对称性药物相关性间擦部及屈侧疹一例

A case of symmetric drug-related intertriginous and flexural exanthema

48岁男性患者,左腋窝红斑、丘疹伴瘙痒3周。皮肤科情况:双侧腋窝、腹股沟可见对称性分布的粟粒至黄豆粒大小的红斑、丘疹,部分皮损表面可见黄褐色厚腻性鳞屑及浅溃疡,并拢双腿后皮损呈V形分布。肛周可见呈环形分布的米粒至绿豆粒大小的红色丘疹,部分丘疹表面可见黄褐色结痂。皮损组织病理示:角质层可见结痂、角化不全及角化过度,棘层灶状水肿,散在凋亡细胞,表皮突延长,基底层细胞液化变性;真皮乳头层水肿、散在红细胞溢出,真皮浅层、毛囊及皮脂腺周围可见较多的淋巴细胞浸润,小血管扩张、充血,血管腔内可见中性粒细胞、嗜酸粒细胞,皮下组织小血管周围散在淋巴细胞浸润。诊断:对称性药物相关性间擦部及屈侧疹。给予复方甘草酸苷及匹多莫德药物治疗后病情改善。随访3个月无复发。

A 48-year-old man presented with erythema,papules in his left axilla with pruritus for 3 weeks.Physical examination revealed symmetrically distributed erythema and papules in bilateral armpit and groin regions,some of the skin lesions showed yellowish brown greasy scales,scratches and shallow ulcers.V-shaped erythematous plaques were noted in a bilaterally symmetrical manner in the inguinal areas.Ring-shaped red papules could be seen around the anus,and some papules had yellowish-brown.Histopathological findings included scabs,parakeratosis and hyperkeratosis,focal spongiosis with scattered apoptotic keratinocytes,elongated rete ridges,liquefaction degeneration of basal cells,lymphocytes infiltrated in the upper dermis,and around hair follicles and sebaceous glands,dilated small blood vessels with congestion,neutrophils and eosinophils in vascular lumen,lymphocytes scattered around small vessels in subcutaneous tissue,and extravasation of erythrocytes in the papillary dermis.The diagnosis of symmetric drug-related intertriginous and flexural exanthema was established.The patients’condition was improved after treatment of compound glycyrrhizin and pidotimod.There was no recurrence after 3 months of follow-up.