Yamamoto. Pathophysiology of generalized pustular psoriasis. Arch Dermatol Res, Apr 2003, 295 Suppl 1: S55-59
[5] Leung D.Y. M.,Travers J. B.,Giorno R, et al. Evidence for a streptococcal superantigen-driven process in acute guttate psoriasis. J Clin Invest, 1995, 96(5): 2106-2112
[6] Leung D.Y. M.,Travers J. B., Norris D.A.. The role of superantigens in skin disease. J Invest Dermatol, 1995, 105 Suppl 1: S37-42
[7] Leung D.Y. M.,Walsh P, Giorno R, Norris D. A.. A potential role for superantigens in the pathogenesis of psoriasis. J Invest Dermatol, 1993, 100: 225-228
[8] Tunus G, Pilger U, Aberer E. Severe initial manifestations of psoriasis in staphylococcal infection. Wien Klin Wochenschr, 2001,113(19): 747-751
[9] Michael P. Schon, M.D., W.-Henning Boehncke, M.D.. Psoriasis. The New England Journal of Medicine, May 2005, 352(18): 1899-1912
[10]Georgala S., Koumantaki E., Rallis E., Papadavid E.. Generalized pustular psoriasis develop- ing during withdrawal of short-term cyclosporin therapy. British Journal of Dermatology, May 2000, 1057-1058
[11]Mahendran R., Grech C. Generalized pustular psoriasis following a short couse of cyclosporin (Neoral). British Journal of Dermatology, Nov 1998,139(5): 934
[12]Elston G. E., Charles-Holmes R. *, Carr R. A.. Precipitation of generalized pustular psoriasis by prednisolone. Clinical & Experimental Dermatology, January 2006, 31(1): 138-140
铩颷13]Ohno S,Miyachi Y,Ozakim,Imamura S.2 case of generalized pustular psoriasisinduced by topical corticosteroids.Acta Dermatological-Kyoto-English edition,1982,77(3):197-200
[14]EM Farber and L Nall.Pustular psoriasis.Cutis,Jan 1993,51(1):29-32
[15]Wilson N.J.E..Evans S..Severe pustular psoriasis provoked by oral terbinafine.British Journal of Dermatology,July 1998,139(1):168
[16]Britschgi M,Steiner UC,Simone Schmid,et al.T-cell involvement in druginducedacute generalized exanthematous pustulosis.J Clin Invest,June 2001,107(11):1433-1441
[17]Britschgi M,Pichler WJ.Acute generalized exanthematous pustulosis,a clue toneutrophil- mediated inflammatory processes orchestrated by T cells.Curr OpinAllergy Clin Immunol,Aug 2002,2(4):325-331
[18]Schaerli P,Britschgi M,Keller M,Steiner UC et al.Characterization of human Tcells that regulate neutrophilic skin inflammation.J Immunol,Aug 2005,173(3):2151-2158
[19]Demitsu T,et al.Acute generalized exanthematous pustulosis induced bydexamethasone injection.Dermatology,1996,193:56-58
[20]Ozawa A,Miyahara M,Sugai J,et al.HLA class Ⅰ and HLA ctass Ⅱ alleles andsusceptibility to generalized pustular psoriasis:significant associations with HLACw1 and HLA DQB1~*0303.J Dermatol,1998,25(9):573-581
[21]Masahiko Muto,Akiko Ohmura,Yoshiaki Hamamoto,Yoshitake Konishi et al.Generalized pustular psoriasis:strategy for identification of psoriasis susceptibilitygene.Arch Dermatol Res,2003,295:S60-S62
[22]王豫平,刘鸿伟,张书岭,张守民.泛发性脓疱型银屑病患者发热和白细胞升高与病情的相关性.临床皮肤科杂志,2002年10月,30(5):308
[23]Allez M,Roux ME,Bertheau P,et al.Recurrent cholestatic jaundice associated withgneralized pustular psoriasis:evidence for a neutrophilic cholangitis.J Hepatol,2000,33(1):160-162
[24]Benoit S,Toksoy A,Broecker E-B,Gillitzer R,Goebeler M.Treatment ofrecalcitrant pustular psoriasis with infliximab:effective reduction of chemokineexpression.British Journal of Dermatology,May 2005,150(5):1009-1012
[25]Ternowitz T,Thestrup-Pedersen K.Neutrophil and monocyte chemotaxis inpustulosis palomo-plantaris and pustular psoriasis.British Journal of Dermatology,1985,113(5):507-514.
[26]Molhuizen HO, Alkemade HA, Zeeuwen PL, de Jongh GJ, Wieringa B. SKALP/elafin: an elastase inhibitor from cultured human keratinocytes. Purification, cDNA sequence, and evidence for transglutaminase cross-linking. J Biol Chem,1993, 268: 12028-12032
[27] P fundt R, Wingens M, Bergers M, Zweers M, Frenken M, Schalkwijk J. TNF-α and serum induces SKALP/elafin gene expression in human keratinocytes by a p38 MAP kinase-dependent pathway. Arch Dermatol Res, 2000, 292: 180-187
[28]Kuijpers ALA, Zeeuwen PLJM, de Jongh GJ, van de Kerkhoh PCM, Alkemade HAC, Schalkwijk J. Skin-derived antileukoproteinase (SKALP) is decreased in pustular forms of psoriasis. A clue to the pathogenesis of pustule formation? Arch Dermatol Res, 1996,288: 641-647
[29]Duan H, Koga T, Kohda F, et al. Interleukin-8-positive neutrophils in psoriasis. J Dermatol Sci, 2001, 26(2): 119-124
[30]Namazi MR. Possible molecular mechanisms to account for the involvement of tryptase in the pathogenesis of psoriasis. Auto immunity, Sep 2005, 38(6): 449-452
[31]Terui T, Ozawa M, Tagami H. Role of neutrophil in induction of acute inflammation in T-cell-mediated immune dermatosis, psoriasis: A neutrophil- associated inflammation-boosting loop. Exp Dermatol, 2000, 9: 1-10
[32]Paquet P, Pierard GE, Interleukin-6 and the skin. Int Arch Allergy Immunol, 1996, 109(4): 308-317
[33] Sjogren F, Ljunghusen O, Baas A et al. Expression and function of beta 2 integrin CD11B/ CD18 on leukocytes from patients with psoriasis.Acta Derm Venereol, 1999, 79(2): 105-110
[34}Silja Rott and Ulrich Mrowietz. Recent developments in the use of biologics in psoriasis and autoimmune disorders. The role of autoantibodies. BMJ, Mar 2005, 330:716-720
[35]Schmick K, Grabbe J. Recalcitrant, gneralized pustular psoriasis: rapid and lasting therapeutic response to antitumor necrosis factor-[alpha] antibody (infliximab). British Journal of Dermatology, Feb 2005, 150(2): 367
[36] Jennifer T Trent, Francisco A Kerdel. Successful treatment of Von Zumbusch pustular psoriasis with infliximab.J Cutan Med Surg, Jul 2005, 8(4): 224-228
[37]Rajan N, Natarajan S. Clearance of lifelong pustular psoriasis with recombinant soluble tumor necrosis alpha receptor (etanercept) treatment: P-56. British Journal of Dermatology, Supplement, Jan 2006,154 Supplement 1: 27