紅斑∮擘鱗屑性皮膚病

紅斑、鱗屑性皮膚病1Erythema

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multiforme）多形紅斑(erythemamultiforme)是一種以多形性Ev皮al疹ua和ti虹on膜o樣n樣l紅y紅.斑為特atedwithAspose.Slidesfor.NET3.5ClientPro征的自C限op性yr炎ig癥ht性20皮04膚-2病01,1常As有po粘se膜Pt損y害Ltd.及全身癥狀。3病

因4病因復(fù)雜，臨床上將病因不明的稱(chēng)特發(fā)性多形紅斑，病因明確稱(chēng)癥狀性多形紅斑。感染:病毒、細(xì)菌E、va真lu菌a、t、i原on蟲(chóng)o等nly.atedwithAspose.Slidesfor.NET3.5ClientPro藥物、C疫op苗yr、i血gh清t等2004-2011AsposePtyLtd.其他因素:某些系統(tǒng)性疾病如LE、皮肌炎、結(jié)節(jié)性動(dòng)脈周?chē)住盒粤馨土?、?nèi)臟惡性腫瘤等，寒冷、日光、妊娠、月經(jīng)來(lái)潮均可引起本病。臨床表現(xiàn)常有畏寒、發(fā)熱、全身不適、乏力、關(guān)節(jié)肌肉疼痛和咽喉疼痛等前驅(qū)癥狀。皮疹于臨床上可分：1.紅斑-丘疹型；水皰-大皰型；重癥型。Evaluationonly.ated1w2i~t2h4小As時(shí)po內(nèi)s突e.然Sl發(fā)id生e，sf對(duì)o稱(chēng)r.分N布ET，3皮.皮5疹Cl多i形en，tPro可有風(fēng)團(tuán)Co、p紅yr斑ig、ht丘2疹00、4紫-2癜01.1水As皰po等s。e。P任ty何L年td.齡均可發(fā)病，兒童、青年女性多見(jiàn)，春秋季節(jié)易發(fā)病。5（一）紅斑—丘疹型圓形或橢圓形水腫性紅斑,顏色鮮紅,或出現(xiàn)紫癜、水皰或丘皰疹,邊緣潮紅,形如虹膜狀或靶形,好發(fā)于四肢遠(yuǎn)端。Evaluation

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Ltd.（二）水皰—大皰型常由紅斑—丘疹型發(fā)展而來(lái),因滲出較嚴(yán)重,形成水皰、大皰或血皰,為漿液性張力性皰,周?chē)@以暗紅色暈輪,表現(xiàn)為虹膜樣。除四肢遠(yuǎn)端外,口鼻部、外生殖器部粘膜也可出現(xiàn)糜爛。Evaluation

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Ltd.7（三）重癥型8又稱(chēng)Steven-Johnson綜合征。本型發(fā)病急劇,有較重的前驅(qū)癥狀如高熱、畏寒、頭痛、關(guān)節(jié)痛等。皮疹出現(xiàn)迅速,為水腫性鮮紅色或暗紅色虹膜樣紅斑或瘀斑,Ev其al上ua很t快i快o出no現(xiàn)n水ly皰.、大皰、ate血dw皰i。th尼A氏sp征os陽(yáng)e.性S。li皮de疹s大fo片r泛.N發(fā)ET,3并.5累C及l(fā)i口en腔tPro粘膜、鼻粘Co膜py、ri眼g結(jié)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.膜糜爛,分泌物多,表面有灰白色假膜,疼痛明顯。眼結(jié)膜充血明顯,分泌物多,甚至發(fā)生角膜炎、角膜潰瘍、全眼球炎及失明。多形紅斑（重癥型）Evaluation

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Ltd.9診斷要點(diǎn)10好發(fā)于兒童及青年,春秋季多見(jiàn)。皮損多形,有典型E虹v膜a膜l樣ua損ti害on,on好l發(fā)y.于四肢遠(yuǎn)atedwithAspose.Slidesfor.NET3.5ClientPro端及面部等Co。pyright2004-2011AsposePtyLtd.有前驅(qū)癥狀,重型可有粘膜損害及全身癥狀。鑒別診斷11紅斑狼瘡凍瘡大皰性類(lèi)Ev天al皰ua瘡tion

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療12加用靜注10％葡萄糖酸鈣。水皰-大皰型1、追查病原，積極尋找病因。2.全身療法：輕癥者口服抗組胺制劑，或Evaluationonly.atedwithAspose.Slidesfor.NET3.5ClientPro及重癥C型op應(yīng)yr早ig期ht足2量00使4-用20糖11皮As質(zhì)po激se素P,ty如Ltd.潑尼松60~80mg/d或用相當(dāng)量的氫化可的松、地塞米松口服或靜滴。皮損消退后逐漸減量,療程達(dá)2~4周或更長(zhǎng)。加強(qiáng)護(hù)理,注意水電解質(zhì)平衡、營(yíng)養(yǎng)及其他并發(fā)癥。有廣泛水皰、E糜va爛lu、atio出n嚴(yán)on重ly者.應(yīng)預(yù)ated防w性it應(yīng)hA用sp抗os生e.素Sl,id有es感f染or者.N選ET用3廣.5譜Cl抗ie生ntPro素。重癥Co患py者ri,gh尤t其20是04進(jìn)-2食01困1A難sp者os可e靜Pt脈yLtd.給予復(fù)方氨基酸、白蛋白,輸新鮮血漿及全血等支持療法。13口腔粘膜糜爛可用生理鹽水、3％雙氧水、復(fù)方硼砂溶液嗽口，外涂1％地卡因甲紫液。4.中醫(yī)療法 有口腔損害者可含服金銀花片。143.局部治療 原則為消炎、收斂、止癢、預(yù)防感染。紅斑-丘疹型可外用爐甘石洗劑或糖皮質(zhì)激素霜?jiǎng)?。有水皰和滲出可用3％硼酸液、0.1％雷佛奴爾液、1％--3%醋酸Ev鋁al溶u液at、io生n理on鹽ly水.、黃柏ated地w榆it煎h液As濕p敷os。e.大Sl皰i可d可e用sf無(wú)o菌r.注N射ET器3抽.5出C皰li液en，tProCopyright

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Ltd.北方＞南方白種人＞黃種人＞黑種人病因及發(fā)病機(jī)理17為遺傳因素與環(huán)境因素等多種因素相互作用的多基因遺傳病,發(fā)生機(jī)制為免疫介導(dǎo)性疾病。Evaluation

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Ltd.關(guān)節(jié)病型紅皮病型尋常型銀屑病起病急炎性紅色丘疹,粟粒至綠豆大,逐漸融合為棕Ev紅aluationonly.ate色d斑wi塊th。Aspose.Slidesfor.NET3.5ClientPro邊界清C楚o,py周ri圍gh有t炎20性04-2011AsposePtyLtd.紅暈,基底浸潤(rùn)明顯。表面覆蓋多層干燥的銀白色鱗屑。19尋常型20皮損 紅斑、白色鱗屑蠟滴現(xiàn)象、薄膜現(xiàn)象、Auspitz征形狀 點(diǎn)滴Ev斑al塊ua狀tio錢(qián)n幣on形ly.地圖樣atedwithAs蠣po殼se狀.S環(huán)l環(huán)i狀d狀es泛fo發(fā)r.NET3.5ClientPro部位C全op身yr性ig,ht以20頭04皮-2和01四1肢As伸po側(cè)se多Pt見(jiàn)yLtd.癥狀 癢病程 慢性、復(fù)發(fā)性薄膜現(xiàn)象、點(diǎn)狀出血:Auspitz征Evaluation

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Ltd.銀屑病病程

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易復(fù)發(fā)分期進(jìn)行期 新皮疹不斷增多,舊皮疹擴(kuò)大,炎癥明顯,鱗Ev屑al增ua厚t,io瘙n癢o癢n劇ly烈.。ated同wi形th反A應(yīng)spose.Slidesfor.NET3.5ClientPro靜止期C病op情yr穩(wěn)ig定h,t2暫0停04發(fā)-2展01。1AsposePtyLtd.退行期 炎癥逐漸消退,皮疹縮小變平,遺留色素減退或色素沉著斑39進(jìn)行期Evaluation

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Ltd.40同形反應(yīng):銀屑病進(jìn)行期，皮膚敏感性增高，各種機(jī)械刺激?？梢鹗艽碳げ课话l(fā)生新的皮損。Evaluation

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Ltd.1.泛發(fā)型膿皰型銀屑病45為臨床上最重E的va一lu型at,io外no用nl刺y.激性藥ated物wi,th感A染sp,os應(yīng)e.用Sl糖id皮es質(zhì)fo激r素.N或ET免3.疫5抑Cl制ie劑ntProCopyright2004-2011AsposePtyLtd.過(guò)程中驟然停藥等均為促發(fā)因素。膿皰,受累,愈后差。皮損為炎性紅斑,表面密集無(wú)菌小膿E皰valuationonly.ated可w擴(kuò)it大hA融sp合os成e.膿Sl湖id,esfor.NET3.5ClientPro46成批出現(xiàn)Co,py全ri身gh皮t膚2004-2011AsposePtyLtd.少見(jiàn),多為青壯年。發(fā)病急劇,高熱,白細(xì)胞增高,低鈣血癥,血沉增快全身癥狀重。皺折部常出現(xiàn)糜爛Ev,al結(jié)ua痂ti。ononly.atedwithAspose.Slidesfor.NET3.5ClientPro勾紋舌C。opyright2004-2011AsposePtyLtd.膿皰周期性復(fù)發(fā),持續(xù)數(shù)日至數(shù)周,自行緩解成為紅皮病。反復(fù)發(fā)作,造成低蛋白血癥,預(yù)后不良。47Evaluation

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Ltd.492.局限性膿皰性銀屑病50不易破裂。皮疹限于手掌及足跖,對(duì)稱(chēng)分布。掌部皮損初發(fā)于大小魚(yú)際,以后逐漸擴(kuò)展到掌心,手背,手指,足Ev跖a部lu好at發(fā)io于n跖on中l(wèi)部y.及內(nèi)側(cè)。ated?w對(duì)it稱(chēng)h性As紅po斑se上.成Sl群id淡es黃f色or針.頭NE至T粟3.粒5大Cl小ie膿n皰tP,ro1~2周后Co膿py皰ri干g涸ht,2結(jié)00痂4-及20脫1屑1屑A鱗sp屑o(jì)下se反P復(fù)ty出Ltd.現(xiàn)成群新皰。時(shí)輕時(shí)重,經(jīng)久不愈。常伴甲病變。Evaluation

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Ltd.關(guān)節(jié)病型53常繼發(fā)于銀屑病反復(fù)發(fā)作后,大多數(shù)與其它幾型并發(fā)。表現(xiàn)銀屑病損害,合并類(lèi)風(fēng)濕關(guān)節(jié)炎癥狀。受累關(guān)節(jié)以腕、Ev踝a、lu指at（io趾n）on末l端y.小關(guān)atedwithAspose.Slidesfor.NET3.5ClientPro節(jié)多見(jiàn)C,o可py有ri全gh身t癥20狀0（4-發(fā)20熱11,A貧sp血os,e肝Pt脾y,Ltd.淋巴結(jié)腫大）。X線檢查可有類(lèi)風(fēng)濕性關(guān)節(jié)炎改變,但類(lèi)風(fēng)濕因子陰性。Evaluation

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Ltd.54紅皮病型55多數(shù)是在尋常型進(jìn)行期應(yīng)用刺激性較大或較Evaluation

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Ltd.也可見(jiàn)于全身膿皰型銀屑病后期全身迅速出現(xiàn)彌漫性潮紅浸潤(rùn),表面有大量麩皮樣鱗屑,其間可見(jiàn)片狀正?！捌u”,指（趾）甲渾濁,變厚變形脫落。蠟滴現(xiàn)象,簿膜E現(xiàn)va象lu,at點(diǎn)io狀n出on血ly消.失。atedwithAspose.Slidesfor.NET3.5ClientPro可伴畏Co寒py,ri發(fā)gh熱t(yī),20關(guān)04節(jié)-2痛01,1A頭sp痛os等e癥Pt狀yL。td.低蛋白血癥。白細(xì)胞及中性粒細(xì)胞計(jì)數(shù)增高。56Evaluation

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Ltd.中醫(yī)中藥焦油制劑65蒽林皮質(zhì)類(lèi)固醇激素:維甲酸其它外用藥:5％水楊酸白降汞軟膏，5－10％硫磺軟膏，1:20000介子氣軟膏預(yù)防:飲酒 食刺激食物 物理化學(xué)和藥物的刺激 感染 精神顧慮治療全身療法維甲酸、維生素、靜脈封閉、抗生素、免疫療法、抗腫瘤藥物、皮E質(zhì)va類(lèi)l固ua醇ti激on素only.ated

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Ltd.浴。66中醫(yī)中藥療法物理療法紫外線:適用于靜止期冬季型病例。禁用于夏季型。光化學(xué)療法（PUEVvAa）lu:at8i－onMOoPn＋lyU.VAate?dw硫it磺h浴As，po焦se油.S浴li，de礦sf泉or浴.，NE海T3水.5浴C，li中en藥tProCopyright

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Ltd.1、治療不當(dāng) 某些皮膚病由于處理不當(dāng)或治療不及時(shí)可演變或發(fā)展成紅皮病，如銀屑病、Ev接al觸ua性ti皮on炎o(hù)、nl天y.皰瘡、atedwithAspose.Slidesfor.NET3.5ClientPro大皰性類(lèi)Co天py皰ri瘡gh、t2特00應(yīng)4-性20皮11炎A.sp脂os溢eP性tyLtd.皮炎、濕疹、多形紅斑、泛發(fā)性扁平苔蘚等。702、藥物過(guò)敏是引起本病的一個(gè)重要原因，如磺胺類(lèi)、青霉素、抗瘧藥、巴比妥類(lèi)、水楊酸類(lèi)、碘、砷等。Evaluationonly.atedwith3A.sp惡os性e.腫Sl瘤ides約f8o%r~.2N0E%T紅3.皮5病Cl患ientPro者伴有惡Co性py腫ri瘤gh。t2004-2011AsposePtyLtd.4、特發(fā)型少數(shù)患者無(wú)確切病因，常為自身免疫性疾病。71臨床表現(xiàn)72一、急性紅皮病 發(fā)病急驟,伴高熱,全發(fā)的細(xì)小密集斑片、斑丘疹,呈猩紅熱樣身乏力,肝脾淋巴結(jié)腫大等。皮損初為泛Evaluationonly.atedwithAspose.Slidesfor.NET3.5ClientPro或麻疹樣Co,py迅ri速gh發(fā)t2展00,4-全20身11彌A漫sp性os潮eP紅ty、Ltd.水腫,面部、肢端顯著,并伴有大量脫屑,呈大片或細(xì)糠狀,掌跖可呈手套或補(bǔ)襪套樣脫屑,常伴有劇烈瘙癢。臨床表現(xiàn)73二、慢性紅皮病 為慢性彌漫性、浸潤(rùn)性潮紅、腫脹,鱗屑呈糠狀,Ev無(wú)al大ua片ti鱗on屑o(jì)。nl由y.于反復(fù)脫at屑e屑d,wi蛋th白As質(zhì)po大se量.S丟li失de,s可fo導(dǎo)r.致NE低T蛋3.白5C血li癥en、t酮Pro癥酸中毒C。op如yr膿ig皰ht性2銀00屑4-病20引11起As者po,se可P見(jiàn)ty無(wú)Lt菌d.性膿皰。紅皮病Evaluation

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Ltd.多形紅斑79病因：不明。感染、藥物、其他。臨床表現(xiàn)：皮疹多形性，可有紅斑、丘疹、水皰、紫癜、風(fēng)團(tuán)等E，va以lu虹a膜ti樣on紅o斑nl為y.其特征，ated常w伴it粘h膜As損po害s。e。.臨Sl床id上es分f紅or斑.-N丘ET疹3型.5.C水li皰e-n大tPro皰型和重C癥op型y。r。ight2004-2011AsposePtyLtd.診斷：好發(fā)于兒童及青年，春秋多見(jiàn)；多形性皮疹，有典型虹膜樣紅斑；有前驅(qū)癥狀，常伴粘膜損害。銀屑病80病因與發(fā)病機(jī)制 為一種多基因遺傳病,其發(fā)生主要與免疫介導(dǎo)性損害有關(guān)。Evaluation

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