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BMJ：红皮病的重要原因-案例报道

2017-04-17 xing.T MedSci原创

红皮病老年挪威疥
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在老年人红皮病的鉴别诊断上，除了更常见的原因，包括牛皮癣、湿疹和药物反应外，应重点考虑挪威疥又称结痂性疥疮或角化性疥疮。疥疮典型的皮肤症状可以缺失，如隧道皮损，生殖器上的结节，广泛的结痂斑块，瘙痒。

患者为一名78岁的男性，因瘙痒性皮炎而就诊，并且对抗真菌和局部类固醇治疗无效。

体格检查显示弥漫性红斑鳞屑，覆盖了身体表面面积的90%，并且在手上皱襞可见黄色痂壳（如图1所示）。矿物油检查呈密集的疥疮。



该患者的瘙痒性皮疹在接受200g/kg伊维菌素治疗4周后消失，并且采用5%氯菊酯乳膏治疗结痂疥疮。

在老年人红皮病的鉴别诊断上，除了更常见的原因，包括牛皮癣、湿疹和药物反应外，应重点考虑挪威疥又称结痂性疥疮或角化性疥疮。疥疮典型的皮肤症状可以缺失，如隧道皮损，生殖器上的结节，广泛的结痂斑块，瘙痒。

这个全身非特异性皮炎患者，病变的主要范围位于皱襞是诊断的关键临床线索。

原始出处：

Ellinor R Quay, et al. An important cause of erythroderma.BMJ 2017; http://www.bmj.com/content/357/bmj.j1205

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    2017-12-30 chenzhuanggui

    #重要原因#

    0

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    2017-04-17 tastas

    #红皮病#

    0

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    2017-11-07 gaoxiaoe

    #BMJ#

    0

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    2017-04-21 1df01bccm39(暂无匿称)

    疥疮的诊断，特别是虫体的采集感觉比较困难

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1814791, encodeId=1b991814e9104, content=<a href='/topic/show?id=d007960622e' target=_blank style='color:#2F92EE;'>#重要原因#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96062, encryptionId=d007960622e, topicName=重要原因)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8949377, createdName=chenzhuanggui, createdTime=Sat Dec 30 17:32:00 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2003898, encodeId=2f6b20038981a, content=<a href='/topic/show?id=0a04e714467' target=_blank style='color:#2F92EE;'>#红皮病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77144, encryptionId=0a04e714467, topicName=红皮病)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=47c5349, createdName=tastas, createdTime=Mon Apr 17 19:32:00 CST 2017, time=2017-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1848285, encodeId=8765184828503, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Tue Nov 07 19:32:00 CST 2017, time=2017-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189261, encodeId=16c318926106, content=疥疮的诊断，特别是虫体的采集感觉比较困难, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM5rqTiaMSVSkFAupcTECOTdcVRmJQXbibJoicv5ibhcpa0vj5MGmac8wlPjuGnJISZGtOnC7rW0gbLuSE7iaEvAn0CC52ZhnRLdxtlQ/0, createdBy=1e291737907, createdName=1df01bccm39(暂无匿称), createdTime=Fri Apr 21 07:46:25 CST 2017, time=2017-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189027, encodeId=0e2618902ed4, content=与免疫有关, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5Kym1A9qicflExZYSdibSZBHDyicKZZj37w4jR44fPa9DI3mVLObHAxzntpTAbwxeHvviclcw8coNrDge/0, createdBy=6dc22001775, createdName=春暖花开8785, createdTime=Thu Apr 20 09:43:17 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188241, encodeId=5661188241ae, content=难治性疾病, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3ia08g8CeyBbh9ZJA3uOmXGicNRf5EgF8K0LBmd9FE8HMMia9LsFfB93UR68micicia9u3kYKT7XYIb5epiaOupgzEwibq/0, createdBy=bde71954073, createdName=Sunny Zhao, createdTime=Mon Apr 17 13:00:41 CST 2017, time=2017-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188236, encodeId=a5ca188236cd, content=学习了很多的事情，, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NcXNhUvfhzd2dD8SUAwqrufRiaKMGaaBScoAzEicJJibuu3wCIWWQxoLgS2UOBx1vsPe3faZtAiatc0pTWlS6868zZH/0, createdBy=0a231960988, createdName=胖红, createdTime=Mon Apr 17 12:41:30 CST 2017, time=2017-04-17, status=1, ipAttribution=)]
    2017-04-20 春暖花开8785

    与免疫有关

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1814791, encodeId=1b991814e9104, content=<a href='/topic/show?id=d007960622e' target=_blank style='color:#2F92EE;'>#重要原因#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96062, encryptionId=d007960622e, topicName=重要原因)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8949377, createdName=chenzhuanggui, createdTime=Sat Dec 30 17:32:00 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2003898, encodeId=2f6b20038981a, content=<a href='/topic/show?id=0a04e714467' target=_blank style='color:#2F92EE;'>#红皮病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77144, encryptionId=0a04e714467, topicName=红皮病)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=47c5349, createdName=tastas, createdTime=Mon Apr 17 19:32:00 CST 2017, time=2017-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1848285, encodeId=8765184828503, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Tue Nov 07 19:32:00 CST 2017, time=2017-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189261, encodeId=16c318926106, content=疥疮的诊断，特别是虫体的采集感觉比较困难, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM5rqTiaMSVSkFAupcTECOTdcVRmJQXbibJoicv5ibhcpa0vj5MGmac8wlPjuGnJISZGtOnC7rW0gbLuSE7iaEvAn0CC52ZhnRLdxtlQ/0, createdBy=1e291737907, createdName=1df01bccm39(暂无匿称), createdTime=Fri Apr 21 07:46:25 CST 2017, time=2017-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189027, encodeId=0e2618902ed4, content=与免疫有关, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5Kym1A9qicflExZYSdibSZBHDyicKZZj37w4jR44fPa9DI3mVLObHAxzntpTAbwxeHvviclcw8coNrDge/0, createdBy=6dc22001775, createdName=春暖花开8785, createdTime=Thu Apr 20 09:43:17 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188241, encodeId=5661188241ae, content=难治性疾病, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3ia08g8CeyBbh9ZJA3uOmXGicNRf5EgF8K0LBmd9FE8HMMia9LsFfB93UR68micicia9u3kYKT7XYIb5epiaOupgzEwibq/0, createdBy=bde71954073, createdName=Sunny Zhao, createdTime=Mon Apr 17 13:00:41 CST 2017, time=2017-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188236, encodeId=a5ca188236cd, content=学习了很多的事情，, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NcXNhUvfhzd2dD8SUAwqrufRiaKMGaaBScoAzEicJJibuu3wCIWWQxoLgS2UOBx1vsPe3faZtAiatc0pTWlS6868zZH/0, createdBy=0a231960988, createdName=胖红, createdTime=Mon Apr 17 12:41:30 CST 2017, time=2017-04-17, status=1, ipAttribution=)]
    2017-04-17 Sunny Zhao

    难治性疾病

    0

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    2017-04-17 胖红

    学习了很多的事情，

    0

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