Erythroderma

红皮病
  • 文章类型: Case Reports
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  • 文章类型: Case Reports
    背景:挪威sc疮(NS)是一种严重的寄生虫性皮肤病。尽管NS是红皮病的原因之一,它经常被忽视。因此,提高对NS表现为红皮病的认识至关重要。
    方法:我们介绍了一例持续3年以上的NS病例。经过非标准治疗后,患者的皮疹恶化并逐渐发展为红皮病。最后,经皮肤镜检和病理确诊为NS。
    结论:当瘙痒性皮肤病患者存在长期卧床和免疫缺陷等高危因素时,临床医生需要提高对NS的认识,并确保及时诊断和治疗。
    BACKGROUND: Norwegian scabies (NS) is a serious parasitic skin condition. Although NS is one of the causes of erythroderma, it is frequently overlooked. Therefore, it is essential to raise awareness regarding NS presenting as erythroderma.
    METHODS: We present a case of NS that persisted for more than 3 years. After following nonstandard treatment, the patient\'s rash worsened and gradually progressed into erythroderma. Finally, NS was diagnosed by skin microscopy and pathology.
    CONCLUSIONS: When patients with pruritic dermatosis have high-risk factors such as prolonged bed rest and immunodeficiency, clinicians need to enhance their awareness of NS and ensure prompt diagnosis and treatment.
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  • 文章类型: Journal Article
    特应性皮炎(AD),牛皮癣,与红皮病相关的药物反应经常因感染而复杂化。然而,血流感染(BSI)受到的研究关注较少。
    本研究旨在探讨红皮病患者与BSI相关的临床特征和危险因素。
    对141例红皮病病例进行回顾性分析。11例患者被确定为患有BSI。回顾并比较了BSI和非BSI组的临床记录。
    在7.80%(11/141)的红皮病病例中诊断出BSI,在AD中分解为7.14%,2.00%的牛皮癣,药物反应占17.14%。值得注意的是,所有阳性皮肤培养物(7/7)均显示细菌分离株与血液培养物一致。单因素logistic回归分析显示与BSI有几个显著关联,包括温度(≤36.0或≥38.5°C;比值比(OR)=28.06;p<0.001),冷却(OR=22.10;p<0.001),肾脏疾病(OR=14.64;p<0.001),药物反应的病因(OR=4.18;p=0.03),白蛋白(ALB)(OR=0.86;p<0.01),C反应蛋白(CRP)(OR=1.01;p=0.02),白细胞介素6(IL-6)(OR=1.02;p=0.02),和降钙素原(PCT)(OR=1.07;p=0.03)。受试者工作特征(ROC)曲线显示与ALB显著相关(p<0.001;曲线下面积(AUC)=0.80),PCT(p=0.009;AUC=0.74),和CRP(p=0.02;AUC=0.71)。
    提高对BSI风险的认识在红皮病管理中至关重要。有特定危险因素的患者,如体温异常(≤36.0或≥38.5℃),令人不寒而栗的感觉,肾病,有药物反应史,CRP升高(≥32mg/L),PCT升高(≥1.00ng/ml),和低白蛋白(≤31.0g/L),需要密切监测BSI的发展。
    UNASSIGNED: Atopic dermatitis (AD), psoriasis, and drug reactions associated with erythroderma are frequently complicated by infections. However, bloodstream infection (BSI) have received less research attention.
    UNASSIGNED: This study aimed to investigate the clinical characteristics and risk factors associated with BSI in patients with erythroderma.
    UNASSIGNED: A retrospective analysis was conducted on 141 erythroderma cases. Eleven cases were identified as having BSI. Clinical records of both BSI and non-BSI groups were reviewed and compared.
    UNASSIGNED: BSI was diagnosed in 7.80% (11/141) of erythroderma cases, with a breakdown of 7.14% in AD, 2.00% in psoriasis, and 17.14% in drug reactions. Notably, all positive skin cultures (7/7) showed bacterial isolates concordant with blood cultures. Univariate logistic regression analysis revealed several significant associations with BSI, including temperature (≤36.0 or ≥38.5 °C; odds ratio (OR) = 28.06; p < 0.001), chilling (OR = 22.10; p < 0.001), kidney disease (OR = 14.64; p < 0.001), etiology of drug reactions (OR = 4.18; p = 0.03), albumin (ALB) (OR = 0.86; p < 0.01), C-reaction protein (CRP) (OR = 1.01; p = 0.02), interleukin 6 (IL-6) (OR = 1.02; p = 0.02), and procalcitonin (PCT) (OR = 1.07; p = 0.03). Receiver operating characteristic (ROC) curves demonstrated significant associations with ALB (p < 0.001; the area under curve (AUC) = 0.80), PCT (p = 0.009; AUC = 0.74), and CRP (p = 0.02; AUC = 0.71).
    UNASSIGNED: Increased awareness of BSI risk is essential in erythroderma management. Patients with specific risk factors, such as abnormal body temperature (≤36.0 or ≥38.5 °C), chilling sensations, kidney disease, a history of drug reactions, elevated CRP (≥32 mg/L), elevated PCT (≥1.00 ng/ml), and low albumin (≤31.0 g/L), require close monitoring for BSI development.
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  • 文章类型: Journal Article
    背景:PRP是一种未知病因的罕见实体。缺乏临床实践指南使临床医生的管理具有挑战性。
    目的:将我们的经验添加到PRP的语料库证据中。
    方法:这是一个回顾性研究,描述性,描述性65例PRP患者的多中心研究,欧洲有史以来最大的PRP患者病例系列报告.
    结果:PRP在平均年龄为51岁的男性中更为普遍,然而,在老年患者中出现红皮病型(平均年龄,61年)。6名(75%)儿科患者和10名(60%)非红皮病患者成年人通过局部皮质类固醇控制了疾病。然而,26例(68%)红皮病患者需要生物疗法作为最后的有效疗法,平均6.5个月才能达到完全缓解。
    结论:我们的研究表明,儿童在治疗结果和反应方面存在统计学差异,或患有局限性疾病的患者和患有红皮病的患者。
    BACKGROUND: PRP is a rare entity of unknown etiopathogenesis. Lack of management guidelines makes it a challenge for clinicians.
    OBJECTIVE: To add our experience to increase evidence about PRP.
    METHODS: We performed a retrospective, descriptive and multicentric study of 65 patients with PRP, being the largest European case series of patients with PRP.
    RESULTS: PRP was more frequent in male patients with an average age of 51 years, but erythrodermic forms presented in older patients (average age 61 years). Six (75%) paediatric patients and ten (60%) non-erythrodermic adults controlled their disease with topical corticosteroids. On the contrary, 26 (68%) erythrodermic patients required biologic therapy as last and effective therapy line requiring an average of 6.5 months to achieve complete response.
    CONCLUSIONS: Our study showed a statistical difference in terms of outcome and response to treatment between children or patients with limited disease and patients who develop erythroderma.
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  • 文章类型: Case Reports
    红皮病,也被称为剥脱性皮炎,是成人发作的斯蒂尔病(AOSD)的罕见非典型皮肤表现。我们介绍了红皮病与AOSD相关的病例,AOSD是类固醇依赖性的,对托珠单抗治疗有反应。皮疹,瘙痒,添加托珠单抗后,相关的实验室检查结果显着改善,而泼尼松龙成功减量至最低维持水平。据我们所知,这是首次报道托珠单抗对AOSD相关红皮病的唯一治疗作用.
    Erythroderma, also known as exfoliative dermatitis, is a rarely reported atypical cutaneous manifestation of adult-onset Still\'s disease (AOSD). We present the case of erythroderma in association with AOSD that was steroid dependent and responded to tocilizumab therapy. Skin rash, pruritis, and related laboratory findings were significantly improved upon the addition of tocilizumab, while prednisolone was successfully tapered to an ever-lowest maintenance level. To our knowledge, this is the first to report the sole therapeutic effect of tocilizumab in erythroderma related to AOSD.
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  • 文章类型: Journal Article
    高级临床从业人员(ACP)在初级和二级护理环境中遇到急性皮肤病表现的患者,范围从轻微到危及生命。然而,ACP通常对评估和治疗皮肤科紧急情况的患者毫无准备。本文旨在为受训者和合格的ACP提供指导,无论是在急症医院还是初级保健,了解咨询急性皮肤病紧急情况患者时要考虑的基本方面。它还强调适当转诊到相关专科进行必要的住院或门诊调查,并确保及时治疗。
    Advanced clinical practitioners (ACPs) encounter patients with acute dermatological presentations ranging from minor to life-threatening conditions in both primary and secondary care settings. However, ACPs often feel unprepared to assess and treat patients with dermatological emergencies. This article aims to provide guidance to trainee and qualified ACPs, whether in acute hospital settings or primary care, in understanding the essential aspects to consider when consulting with patients presenting with acute dermatological emergencies. It also emphasises appropriate referrals to relevant specialties for necessary inpatient or outpatient investigations and ensure prompt treatment.
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  • 文章类型: Letter
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  • 文章类型: Journal Article
    背景:PRP是一种未知病因的罕见实体。缺乏临床实践指南使临床医生的管理具有挑战性。
    目的:将我们的经验添加到PRP的语料库证据中。
    方法:这是一个回顾性研究,描述性,描述性65例PRP患者的多中心研究,欧洲有史以来最大的PRP患者病例系列报告.
    结果:PRP在平均年龄为51岁的男性中更为普遍,然而,在老年患者中出现红皮病型(平均年龄,61年)。6名(75%)儿科患者和10名(60%)非红皮病患者成年人通过局部皮质类固醇控制了疾病。然而,26例(68%)红皮病患者需要生物疗法作为最后的有效疗法,平均6.5个月才能达到完全缓解。
    结论:我们的研究表明,儿童在治疗结果和反应方面存在统计学差异,或患有局限性疾病的患者和患有红皮病的患者。
    BACKGROUND: PRP is a rare entity of unknown etiopathogenesis. Lack of management guidelines makes it a challenge for clinicians.
    OBJECTIVE: To add our experience to increase evidence about PRP.
    METHODS: We performed a retrospective, descriptive and multicentric study of 65 patients with PRP, being the largest European case series of patients with PRP.
    RESULTS: PRP was more frequent in male patients with an average age of 51 years, but erythrodermic forms presented in older patients (average age 61 years). Six (75%) paediatric patients and ten (60%) non-erythrodermic adults controlled their disease with topical corticosteroids. On the contrary, 26 (68%) erythrodermic patients required biologic therapy as last and effective therapy line requiring an average of 6.5 months to achieve complete response.
    CONCLUSIONS: Our study showed a statistical difference in terms of outcome and response to treatment between children or patients with limited disease and patients who develop erythroderma.
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  • 文章类型: Journal Article
    红皮病是一种以红斑影响至少90%的皮肤表面积为特征的病症。它可能是由各种潜在条件引起的。由于非特异性的临床和实验室检查结果,确定原因可能会带来挑战。在回顾性研究中,我们在皮肤科确定了212例因红皮病住院的患者,性病,2012年1月至2022年3月期间在弗罗茨瓦夫医科大学学习和变态反应学。临床,实验室,和组织病理学特征,以及病人的管理,被研究过。成年人的平均年龄为61岁(IQR=47-68)。红皮病最常见的原因是银屑病(n=49,24.01%),其次是特应性皮炎(AD)(n=27,13.23%),皮肤T细胞淋巴瘤(CTCL)(n=27,13.23%)。尽管进行了实验室检查和组织病理学检查,39例(19.12%)红皮病的病因尚未确定。在70.59%的患者中,这是红皮病的第一次发作,而29.41%的人经历了反复发作。不管红皮病的病因是什么,患者最常接受全身性抗组胺药治疗(146例,71.57%)和全身性类固醇(132例,64.71%)。特发性红皮病患者构成了最大的诊断和治疗挑战,需要特别彻底的评估。
    Erythroderma is a condition characterized by erythema affecting at least 90% of the skin surface area. It can be caused by various underlying conditions. Due to nonspecific clinical and laboratory findings, determining the cause may pose a challenge. In the retrospective study, we identified 212 patients hospitalized for erythroderma in the Department of Dermatology, Venereology, and Allergology at Wroclaw Medical University between January 2012 and March 2022. Clinical, laboratory, and histopathological features, as well as the management of patients, were studied. The median age of adults was 61 years (IQR = 47-68). The most common causes of erythroderma were psoriasis (n = 49, 24.01%), followed by atopic dermatitis (AD) (n = 27, 13.23%), and cutaneous T-cell lymphomas (CTCL) (n = 27, 13.23%). Despite laboratory tests and histopathological examination, the etiology of erythroderma remained undetermined in 39 cases (19.12%). In 70.59% of patients, it was the first episode of erythroderma, while 29.41% experienced a recurrent episode. Regardless of the etiology of erythroderma, patients were most frequently treated with systemic antihistamines (146 cases, 71.57%) and systemic steroids (132 cases, 64.71%). Patients with idiopathic erythroderma constitute the greatest diagnostic and therapeutic challenge, requiring particularly thorough evaluation.
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  • 文章类型: Case Reports
    人类免疫缺陷病毒(HIV)相关的CD8T细胞皮肤浸润性疾病伴严重红皮病的报道很少。虽然HIV阳性患者容易患上淋巴瘤,通常与爱泼斯坦-巴尔病毒有关,多形性淋巴增生性疾病是罕见的,占病例的5%。我们在此报告一名41岁的HIV阳性男子,他出现了发烧,红皮病,和淋巴结病,并被诊断为两种疾病并存。通过持续的抗逆转录病毒治疗,他的病情明显改善。这种情况表明,HIV诱导的免疫缺陷对两种实体的发病机理至关重要,并且改善免疫缺陷状态是有效的治疗方法。
    Human immunodeficiency virus (HIV)-associated CD8+ T-cell skin infiltrative disease with severe erythroderma has rarely been reported. While HIV-positive patients are prone to develop lymphoma, which is often associated with Epstein-Barr virus, polymorphic lymphoproliferative disorder is rare, accounting for <5% of cases. We herein report a 41-year-old HIV-positive man who presented with a fever, erythroderma, and lymphadenopathy and was diagnosed with the coexistence of both diseases. His condition improved significantly with continued antiretroviral therapy. This case suggests that HIV-induced immunodeficiency is central to the pathogenesis of both entities and that improvement of the immunodeficient state is an effective treatment.
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