阿达木单抗治疗毛囊闭锁三联征合并胰岛素抵抗1例  

Follicular Occlusion Triad Complicated with Insulin Resistance Treated by Adalimumab:A Case Report

作　　者：杨岚 赖惠君 游馥榕 赖美妍 郭红卫 YANG Lan;LAI Huijun;YOU Furong;LAI Meiyan;GUO Hongwei(Dermatological Department of the Second Affiliated Hospital of Guangdong Medical University,Zhanjiang 524003,China;Guangdong Medical University,Zhanjiang 524003,China)

机构地区：[1]广东医科大学附属第二医院皮肤病科,广东湛江524003 [2]广东医科大学,广东湛江524003

出　　处：《中国皮肤性病学杂志》2023年第2期191-195,共5页The Chinese Journal of Dermatovenereology

摘　　要：患者男,14岁,枕部、双侧腋窝、腹股沟出现红色疼痛性丘疹、结节、脓肿半年。皮肤科情况:颈部、双侧腋窝和腹股沟处可见不规则的天鹅绒样增厚的色素沉着斑块,散在蚕豆大小的暗红色结节,部分结节破溃,表面伴有脓性分泌物,部分贯通形成窦道及瘘管。男孩身高140 cm,体重75 kg,BMI值38.3 kg/m^(2)(肥胖)。实验室检查显示胰岛素抵抗和尿酸增加。诊断:毛囊闭锁三联征;肥胖相关性黑棘皮病;胰岛素抵抗;高尿酸血症。予糖皮质激素0.3 mg/(kg·d)治疗5 d、异维A酸20 mg/d治疗1个月、光动力治疗3次、局部创面护理并饮食控制治疗,但皮损改善不明显,且出现新病灶。遂采用肿瘤坏死因子(TNF-α)抑制剂阿达木单抗联合异维A酸20 mg/d及局部创面护理,阿达木单抗3次(80 mg、40 mg、40 mg,1次/周)治疗后,病灶迅速消减,不再出现新病灶,但是患者出现全身骨痛,不得已终止阿达木单抗治疗。停止阿达木单抗治疗后1周,骨痛症状逐渐消退,偶有新发皮损。该患者仍然在随访中。A 14-year-old male patient presented with red and painful papules, nodules, and abscesses on the occipital region, bilateral axillae and groins for half a year. Dermatological examination showed irregular dark, velvety, and thick patches in neck, bilateral axillae and groins, where there were scattered broad bean-sized dark red nodules. Some nodules ruptured with purulent secretions attached to the surface and some connected to form sinuses and fistulas. The pain and tenderness were significant. The boy was 140 cm and 75 kg, body mass index(BMI) 38.3 kg/m^(2)(obese). The Laboratory tests demonstrated insulin resistance and increased circulating uric acid. Therefore, the diagnosis was established as follicular occlusion triad, obesity-associated acanthosis nigricans;insulin resistance;hyperuricemia. Then glucocorticoid 0.3 mg/(kg·d) for 5 days, isotretinoin 20 mg/d for 1 month, and photodynamic therapy three times, local wound care combined with diet control were employed, but the improvement was insignificant and new lesions were appearing. So the TNF-α blocker adalimumab was used in addition to isotretinoin 20 mg/d and local wound care. After three times of adalimumab(80 mg, 40 mg, 40 mg, weekly) treatments, the lesions rapidly resolved and no more new lesions came out. However, the patient complained bone pain all over his body, the subsequent adalimumab treatment had to be terminated. One week after the termination of adalimumab treatment, the bone pain gradually disappeared, whereas the mild lesion came out occasionally. The patient is still followed-up.

关 键 词：毛囊闭锁三联征 黑棘皮病 肥胖相关性 胰岛素抵抗 阿达木单抗治疗 

分 类 号：R758.7[医药卫生—皮肤病学与性病学]