Airway management of a patient with linear immunoglobulin A bullous dermatosis:A case report

BACKGROUND There is limited literature on managing the airway of patients with linear immunoglobulin A(IgA)bullous dermatosis,a rare mucocutaneous disorder that leads to the development of friable bullae.Careful clinical decision making is necessary when there is a risk of bleeding into the airway,and a multidisciplinary team approach may lead to decreased patient morbidity during these high-risk scenarios,especially when confronted with an unusual cause for bleeding.CASE SUMMARY A 45-year-old African American female presented to our ambulatory surgical center for right corneal transplantation due to corneal perforation after blunt trauma in the setting of cicatricial conjunctivitis and diffuse corneal neovascularization from linear IgA bullous dermatosis.The diagnosis of IgA dermatosis was recent,and the patient had been lost to follow-up.The severity of the disease and extent of airway involvement was unknown at the time of the surgery.Significant airway bleeding was noticed upon intubation and the otorhinolaryngology team had to be called to the operating room.The patient required transfer to the intensive care unit where a multidisciplinary team was involved in her case.The patient was extubated on postoperative day 4.CONCLUSION A multidisciplinary approach to treating this disease is the best course of action before a surgical procedure.In our case,key communication between the surgery,anesthesia,and dermatology teams led to the quick and safe treatment of our patient’s disease.Ambulatory surgery should not be considered for these cases unless they are in full remission and there is no mucous membrane involvement.

Transient Acantholytic Dermatosis: A Case Report and Literature Review

Transient acantholytic dermatosis (TAD, Grover disease) is a benign skin disease with a nonspecific rash that may present as a reddish-brown, dermatomal edematous papule or herpetiform rash with a partially central horny plug. This disease is usually self-limiting and can subside within weeks or months, but it may also have a chronic progression with a trend towards long-term recurrence. The patient is an 80-year-old male who visited the clinic due to recurring erythema and blisters all over his body that had been present for over 2 years. Based on the patient’s course, laboratory tests and histopathological findings were consistent with the diagnosis. The final diagnosis was transient acantholytic dermatosis. The patient has a long course of the disease, a wide range of skin lesions and he has the different subtypes of pathological manifestations. This case and corresponding literature review help us have a clear understanding of Grover’s disease, which has received reference value for the diagnosis and treatment of this disease in clinical work.

Is it relevant a correct intimate cleansing in the treatment of vulvar dermatosis?

Background: Vulvar dermatoses are inflammatory disorders of genital skin causing itch, pain, dysuria and dyspareunia. Objective: To compare the efficacy of two intimate cleansers as adjuvants in the treatment of the two common vulvar dermatoses: Lichen sclerosus (LS) and lichen simplex chronicus (LSC). Method: 32 patients with the diagnosis of LS or LSC initially treated with Mometasone furoate 0.1% cream were then randomly assigned to receive either cleanser A (cleaner based on amigdalus dulcis, malva, jojoba oil, PCL solid, Hyaluronic acid) or cleanser B (cleaner based on Cocoyl Wtheat Amino Acids, Maltodextrins, Aveena sativa, Caprylic Glycol) twice a day in association with lanolin cream one application daily for 30 days, following which the lanolin cream was applied only when needed as a rescue treatment. The amount of the rescue cream used, rubbing, applicability and pleasantness of the product were classified before and after 60 days of treatment. Results: The differences between the two treatments for rubbing, applicability and pleasantness of the product were statistically non-significant, while “as needed” use of the emollient lanolin cream was significantly superior in a total number of doses in the B group versus the A group (8.25 vs 5.28 (P < 0.001). Conclusion: The parameters showed a high score for both the cleansers, demonstrating the acceptability of these products by the women. The best results of the cleaner A can be attributed to not only to the pool of moisturizing and emollient active ingredients but that of the soothing effects as well. This shows that the role of intimate cleanser is not only for vulval cleansing, but can also play a therapeutic role of moisturization and emollience.

Epidemiological Profile of Dermatosis among Automobile Repair and Maintenance Garages in the City of Parakou in 2020

Background: Occupational dermatoses, also called occupational dermatitis or occupational dermatitis, are very common in the workplace and are still a topical subject. All over the world, especially in developed countries. They handicap the professional activities of the workers. Purpose: To determine the epidemiological profile of dermatosis among automobile repair and maintenance garages in Parakou. Methods: It was a cross-sectional and descriptive study carried out from 20 April to 17 May 2020. The sampling method was non-probabilistic. Data collected from a questionnaire, clinical examination and worksite observation were analyzed with Epi Info 7.2.2.1 software. Results: The participation rate was 98.08%. The sex ratio (male/female) was 178. The mean age of the respondents was 25.80 ± 10.22 years. Respondents with less than 5 years of experience in the field were 61.22%. Mechanics were the most numerous. In the sample, 95.81% had frequent skin contact with fuels, 84.08% had contact with motor oils and 15.92% had contact with dilute battery electrolyte solutions. The frequency of dermatosis was 73.46%. Hands and wrists were the most affected seats (47.35%). Some (33.84%) wore them before the start of the activity in the garage but in 66.22% of them, the dermatosis had occurred because of their arrival in the garage. Among these skin diseases, keratoderma predominated at 80.01%. Conclusion: Dermatosis is very common among garage owners in Parakou.

Diagnostic Sign of Terra Firma-Forme Dermatosis

Background: Terra Firma-Forme Dermatosis (TFFD), a benign skin condition which presents with asymptomatic brown to black plaques which resemble dirty skin. Aim: To document a new case presentation with TFFD in the Arab region which is considered as one of the differential diagnoses of dirty neck. Case presentation: A 15-year-old girl presented with a history of asymptomatic brownish dirt-like lesion on the nape and sides of the neck for 4-years duration, not resolved by wash with water and soap and confused with other dermatoses like acanthosis nigricans or atopic dermatitis. The diagnosis of TFFD was confirmed when the lesions were completely resolved after gentle swabbing with 70% isopropyl alcohol. Conclusion: TFFD is rarely reported in Arab region and should be considered when evaluating cases of dirty neck-like presentation of atopic dermatitis or acanthosis nigricans.

Sweet综合征的发病机制及治疗进展

Sweet综合征(Sweet syndrome, SS)是一种病因不明的炎症性嗜中性皮肤病,与感染、药物、肿瘤及自身免疫性疾病等相关。发病机制涉及中性粒细胞功能障碍、免疫失衡及遗传因素等。传统一线治疗首选系统应用糖皮质激素。近年来随着SS的研究取得一定进展,生物制剂及小分子靶向药物也有成功治疗SS的报道。本文就SS的发病机制及治疗进展作一综述。

α-促黑素细胞激素在皮肤病治疗中的研究进展

α-促黑素细胞激素是一种神经内分泌激素,主要负责刺激毛发和皮肤中黑色素的产生。另外,它在控制食欲和能量平衡、性行为和缺血再灌注相关损伤等方面也发挥着重要作用。近年来,人们对开发α-促黑素细胞激素类似物有着很大的兴趣,并且已经初步用于治疗卟啉病、白癜风、家族性良性慢性天疱疮、多形性日光疹、日光性荨麻疹、寻常性痤疮等皮肤病。本文综述了α-促黑素细胞激素在皮肤病中的作用机制和治疗应用。

磷酸二酯酶4抑制剂在皮肤病中应用的研究进展

磷酸二酯酶4是在炎症细胞中代谢环磷酸腺苷的主要酶,并在调节第二信使的平衡中起着至关重要的作用。作为信号转导的关键调节因子,磷酸二酯酶4在多种疾病中显示出有希望的药理学靶点作用,其抑制剂已被用作治疗药物。本文综述了磷酸二酯酶4抑制剂治疗皮肤病的机制、疗效及不良反应。

Sweet综合征口腔黏膜表现1例报道及文献回顾

目的探讨Sweet综合征的口腔黏膜病损表现,为临床早发现并正确诊断该病提供参考。方法报道1例60岁女性Sweet综合征患者的口腔黏膜病损表现,并结合相关文献对Sweet综合征进行分析。结果患者双下肢皮肤红斑伴口腔黏膜破溃疼痛3 d,患者皮损症状较轻,但口腔黏膜多发性大面积糜烂,疼痛明显,故首诊于口腔科。患者发病过程中伴有发烧,体温38.5℃;实验室检查示C反应蛋白升高(35.2 mg/L),血沉加快(77.00 mm/h);患者两侧膝盖及下肢可见散在分布红色斑块,轻度压痛,皮损组织病理学检查示:真皮全层见散在不成熟中性粒细胞聚集灶浸润。根据患者临床体征和实验室检查,皮损组织病理结果的镜下符合Sweet综合征的表现,诊断为Sweet综合征。给予患者1 mL复方倍他米松注射液肌肉注射仅1次;患者对糖皮质激素治疗效果反应良好;口腔采用复方氯己定溶液含漱,病损黏膜处重组牛碱性成纤维细胞生长因子溶液外用,3次/d,疗程为1周;用药4 d后复诊,体温恢复正常,口腔病损明显减轻;2周后复诊,小腿及膝盖处红斑几乎全部消退,口腔黏膜病损基本消失;半年后随访,结果显示皮损未复发;2年后随访,病情稳定,病损未见复发。回顾相关文献表明,Sweet综合征是一种少见的病因不明的炎性反应性皮病,临床上可分为3种类型:特发型、肿瘤相关型以及药物诱导型,男女患病比为1∶4,典型临床表现为急性出现的疼痛性红色斑块或结节,病损多位于四肢,常伴发热,外周血中性粒细胞数目增多,血沉加快,C反应蛋白阳性。系统应用糖皮质激素是本病最重要的治疗方法,大多数患者可在短期内改善皮损,但可能会存在潜在感染或停药后复发的情况。部分Sweet综合征患者可伴有口腔病损,但目前有关Sweet综合征在口腔黏膜表现的病例报道却很少,使得临床容易误诊。结论口腔黏膜病损可能为Sweet综合征的皮肤外表现,应综合考虑患者的全身情况,尽快完善皮肤活检以明确诊断,以免延误病情。

Janus激酶抑制剂在皮肤病中应用的研究进展

Janus激酶(JAK)抑制剂是一种抑制JAK/信号转导和转录激活因子(STAT)信号通路的药物,可选择性抑制JAK家族,近几年已成为治疗许多炎症性皮肤病的新方案。JAK/STAT通路是一种细胞内信号通路,细胞因子通过该通路引起疾病。使用JAK抑制剂可能是治疗此类疾病的有用策略。本文对JAK抑制剂治疗皮肤病的机制、疗效及不良反应进行综述。

犬和猫皮肤癣菌三重荧光定量PCR检测方法的建立及应用

建立鉴别犬小孢子菌(Microsporum canis,MC)、须癣毛癣菌(Trichophyton mentagrophytes,TM)和秕糠马拉色菌(Malassezia furfur,MF)的三重荧光PCR检测方法,根据MC、TM和MF 3种真菌的ITS基因保守序列设计引物和探针,建立三重荧光PCR检测方法。所建立的三重荧光PCR方法仅对MC、TM和MF出现阳性扩增,与大肠埃希氏菌、产色葡萄球菌和铜绿假单胞菌等犬、猫皮肤病常见病原无交叉反应,对MC、TM和MF的最低检出限分别为1.36×10~1、1.35×10~1、1.33×10~1拷贝;组内和组间变异系数均小于2%,重复性好。应用建立三重荧光PCR方法对88份犬、猫临床样品进行检测,结果检出1份MC阳性、21份TM阳性、20份MF阳性,检测结果与单一荧光PCR方法一致。该方法可对MC、TM和MF同时快速检测,可用于犬、猫真菌性皮肤病的快速诊断。

温经汤治疗皮肤病的临床研究进展

温经汤首载于《金匮要略·妇人杂病脉证并治》,主要用于治疗妇科病,后世医家拓展用于治疗冲任失调、血虚津伤、瘀血阻滞、寒凝拘急、内生虚热等病证,临床上被广泛应用于各科室。温经汤重于“降阳明,调冲任”,有温经散寒、养血祛瘀等功效,在皮肤科应用日益普遍,逐渐被重视,并取得显著疗效。作者就近5年温经汤治疗皮肤病的文献做一综述,探讨其优势和现状,给临床治疗提供思路。

陈金莲教授运用自拟二防汤治疗瘙痒性皮肤病经验总结

瘙痒性皮肤疾病是皮肤疾病中重要的常见疾病,具有病种复杂、慢性易成迁延等特点,主要表现为皮肤瘙痒症状,严重影响了患者的身心健康和生活质量。现代医学多使用抗组胺药、激素药等进行药物治疗,长期服用不良反应明显,甚至容易产生依赖性。中医认为“无风不作痒”,风邪在其致病过程中起着重要作用,中医药治疗瘙痒类皮肤疾病具有辨治灵活、减轻不良反应、增强疗效等独特优势。湖南省名老中医皮肤病专家陈金莲教授经过数十年临床经验总结及实践,认为风邪与瘙痒性皮肤疾病密切相关,主张内外兼顾,从“风”的角度论治,治以“祛外风,息内风”,自创二防汤加减,运用于瘙痒性皮肤疾病,取得了良好效果。文章将陈师二防汤加减治疗瘙痒性皮肤疾病的经验进行总结,并结合案例予以介绍,为瘙痒性皮肤疾病的中医药治疗提供参考。

上海市职业性皮肤病高危企业管理现状调查

目的:通过对职业性皮肤病高危企业调查,了解职业性皮肤病管理现状及问题。方法:根据文献检索法和德尔菲专家咨询法确定了10个职业性皮肤病高危行业,通过抽样对高危企业的管理人员进行问卷调查,并对获得的数据进行统计分析。结果:共调查419家企业的502位管理人员,其中有136家(32.5%)的受访高危企业没有设置明确的职业卫生管理部门;平均每家企业配备0.6名职业卫生管理专职人员;职业病防治培训总人数占接害工人总数81.0%,占生产一线职工50.6%;269名(53.6%)的管理人员不了解职业性皮肤病;345人(68.7%)不了解所在企业相关岗位可能存在罹患职业性皮肤病的风险。结论:部分企业对职业性皮肤病的防治和管理存在重视程度较低、管理力量配备不足、员工培训不到位、管理人员认知不足等问题。

硫酸羟氯喹致急性发热性嗜中性皮病1例分析

1例48岁女性患者因类风湿性关节炎服用硫酸羟氯喹和甲氨蝶呤,2周后躯干和四肢部位出现触痛性红斑、丘疹,伴发热,皮肤活检提示真皮浅中层中性粒细胞浸润。停药并给予甲泼尼龙琥珀酸钠、卤米松乳膏等治疗18 d后好转,诊断为急性发热性嗜中性皮病。该病例发生的急性发热性嗜中性皮病与硫酸羟氯喹关联性评价结果为“很可能有关”,国内尚无相关文献报道。硫酸羟氯喹致急性发热性嗜中性皮病的发病机制可能与粒细胞集落刺激因子水平升高、细胞因子调节异常和遗传易感性有关。停用可疑药物并应用糖皮质激素是目前最有效的治疗手段。

常见皮肤病快速诊断模式在征兵入伍医学选拔中的研发及应用现状

目的综述常见皮肤病快速诊断模式的研发及应用现状,为推动常见皮肤病快速诊断、提高其在征兵入伍医学选拔中的应用效率提供支持。资源来源与引用在中国知网(CNKI)、万方、维普(VIP)、PubMed、Web of Science等数据库检索国内外有关皮肤病快速诊疗模式的相关文献。资料综合回顾总结国内外皮肤病快速诊疗模式的主要产品类型,分析现有皮肤病快速诊疗模式的优势及问题。结论国内外已建立多种皮肤病快速诊断模式,覆盖皮肤肿瘤、炎症性皮肤病、皮肤罕见病等多方面,整体准确度可比肩中级皮肤专科医师,在征兵入伍的医学选拔中具备推广价值。

超分子水杨酸联合凉血五花汤加减治疗玫瑰痤疮的效果及对DLQI评分、皮肤红斑指数的影响

目的:探讨超分子水杨酸联合凉血五花汤加减治疗玫瑰痤疮的效果及对皮肤病生活质量量表(Dermatosis quality of life scale,DLQI)评分、皮肤红斑指数的影响。方法:选择2021年6月-2022年6月在笔者医院接受治疗的60例玫瑰痤疮患者,采用随机数表法分为实验组(n=30)和对照组(n=30)。对照组给凉血五花汤治疗,实验组给予超分子水杨酸联合凉血五花汤治疗。比较两组临床疗效、DLQI评分、皮肤红斑指数、皮肤屏障相关指标水平变化情况、临床症状改善情况及不良反应发生情况。结果:治疗后,两组总有效率比较差异有统计学意义(P<0.05);治疗后,两组DLQI评分、皮肤红斑指数水平均降低,实验组降低更为明显(P<0.05);治疗后,两组经皮水分丢失水平均降低,实验组降低更为明显,角质层水含量水平均升高,实验组升高更为明显(P<0.05);治疗后,两组毛细血管扩张缓解、红斑变浅、皮肤潮红减退及皮肤敏感度降低时间比较差异有统计学意义(P<0.05);治疗期间,两组不良反应主要表现为面部刺激、恶心呕吐及头晕头痛,两组比较差异无统计学意义(P>0.05)。结论:超分子水杨酸联合凉血五花汤加减治疗玫瑰痤疮具有较好的效果,可有效改善DLQI评分、皮肤红斑指数水平。

184例过敏性皮肤病患儿过敏原特异性免疫球蛋白E检测结果分析

目的分析184例过敏性皮肤病患儿过敏原特异性免疫球蛋白E(IgE)检测结果。方法选取2022年1月至2023年1月于兰陵县人民医院皮肤科治疗的184例过敏性皮肤病患儿,检测血清特异性IgE抗体表达水平并进行分析。结果184例过敏性皮肤病患儿中,102例患儿过敏原特异性IgE抗体阳性,阳性率为55.43%。吸入性过敏原中,阳性率较高的依次为粉尘螨、树花粉和户尘螨;食入性过敏原中,阳性率较高的依次为鸡蛋、牛奶及芒果。男性患儿过敏原特异性IgE抗体阳性率高于女性(P<0.05)。在几种主要的过敏原中,男性患儿鸡蛋蛋白阳性检出率高于女性(P<0.05)。结论过敏性皮肤病患儿的过敏原特异性IgE抗体阳性率较高,过敏原种类分布具有特异性,且不同性别过敏原特异性IgE抗体阳性率存在差异。

治未病模式在特应性皮炎康复中的运用及其重要意义

特应性皮炎是一种常见的慢性、炎症性皮肤病。该病反复发作,迁延难愈,严重影响患者及家属生活质量,为医学顽疾之一。之所以被称为顽疾,除了该病本身性质决定,更多要归因于“重治疗轻调护”的医疗现状。目前针对该病的医疗误区仍在于过度重视治疗,忽视了机体康复的能动性,忽视了患者自身调护对康复的重要性。因为治愈该病的根本途径是改变患者的过敏体质,只有体质改善了,该病才能被治愈。任何不能促进患者体质改善的药物和技术,最终证明是徒劳,还延误了治疗时机,浪费了资源。若要改变体质,中医古籍已有“未病先防,既病求愈”治未病的中医调理模式,即治未病模式。治未病模式可以激发机体康复的能动性,让患者身体得到康复或自愈,这也是“治病必求于本”的体现。中国中医科学院西苑医院皮肤科在黄尧洲教授倡导的治未病学术思想的指导下,运用治未病模式在临床上救治了众多患者,显示了优越的治疗效果。

何炳元教授运用“角药”辨治瘙痒性皮肤病经验浅析

角药是三药的有机联用,也是互为犄角的配伍形式。已故何炳元教授从事临床四十余载,在中医治疗瘙痒性皮肤病方面积累了丰富经验,擅长运用具有“藤”“草”“皮”“子”等特色的5组角药,其功能为祛风解表、凉血消癍、解毒透疹、活血通络、祛风止痒。临证时尤其善用角药,自拟方名,组方独特,疗效颇佳。文章总结何炳元教授运用角药临证配伍特色,为临床诊治瘙痒性皮肤病提供宝贵的借鉴经验。