红斑∮擘鳞屑性皮肤病

红斑、鳞屑性皮肤病1Erythema

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因4病因复杂，临床上将病因不明的称特发性多形红斑，病因明确称症状性多形红斑。感染:病毒、细菌E、va真lu菌a、t、i原on虫o等nly.atedwithAspose.Slidesfor.NET3.5ClientPro药物、C疫op苗yr、i血gh清t等2004-2011AsposePtyLtd.其他因素:某些系统性疾病如LE、皮肌炎、结节性动脉周围炎、恶性淋巴瘤、内脏恶性肿瘤等，寒冷、日光、妊娠、月经来潮均可引起本病。临床表现常有畏寒、发热、全身不适、乏力、关节肌肉疼痛和咽喉疼痛等前驱症状。皮疹于临床上可分：1.红斑-丘疹型；水疱-大疱型；重症型。Evaluationonly.ated1w2i~t2h4小As时po内s突e.然Sl发id生e，sf对o称r.分N布ET，3皮.皮5疹Cl多i形en，tPro可有风团Co、p红yr斑ig、ht丘2疹00、4紫-2癜01.1水As疱po等s。e。P任ty何L年td.龄均可发病，儿童、青年女性多见，春秋季节易发病。5（一）红斑—丘疹型圆形或椭圆形水肿性红斑,颜色鲜红,或出现紫癜、水疱或丘疱疹,边缘潮红,形如虹膜状或靶形,好发于四肢远端。Evaluation

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Ltd.（二）水疱—大疱型常由红斑—丘疹型发展而来,因渗出较严重,形成水疱、大疱或血疱,为浆液性张力性疱,周围绕以暗红色晕轮,表现为虹膜样。除四肢远端外,口鼻部、外生殖器部粘膜也可出现糜烂。Evaluation

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Ltd.7（三）重症型8又称Steven-Johnson综合征。本型发病急剧,有较重的前驱症状如高热、畏寒、头痛、关节痛等。皮疹出现迅速,为水肿性鲜红色或暗红色虹膜样红斑或瘀斑,Ev其al上ua很t快i快o出no现n水ly疱.、大疱、ate血dw疱i。th尼A氏sp征os阳e.性S。li皮de疹s大fo片r泛.N发ET,3并.5累C及li口en腔tPro粘膜、鼻粘Co膜py、ri眼g结ht膜2及00外4-生20殖1器1器A粘sp膜o。se口P鼻ty粘Ltd.膜糜烂,分泌物多,表面有灰白色假膜,疼痛明显。眼结膜充血明显,分泌物多,甚至发生角膜炎、角膜溃疡、全眼球炎及失明。多形红斑（重症型）Evaluation

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Ltd.9诊断要点10好发于儿童及青年,春秋季多见。皮损多形,有典型E虹v膜a膜l样ua损ti害on,on好l发y.于四肢远atedwithAspose.Slidesfor.NET3.5ClientPro端及面部等Co。pyright2004-2011AsposePtyLtd.有前驱症状,重型可有粘膜损害及全身症状。鉴别诊断11红斑狼疮冻疮大疱性类Ev天al疱ua疮tion

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疗12加用静注10％葡萄糖酸钙。水疱-大疱型1、追查病原，积极寻找病因。2.全身疗法：轻症者口服抗组胺制剂，或Evaluationonly.atedwithAspose.Slidesfor.NET3.5ClientPro及重症C型op应yr早ig期ht足2量00使4-用20糖11皮As质po激se素P,ty如Ltd.泼尼松60~80mg/d或用相当量的氢化可的松、地塞米松口服或静滴。皮损消退后逐渐减量,疗程达2~4周或更长。加强护理,注意水电解质平衡、营养及其他并发症。有广泛水疱、E糜va烂lu、atio出n严on重ly者.应预ated防w性it应hA用sp抗os生e.素Sl,id有es感f染or者.N选ET用3广.5谱Cl抗ie生ntPro素。重症Co患py者ri,gh尤t其20是04进-2食01困1A难sp者os可e静Pt脉yLtd.给予复方氨基酸、白蛋白,输新鲜血浆及全血等支持疗法。13口腔粘膜糜烂可用生理盐水、3％双氧水、复方硼砂溶液嗽口，外涂1％地卡因甲紫液。4.中医疗法 有口腔损害者可含服金银花片。143.局部治疗 原则为消炎、收敛、止痒、预防感染。红斑-丘疹型可外用炉甘石洗剂或糖皮质激素霜剂。有水疱和渗出可用3％硼酸液、0.1％雷佛奴尔液、1％--3%醋酸Ev铝al溶u液at、io生n理on盐ly水.、黄柏ated地w榆it煎h液As湿p敷os。e.大Sl疱i可d可e用sf无o菌r.注N射ET器3抽.5出C疱li液en，tProCopyright

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Ltd.关节病型红皮病型寻常型银屑病起病急炎性红色丘疹,粟粒至绿豆大,逐渐融合为棕Ev红aluationonly.ate色d斑wi块th。Aspose.Slidesfor.NET3.5ClientPro边界清C楚o,py周ri围gh有t炎20性04-2011AsposePtyLtd.红晕,基底浸润明显。表面覆盖多层干燥的银白色鳞屑。19寻常型20皮损 红斑、白色鳞屑蜡滴现象、薄膜现象、Auspitz征形状 点滴Ev斑al块ua状tio钱n币on形ly.地图样atedwithAs蛎po壳se状.S环l环i状d状es泛fo发r.NET3.5ClientPro部位C全op身yr性ig,ht以20头04皮-2和01四1肢As伸po侧se多Pt见yLtd.症状 痒病程 慢性、复发性薄膜现象、点状出血:Auspitz征Evaluation

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易复发分期进行期 新皮疹不断增多,旧皮疹扩大,炎症明显,鳞Ev屑al增ua厚t,io瘙n痒o痒n剧ly烈.。ated同wi形th反A应spose.Slidesfor.NET3.5ClientPro静止期C病op情yr稳ig定h,t2暂0停04发-2展01。1AsposePtyLtd.退行期 炎症逐渐消退,皮疹缩小变平,遗留色素减退或色素沉着斑39进行期Evaluation

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Ltd.40同形反应:银屑病进行期，皮肤敏感性增高，各种机械刺激常可引起受刺激部位发生新的皮损。Evaluation

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Ltd.1.泛发型脓疱型银屑病45为临床上最重E的va一lu型at,io外no用nl刺y.激性药ated物wi,th感A染sp,os应e.用Sl糖id皮es质fo激r素.N或ET免3.疫5抑Cl制ie剂ntProCopyright2004-2011AsposePtyLtd.过程中骤然停药等均为促发因素。脓疱,受累,愈后差。皮损为炎性红斑,表面密集无菌小脓E疱valuationonly.ated可w扩it大hA融sp合os成e.脓Sl湖id,esfor.NET3.5ClientPro46成批出现Co,py全ri身gh皮t肤2004-2011AsposePtyLtd.少见,多为青壮年。发病急剧,高热,白细胞增高,低钙血症,血沉增快全身症状重。皱折部常出现糜烂Ev,al结ua痂ti。ononly.atedwithAspose.Slidesfor.NET3.5ClientPro勾纹舌C。opyright2004-2011AsposePtyLtd.脓疱周期性复发,持续数日至数周,自行缓解成为红皮病。反复发作,造成低蛋白血症,预后不良。47Evaluation

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Ltd.492.局限性脓疱性银屑病50不易破裂。皮疹限于手掌及足跖,对称分布。掌部皮损初发于大小鱼际,以后逐渐扩展到掌心,手背,手指,足Ev跖a部lu好at发io于n跖on中l部y.及内侧。ated•w对it称h性As红po斑se上.成Sl群id淡es黄f色or针.头NE至T粟3.粒5大Cl小ie脓n疱tP,ro1~2周后Co脓py疱ri干g涸ht,2结00痂4-及20脱1屑1屑A鳞sp屑o下se反P复ty出Ltd.现成群新疱。时轻时重,经久不愈。常伴甲病变。Evaluation

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Ltd.关节病型53常继发于银屑病反复发作后,大多数与其它几型并发。表现银屑病损害,合并类风湿关节炎症状。受累关节以腕、Ev踝a、lu指at（io趾n）on末l端y.小关atedwithAspose.Slidesfor.NET3.5ClientPro节多见C,o可py有ri全gh身t症20状0（4-发20热11,A贫sp血os,e肝Pt脾y,Ltd.淋巴结肿大）。X线检查可有类风湿性关节炎改变,但类风湿因子阴性。Evaluation

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Ltd.也可见于全身脓疱型银屑病后期全身迅速出现弥漫性潮红浸润,表面有大量麸皮样鳞屑,其间可见片状正常“皮岛”,指（趾）甲浑浊,变厚变形脱落。蜡滴现象,簿膜E现va象lu,at点io状n出on血ly消.失。atedwithAspose.Slidesfor.NET3.5ClientPro可伴畏Co寒py,ri发gh热t,20关04节-2痛01,1A头sp痛os等e症Pt状yL。td.低蛋白血症。白细胞及中性粒细胞计数增高。56Evaluation

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Ltd.59组织病理60角化不全伴角化过度,颗粒层减少或消失,棘层肥厚,表皮突规则下延,末段增宽,真皮乳头向上延伸E,va白lu细at胞io在n角o角n化l化y不.不全的ated角w质it层hA内sp聚os集e.形Sl成idMeusnrfor微.脓NE疡T3,.5真C皮l皮i浅e浅ntProCopyright2004-2011AsposePtyLtd.层血管周围有淋巴细胞浸润。脓疱型在棘层上部出现Kogoj海绵状微脓疱,疱内为中性粒细胞。诊断临床表现、皮疹特点、好发部位,结合组织病理。Evaluationonly.atedwithAspose.Slidesfor.NET3.5ClientProCopyright2004-2011AsposePtyLtd.61鉴别诊断62脂溢性皮炎二期梅毒疹慢性单纯性Ev苔al藓uation

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Ltd.连续性肢端皮炎疱疹样脓疱病红皮病治疗63尚无根治办法,在现有条件下既要努力帮助病人消除症状,又要不使病人健康受损。Evaluationonly.at•ed说wi服th患A者sp勿os乱e.投Sl医id、es滥fo用r药.N,ET对3.“5秘Cl方ie”nt不Pro可偏信。Copyright2004-2011AsposePtyLtd.解除顾虑,树立信心。治疗原则:安全无害重在调理去除诱因外用药Evaluation

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Ltd.1、治疗不当 某些皮肤病由于处理不当或治疗不及时可演变或发展成红皮病，如银屑病、Ev接al触ua性ti皮on炎o、nl天y.疱疮、atedwithAspose.Slidesfor.NET3.5ClientPro大疱性类Co天py疱ri疮gh、t2特00应4-性20皮11炎A.sp脂os溢eP性tyLtd.皮炎、湿疹、多形红斑、泛发性扁平苔藓等。702、药物过敏是引起本病的一个重要原因，如磺胺类、青霉素、抗疟药、巴比妥类、水杨酸类、碘、砷等。Evaluationonly.atedwith3A.sp恶os性e.肿Sl瘤ides约f8o%r~.2N0E%T红3.皮5病Cl患ientPro者伴有恶Co性py肿ri瘤gh。t2004-2011AsposePtyLtd.4、特发型少数患者无确切病因，常为自身免疫性疾病。71临床表现72一、急性红皮病 发病急骤,伴高热,全发的细小密集斑片、斑丘疹,呈猩红热样身乏力,肝脾淋巴结肿大等。皮损初为泛Evaluationonly.atedwithAspose.Slidesfor.NET3.5ClientPro或麻疹样Co,py迅ri速gh发t2展00,4-全20身11弥A漫sp性os潮eP红ty、Ltd.水肿,面部、肢端显著,并伴有大量脱屑,呈大片或细糠状,掌跖可呈手套或补袜套样脱屑,常伴有剧烈瘙痒。临床表现73二、慢性红皮病 为慢性弥漫性、浸润性潮红、肿胀,鳞屑呈糠状,Ev无al大ua片ti鳞on屑o。nl由y.于反复脱at屑e屑d,wi蛋th白As质po大se量.S丢li失de,s可fo导r.致NE低T蛋3.白5C血li症en、t酮Pro症酸中毒C。op如yr脓ig疱ht性2银00屑4-病20引11起As者po,se可P见ty无Lt菌d.性脓疱。红皮病Evaluation

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疗76一般治疗全身治疗免疫抑制剂 甲氨喋呤2.5—5mg/次,每12小时一次,连服3次,以后每周同样方法给药。维A酸类寻找病因,如为药物引起者,需停用致敏或可疑药物。Evaluationonly.ated•w糖it皮h

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疗77者可用1％冰片炉甘石洗剂、10％硼酸滑石粉等；有糜烂渗出者可用0.1％雷佛奴尔、三黄汤等湿敷；脱屑者可选用糖皮质激素制剂。局部治疗原则是滋润皮肤,消炎止痒。宜选用温和制剂,禁用刺激Ev性al药ua物ti。on潮o红nl水y.肿明显ated

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