度普利尤单抗联合外用糖皮质激素治疗结节性类天疱疮2例临床观察

Combination of topical glucocorticoids and dupilumab for pemphigoid nodularis:a clinical observation of two cases

例1女,70岁。躯干四肢反复斑丘疹、结节伴瘙痒1个月,水疱1周。皮肤组织病理:表皮轻度角化过度,颗粒层略增厚,棘层肥厚。真皮浅层小血管扩张,周围少量淋巴细胞浸润。血清间接免疫荧光示基底膜带IgG、C3线状沉积,酶联免疫吸附实验检测血清抗BP180抗体、抗BP230抗体均阳性。例2男,77岁。全身反复红斑、丘疹、结节伴瘙痒半年,加重伴水疱2周。皮肤组织病理:表皮下水疱伴真皮浅层嗜酸性粒细胞浸润。皮肤直接免疫荧光示基底膜带IgG、C3线状沉积,酶联免疫吸附实验检测血清抗BP180抗体、抗BP230抗体均阳性。两例患者均诊断为结节性类天疱疮,由于存在系统糖皮质激素禁忌症,2例患者均采用外用强效糖皮质激素联合度普利尤单抗治疗,病情控制良好,逐渐停用后未见复发。

Case 1.A 70-year-old female patient presented with pruritic erythema,papules and nodules of trunk and limbs for one month,and blisters around the original lesions for one week.Histopathological examination of the skin lesions showed mild hyperkeratosis of the epidermis,slightly thickened granular layer and acanthosis.Small blood vessels in the superficial dermis were dilated,surrounded by a small amount of lymphocyte infiltration.Serum sample indirect immunofluorescence testing showed IgG and complement C3 deposited along the basement membrane zone.ELISA showed the presence of serum anti-BP180 and anti-BP230 antibody.Case 2.A 77-year-old male patient presented with pruritic erythema,papules and nodules of all over the body for one year.The lesions worsened and blisters existed for two weeks.Histopathological examination of the skin lesions showed blisters forming under the epidermis,and eosinophils in the superficial dermis.Skin biopsy sample direct immunofluorescence testing showed IgG and complement C3 deposited along the basement membrane zone.ELISA showed the presence of serum anti-BP180 and anti-BP230 antibody.Both patients were diagnosed with pemphigoid nodularis.Due to contraindications to systemic glucocorticoids,both patients were treated with topical glucocorticoids combined with dupilumab.The lesions were well controlled and no recurrence was observed.