中西医结合治疗太藤丘疹性红皮病1例

Ofuji′s Papuloerythroderma Treated with Combination of Chinese and Western Medicine:A Case Report

患者男,60岁,全身红斑、丘疹伴瘙痒半年,再发加重2周。皮肤科情况:可见沿Langer线(Langer′s line)分布泛发针尖至豌豆大小丘疹,部分融合成片,呈铺路石样外观,以腹部为重,腋下、腹股沟、腘窝及体表皱褶处无皮疹,呈“帆布椅”征(desk-chair sign)。皮损组织病理示:表皮增厚伴皮突轻度不规则延长,皮肤附属器和皮下脂肪组织无明显病变,表皮呈轻度海绵水肿伴局灶性液化变性,真皮浅层血管周围可见中等量的淋巴细胞、浆细胞、组织细胞浸润,血管内皮肿胀并见其内有中性粒细胞、嗜酸性粒细胞分布。诊断:太藤丘疹性红皮病。中医辨证为伤寒少阳证,予加味柴胡桂枝干姜汤内服配合本院祛风止痒散中药熏洗、刺络拔罐、火针、全舱窄波紫外线照射治疗,10 d后患者全身皮疹变平、颜色变暗,无新发皮损出现,随访至今未见复发,疗效满意。

A 60-year-old male was admitted to hospital presented with systemic erythema and papule with pruritus for half a year.Physical examination showed irregular papules,erythema and eruptions,ranging from the size of a needle head to that of a pea on the trunk along the Langer′s line were obvious.Intertriginous uninvolved areas on the abdominal wall(deck-chair sign) were seen.Histological examination showed epidermal thickening and prolongation of the epidermal processes were unremarkable.There were no significant changes in the adnexa or subcutaneous fatty tissue.The epidermis showed spongiosis and mild liquid degeneration.In the dermis,there was moderate lymphocyte,plasmacyte and histiocyte infiltrate in a shallow perivascular area.The vascular endothelium was mildly enlarged,and neutrophils and eosinophils were distributed within the vessels.The diagnosis of papuloerythroderma of ofuji was confirmed.After 10 days of treatment,rash became flat,the color became darker than before,and there was no new skin lesions.According to the diagnosis based on TCM,the problem is typhoid and Shaoyang syndrome,hence,Chaihu Guizhi Ganjiang decoction was administered in combination with the Chinese medicine fumigation-washing therapy of Qufeng Zhiyang formula,together with pricking blood,cupping,fire acupuncture plus whole cabin narrow-wave ultraviolet irradiation treatment.The patient′s rash became flattened and darkened after 10 days,and no new lesions appeared.The curative effect was satisfactory.