Misdiagnosed dystrophic epidermolysis bullosa pruriginosa:A case report

BACKGROUND Dystrophic epidermolysis bullosa pruriginosa(DEB-Pr)is a rare subtype of DEB,characterized by recurrent pruritus of the extremities,pruritus papules,nodules,and mossy-like plaques.To date,fewer than 100 cases have been reported.We report a misdiagnosed 30-year-old man with sporadic late-onset DEB-Pr who responded well to tacrolimus treatment,thereby serving as a guide to correct diagnosis and treatment.CASE SUMMARY A 30-year-old man presented with recurrent itching plaques of 1-year duration in the left tibia that aggravated and involved both legs and the back.Examination revealed multiple symmetrical,purple,and hyperpigmented papules and nodules with surface exfoliation involving the tibia and dorsum of the neck with negative Nissl's sign,no abnormalities in the skin,mucosa,hair,or fingernail,and no local lymph node enlargement.Blisters were never reported prior to presentation.Serum immunoglobulin E level was 636 IU/mL.Clinical manifestations suggested DEB-Pr.Histological examination showed subepidermal fissure,scar tissue,and milia.Direct immunofluorescence showed no obvious abnormalities.However,we were unable to perform electron microscopy or genetic research following his choice.We treated him with topical tacrolimus.After 2 wk,the itching alleviated,and the skin lesions began to subside.No adverse reactions were observed during treatment.CONCLUSION Topical tacrolimus is a safe treatment option for patients with DEB-Pr and can achieve continuous relief of severe itching.

Study on the clinical correlation between serum total IgE level and peripheral blood eosinophil count in patients with eczema

Objective:To explore the correlation between the expression of serum total IgE level and peripheral blood EOS count in patients with eczema and the severity of clinical eczema.Methods:The EASI and pruritus VAS score were used to evaluate the disease severity of 100 patients with eczema.According to the EASI score,patients with eczema were divided into three groups:mild(<7 points)、moderate(7-15 points)and severe(>15 points).At the same time,the serum total IgE level and peripheral blood EOS count were tested before and after the 4-week Chinese medicine treatment.Results:The serum total IgE level of 42%of eczema patients increased,and the peripheral blood EOS count increased in 26%.In the three groups of mild,moderate,and severe,as the severity of eczema increased,the level of serum total IgE and peripheral blood EOS count continued to increase,and the positive rate increased significantly(all P<0.05).In terms of correlation analysis,the study showed that in patients with eczema total IgE level and EASI score(r=0.421,P<0.01),EOS count and EASI score(r=0.326,P<0.01),EOS count and pruritus VAS score(r=0.529,P<0.01)all show relatively weak positive correlation;and a high proportion of patients had the same changes in IgE and EOS after treatment(82%of IgE is consistent with EASI,76%of EOS is consistent with EASI).Conclusion:This study shows that the total IgE level and EOS count of patients with eczema are positively correlated with the severity of eczema,but at the same time this correlation is relatively limited.In clinical practice,it is necessary to combine the dynamic changes of the individual's own indicators in order to diagnose,comprehensively treat and evaluate eczema.Provide greater reference value in other aspects.