疱疹样脓疱病5例患者临床特征和治疗  

Clinical Features and Treatment of Five Patients with Impetigo Herpetiformis

作　　者：刘琼[1] 许贵霞 蒋法兴 刘金丽 谢佳佳 张思平 LIU Qiong;XU Guixia;JIANG Faxing;LIU Jinli;XIE Jiajia;ZHANG Siping(Department of Dermatology and Venerology,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)皮肤科,安徽合肥230001

出　　处：《中国皮肤性病学杂志》2024年第9期1007-1011,共5页The Chinese Journal of Dermatovenereology

摘　　要：目的探讨疱疹样脓疱病的临床特点、治疗和转归。方法回顾性分析本院诊治的5例疱疹样脓疱病患者的临床特点、组织病理、治疗方法和转归。结果1例孕早期发病,3例孕中期发病,1例孕晚期发病。5例患者炎症指标均升高。2例有连续性肢端皮炎病史,皮损表现为离心性环状损害,其上密集分布的脓疱,类似环状银屑病,伴有发热。2例系胚胎移植患者,无银屑病病史,皮损表现和von Zumbusch型脓疱型银屑病相似,均无发热。5例患者初始均予糖皮质激素治疗,病情均控制不佳,其中3例于孕晚期时诱导生产,2例联合生物制剂治疗后病情控制。5例均早产,胎儿均存活。结论胚胎移植和自然受孕后发生的疱疹样脓疱病皮损表现不同,有连续性肢端皮炎病史、自身免疫性不孕行胚胎移植、发病时间早提示病情重,应用生物制剂可能改善预后。Objective To explore the clinical features,treatment options,and outcomes of impetigo herpetiformis.Methods A retrospective analysis was conducted on the clinical features,histopathological findings,treatment approaches,and outcomes of five patients with impetigo herpetiformis treated in our hospital.Results The patients exhibited various presentations:one patient developed impetigo herpetiformis during early pregnancy,three during mid-pregnancy,and one during late pregnancy.All patients had elevated inflammatory markers.Two patients had a history of acrodermatitis continua of Hallopeau,presenting with erythema annulare centrifugum-like lesions covered with dense pustules and fever.In contrast,two other patients who underwent embryo transplantation without a history of psoriasis exhibited skin lesions resembling von Zumbusch-type pustular psoriasis but without fever.Initially,all patients were treated with glucocorticoids,but their skin lesions remained poorly controlled.Subsequently,three patients underwent induction of labor in late pregnancy,while two patients received treatment with biological agents.All five pregnancies resulted in premature births,but all fetuses survived.Conclusion The skin manifestations of impetigo herpetiformis differ between patients undergoing embryo transplantation and those with natural conception.A history of acrodermatitis continua of Hallopeau,embryo transplantation due to autoimmune infertility,and early onset of the disease indicate a severe prognosis.The use of biological agents may potentially improve the outcomes in these patients.

关 键 词：疱疹样脓疱病 泛发型脓疱型银屑病 连续性肢端皮炎 胚胎移植 生物制剂 

分 类 号：R758.63[医药卫生—皮肤病学与性病学] R714.21[医药卫生—临床医学]