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.

生物制剂治疗皮肤病过程中的矛盾性反应

生物制剂在治疗皮肤病的过程中,可能会引发其他疾病或导致原有疾病的恶化,这种现象在临床上被称为矛盾性反应。已经有大量的矛盾反应被报道,如矛盾性银屑病、炎症性肠病、化脓性汗腺炎等。本文综述了生物制剂在治疗皮肤病过程中引起的各类矛盾反应。

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。

点阵激光辅助透皮给药在皮肤美容及损容性皮肤病中的应用

点阵激光通过产生矩阵排列的微光束,在皮肤上形成分布均匀的微热治疗区,最大限度地保留了正常皮肤组织,与传统激光相比创伤小、恢复快。近年来发现点阵激光能够作为辅助透皮给药手段,可控地破坏皮肤屏障,促进局部用药的透皮吸收,拓展了外用制剂的选择范围。本文就点阵激光辅助透皮给药技术在皮肤美容及损容性皮肤病中的应用做一综述。

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。

双轨合一模式下中医皮肤病案例库建立的意义探析

“双轨合一”培养模式下,专业学位硕士研究生需要进行两个阶段的中医规范化临床培训(简称“规培”)轮训,毕业后获得“四证”,以便未来更好地进入临床工作。皮肤科疾病诊断直观、病种复杂、实践性强,但中医皮肤病学专业学位硕士研究生在此科室轮训时间较少,临床了解皮肤病病种和操作实践机会有限,对掌握皮肤科专科知识存在一定的困难。中医皮肤病案例库的建立不仅可以丰富规培基地教学人员的实践经验,还可以打破规培教学活动的时间、空间限制,使中医学专业硕士研究生在较少的轮训时间内尽可能多地认识、学习更多典型病例并掌握皮肤病学知识,对提高双轨合一模式下中医皮肤科的整体规培教学质量具有重要的意义。

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。

基于“复气”理论论治过敏性皮炎

[目的]基于“复气”理论探讨过敏性皮炎病机及治法。[方法]查阅古籍及文献,论述“复气”理论内涵,结合过敏性皮炎发病特点,从“复气”理论深入分析过敏性皮炎病机与治法,并附病案佐证之。[结果]过敏性皮炎属中医学中“漆疮”“桃花癣”等范畴,常于春、秋季节加重或发病,并易复发。“复气”是自然界中五行之间保持阴阳平衡的一种方式,也是一种人体调节五行平衡的机制。受《素问·气交变大论》“复气”理论的启发,结合过敏性皮炎临床特点及春、秋季节气候特点探讨其病机及治疗方法,认为其核心病机为“脾土不及,易感外邪;肝风助发,来势急骤;金气来复,燥热相兼”,并提出“培土疏肝,清金润燥”的治疗原则。基于此及大量临床实践,自拟制复润燥消红方并收效甚好。文中病案,辨为脾虚肝旺证,治以健脾疏肝、润燥消红,方拟制复润燥消红方,随证加减,疗效显著。[结论]基于“复气”理论论治过敏性皮炎,本质在于调节五行之间的平衡,制复润燥消红方临床应用疗效确切并可防其复发,为过敏性皮炎提供了一种有所裨益的辨治新思路。

呼和浩特市犬猫真菌性皮肤病的流行病学调查

文章对2022年6月至2023年6月就诊于内蒙古呼和浩特市几所宠物医院的328例犬猫真菌性皮肤病流行病学情况进行调查,并对所得数据进行分析,以探讨该病的发生与性别、年龄、发病季节、品种等因素的关系。结果显示:一年内几所宠物医院犬猫真菌性皮肤病的发病率占就诊总病例数的8.42%,其中猫真菌性皮肤病病例数为158例,占猫总皮肤病病例的75.6%;犬真菌性皮肤病病例数为170例,占犬总皮肤病病例的54.8%。犬、猫真菌性皮肤病雌雄比例分别为81:89、52:106;1岁龄左右的犬、猫更易患真菌性皮肤病,分别占该物种皮肤病病例总数的25.3%、61.4%;犬在夏季高发真菌性皮肤病,而猫以春季高发;品种上犬以金毛犬、中华田园犬、法国斗牛犬多发,猫以英国短毛猫和布偶猫高发。研究表明,犬、猫的真菌性皮肤病在本地的流行趋势表现出幼龄动物更易发病,且发病情况与季节和品种均存在一定的关系,需要根据这些因素做到有针对性的预防,以此降低犬猫真菌性皮肤病的发病率。

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。