不累及腋臭手术部位的间擦疹型手足综合征一例国际首报

Intertrigo-like hand-foot syndrome unaffecting the site of surgery for axillary osmidrosis:the first case reported worldwide

患者女,25岁,因手足、腋下和腹股沟红斑水疱伴疼痛反复1个月就诊。7年前患者因腋臭双腋下曾行小切口汗腺切除术。1个月前因颈部滑膜肉瘤(ⅡB期)术后行多柔比星脂质体化疗,3次化疗期间,出现手足、腋下和腹股沟红斑水疱伴疼痛,皮损逐次加重。皮肤科检查:双手掌、足跖及腋下、腹股沟等间擦部位可见大片水肿性红斑,边界较清楚,上有粟粒至黄豆大小水疱,可见糜烂;皮疹处皮温高,触痛明显,尼氏征阳性;双腋下行小切口腋臭手术的部位无皮损,无疼痛。腋下皮损组织病理检查:基底层下水疱形成及部分汗腺坏死。诊断:多柔比星脂质体相关间擦疹型手足综合征。根据该病例合并腋臭手术史,手术部位皮肤正常,推测该病发病机制可能为药物经汗腺排泄到皮肤后诱发的皮肤毒性反应。

A 25-year-old female patient presented with recurrent painful erythema and blisters on the palms and soles as well as in the axillary and inguinal regions for 1 month.Seven years ago,the patient underwent a small-incision sweat gland resection in the bilateral axillae for the treatment of axillary osmidrosis.One month ago,she underwent chemotherapy with pegylated liposomal doxorubicin(PLD)after surgery for stage-ⅡB cervical synovial sarcoma.During the 3 sessions of chemotherapy,she developed painful edematous erythema on the palms,soles,axillae and groins,which gradually worsened along with the increase in the number of chemotherapy sessions.Skin examination showed large areas of edematous erythema with clear boundaries at bilateral palms,soles,and intertriginous sites including axillae and groins,with millet-to soybean-sized blisters and erosions on the surface;the skin lesions showed relatively high temperature and positive Nikolsky's sign with obvious tenderness;there was no skin lesions or tenderness at the site of small-incision surgery for axillary osmidrosis in bilateral axillae.Histopathological examination of the axillary skin lesions showed formation of blisters under the basal layer and necrosis of some sweat glands.The diagnosis of PLD-associated intertrigo-like hand-foot syndrome was confirmed.The history of surgery for axillary osmidrosis and normal skin at the surgical site in this case suggest that the pathogenesis of this disease may be related to toxic skin reactions to the drug excreted through sweat glands.