外伤诱发自身免疫性大疱性皮肤病三例  

Three cases of trauma-triggered autoimmune bullous skin diseases

作　　者：邹雅茹[1] 周生儒[1] 朱海琴[1] 潘萌[1] Zou Yaru Zhou Shengru Zhu Haiqin Pan Meng(Department of Dermatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, Chin)

机构地区：[1]上海交通大学医学院附属瑞金医院皮肤科,200025

出　　处：《中华皮肤科杂志》2017年第8期567-570,共4页Chinese Journal of Dermatology

基　　金：国家自然科学基金（81673064、81472875）

摘　　要：目的 总结皮肤外伤诱发自身免疫性大疱性皮肤病的临床特点、组织病理学表现等，探讨其可能的发病机制。方法 分析3例由皮肤外伤所诱发的天疱疮或类天疱疮患者的临床表现、组织病理特点及治疗，结合国内外相关文献讨论与总结。结果 3例自身免疫性大疱性皮肤病患者，女1例，男2例，年龄分别为62、60、71岁，由外伤或手术诱发，与发病间隔时间分别为5周、5周和3 d，分别确诊为大疱性类天疱疮（BP180抗体109 U/ml，BP230抗体阴性）、寻常型天疱疮（Dsg1抗体68.8 U/ml，Dsg3抗体219 U/ml）和落叶型天疱疮（Dsg1抗体143 U/ml，Dsg3抗体阴性）。经糖皮质激素系统和（或）外用治疗后皮疹均明显好转。结论 外伤可能是自身免疫性大疱性皮肤病的1个诱发因素。对于外伤后伤口愈合不良或皮肤出现红斑、水疱、糜烂，用外伤或手术难以解释时，都应警惕自身免疫性大疱性皮肤病的可能，及时行组织病理或免疫病理检查。Objective To summarize clinical and histopathological features of trauma-triggered autoimmune bullous skin diseases, and to explore its possible pathogenesis. Methods Clinical manifestations, histopathological features and treatment of 3 cases of trauma-triggered pemphigus or pemphigoid were analyzed, and summarized according to related domestic and overseas literature. Results Of the 3 cases, 1 was a female aged 62 years, and 2 were males aged 60 and 71 years respectively. They all had a history of skin trauma or surgery before the onset of the diseases, and time intervals from trauma to diseases were 5, 5 weeks and 3 days respectively. The 3 cases were diagnosed as bullous pemphigoid （anti-BP180 antibody 109 U/ml, anti-BP230 antibody negative）, pemphigus vulgaris （anti-Dsg1 antibody 68.8 U/ml, anti-Dsg3 antibody 219 U/ml） and pemphigus foliaceus （anti-Dsg1 antibody 143 U/ml, anti-Dsg3 antibody negative） respectively. Their lesions were relieved dramatically after oral and （or） topical glucocorticoid treatment. Conclusions Trauma may be a triggering factor for autoimmune bullous skin diseases. For patients with post-traumatic poor wound healing or skin erythema, blisters and erosion, which can hardly be attributed to trauma or surgery itself, autoimmune bullous skin diseases should be considered, and histopathological or immunopathological examinations should be performed timely.

关 键 词：天疱疮 类天疱疮 大疱性 创伤和损伤 

分 类 号：R758.66[医药卫生—皮肤病学与性病学]