疱疹样皮炎10例临床、组织病理及直接免疫荧光特征分析  

Analysis of the Clinical,Histopathological and Direct Immunofluorescence Characteristics of 10 Cases of Dermatitis Herpetiformis

作　　者：叶瑜 郭娟[1] 李文静[1] 王雷[1] 陈凤鸣[1] 刘宇[1] YE Yu;GUO Juan;LI Wenjing;WANG Lei;CHEN Fengming;LIU Yu(Department of Dermatology,Xijing Hospital,the Fourth Military Medical University,Xi'an 710032,China)

机构地区：[1]第四军医大学西京皮肤医院,陕西西安710032

出　　处：《中国皮肤性病学杂志》2022年第8期920-925,共6页The Chinese Journal of Dermatovenereology

基　　金：国家临床重点专科建设项目(2016LCZX-06);陕西省科技计划项目,陕西省科技统筹创新工程计划项目(2016KTZDSF02-05,2016SF-374)。

摘　　要：目的探讨疱疹样皮炎的临床表现、组织病理及直接免疫荧光特征。方法对2015年1月-2020年9月西京皮肤医院确诊的10例疱疹样皮炎的临床及病理资料进行回顾性分析。结果男6例,女4例,发病年龄为12~74岁,平均发病年龄(53.60±20.97)岁。10例患者皮损以四肢(肘部、膝部)及臀部为主,对称分布,其中有4例累及头面部。1例患者面部水疱,背部及上肢为荨麻疹样红斑。所有患者均伴剧烈瘙痒。组织病理:8例可见真皮乳头中性粒细胞微脓肿,7例见表皮下疱。直接免疫荧光显示10例患者真皮乳头IgA颗粒状沉积,其中9例患者同时伴有真表皮交界处IgA颗粒状沉积。3例真皮浅层纤维状IgA沉积。结论疱疹样皮炎皮损好发于肘部、膝部及臀部,对称分布,剧烈瘙痒,病理表现为真皮乳头中性粒细胞微脓肿。直接免疫荧光显示真皮乳头及(或)真表皮交界处有IgA颗粒状沉积,可伴真皮浅层纤维状IgA沉积。Objective To investigate the clinicopathological features and results of direct immunofluorescence of dermatitis herpetiformis.Methods We collected 10 cases of dermatitis herpetiformis patients from January 2015 to September 2020 in the Department of Dermatology Xijing Hospital and evaluated the pathological symptoms.Results There were 6 males and 4 females.The age of onset was 12-74 years old,and the average age of onset was(53.60±20.97)years old.The skin lesions of 10 patients were mainly extremities(elbows,knees)and buttocks,and distributed symmetrically.Among them,4 cases involved the head and face.One patient had facial blisters,urticaria-like erythema on the back and upper limbs.The clinical manifestations of the enrolled patients were erythema,blisters and erosion,all accompanied by intense itching.The pathological features were listed as below:blisters located in subepidermal in which infiltrated with extensive neutrophils,lymphocytes,histiocytes,and several neutrophils infiltrated in the superficial dermis around blood vessels and among collagens.Direct immunofluorescence showed granular deposition of IgA at dermal papilla.Conclusion Dermatitis herpetiformis usually occurs in the elbow,knee and buttocks.The pathological manifestations are dermal papillomedema which lead to subepidermal blister,and the accumulation of neutrophils in the papilla.Direct immunofluorescence showed IgA granular deposition at dermal papilla,microgranular IgA deposits along the dermal-epidermal junction(DEJ)or fibrillar deposits at the tips of the dermal papillae.

关 键 词：疱疹样皮炎 临床表现 组织病理 直接免疫荧光 IGA 

分 类 号：R758.66[医药卫生—皮肤病学与性病学]