对称性肢端角化病九例分析  

Symmetric acral keratoderma： 9 case reports

作　　者：张志扬 郑晓晖 

机构地区：[1]厦门长庚医院,福建361022

出　　处：《中华皮肤科杂志》2011年第10期737-738,共2页Chinese Journal of Dermatology

摘　　要：目的探讨9例对称性肢端角化病患者的相关危险因素、临床表现、治疗及疗效。方法门诊收集9例对称性肢端角化病患者的临床资料。对皮损进行拍照，真菌镜检、组织病理检查。予外用药治疗并随访。结果男8例，女1例，平均年龄28．2岁，平均发病年龄24．6岁，病程2个月至16年；皮损对称分布，双手背、腕全部累及，踝次之；手腕部皮损分布呈圈状；夏季重、冬秋季多数自愈；大部分患者与塑胶或橡胶接触有关，部分合并寻常性鱼鳞病；真菌镜检均阴性，组织病理学表现为表皮角化过度，棘层肥厚，轻微乳头瘤样增生；尿素维E乳膏、丙酸氯倍他索乳膏按1：1调用明显有效。结论寻常性鱼鳞病患者存在对称性肢端角化病的易患因素，遇水变白可能是水、空气参与的一种物理现象。外用糖皮质激素可作为第一线药物选择。Objective To investigate the relevant risk factors for, clinical manifestation and treatment responses of symmetric acral keratoderma in 9 patients. Methods Clinical data were collected from 9 outpatients with symmetric acral keratoderma. Skin lesions were photographed, tissue specimens were obtained from the lesions and subjected to fungal and histopathological examinations. The patients were given topical treatment. Results There were 8 males and 1 female in these patients with an average age of 28.2 years and age at onset of 24.6 years. The disease duration varied from 2 months to 16 years. The lesions were predominantly distributed on the dorsum of both hands and wrists symmetrically and circularly. Ankles were the third popular site involved. Generally, the lesions were aggravated in summer, spontaneously cured in winter. Most of the patients had a history of occupational contact with plastics or rubber. Some patients suffered from ichthyosis vulgaris. Microscopic examination for fungal element was negative. Histopathology revealed epidermal hyperkeratosis, acanthosis and mild papillomatosis. The urea and Vitamin E cream mixed with clobetasol propionate cream at a ratio of 1 ： 1 proved to be effective. Conclusions Ichthyosis vulgaris may be a risk factor for symmetric acral keratoderma. The whitening of lesions after short exposure to water may be a kind of physical phenomenon with the involvement of water and air. Topical steroids may serve as the first-line treatment choice for symmetric acral keratoderma.

关 键 词：肢端角化病 对称性 丙酸氯倍他索乳膏 组织病理检查 寻常性鱼鳞病 相关危险因素 皮损分布 乳头瘤样增生 

分 类 号：R758.6[医药卫生—皮肤病学与性病学]