伴牙齿异常棘状秃发性毛囊炎一例

患者男,24岁.因头皮脓疱、萎缩性瘢痕伴脱发6年.皮肤科检查:头皮弥漫性秃发伴萎缩性瘢痕.头顶仅残留少数头发,发根处有角化性丘疹、脓疱或黑色痂,前额、颞、枕部近发际处尚有部分头发,枕部头发成小簇,发根处见角化性丘疹.眉弓有红斑、鳞屑及毛囊角化性丘疹,眉毛稀疏、脱落.腋毛也稀疏.两颊、腋、胸、腹、后背、四肢均有明显毛囊角化性丘疹.口腔科检查:上下前牙排列间隙过大,上前牙前倾,(+1)先天性缺失,前牙深覆(牙合),深覆盖.沟纹舌,丝状乳头消失.皮损组织病理:表皮棘层增厚,毛囊周围可见大量浆细胞、中性粒细胞及多核巨细胞浸润.结合临床及组织病理表现,符合棘状秃发性毛囊炎的诊断.     

棘状秃发性毛发角化病

报告1例棘状秃发性毛发角化病.患者男,22岁.因头皮弥漫性毛囊角化性丘疹伴脱发10余年就诊.皮肤科检查:头皮弥漫性瘢痕性脱发和毛囊角化性丘疹,并可见散在分布细小和稀疏的头发.组织病理检查可见表皮毛囊角化过度和轻度的毛囊周围纤维化,毛囊和血管周围有少量慢性炎性细胞浸润.结合临床和组织病理检查,符合棘状秃发性毛发角化病的诊断.临床上,该病需与棘状秃发性毛囊炎、毛囊性鱼鳞病伴脱发和畏光综合征(IFAP)、角膜炎-鱼鳞病-耳聋综合征(KID综合征)和无萎缩脱毛性毛发角化病等病鉴别.     

无肌病性皮肌炎一例

患者,女,21岁。面部、躯干、四肢皮肤红斑、丘疹伴脱发6年,皮损基本损害为红斑,双眼睑见明显水肿性紫红斑,其他部位皮损为弥漫性对称性暗紫红色斑,双手可见Gottron丘疹。肌力正常。皮损组织病理检查：表皮轻度角化过度,基底膜增厚,真皮浅层水肿,血管周围单一核细胞浸润。诊断：无肌病性皮肌炎。给予泼尼松联合甲氨蝶呤治疗2个月后皮损明显好转。     

增殖性脓性皮炎-脓性口炎一例

【摘要】 患者女,58岁,唇、头皮、皱褶部位反复发生红斑、脓疱、增殖性斑块3个月。患者有溃疡性结肠炎病史2年,皮疹发生前肠炎加重。皮肤科检查：双唇弥漫性增厚,上有密集米粒至绿豆大脓疱,部分脓疱融合,唇缘黄色结痂;左颊黏膜有一1.5 cm × 2 cm的增殖性斑块,边缘脓疱呈环状排列;头皮、颈、左腋窝、脐周、左腹股沟可见多发性大小不等的增殖性斑块、糜烂、黄色结痂,中央和边缘有环状排列的水疱和脓疱,皮疹消退后留色素沉着斑;右腋4个新发脓疱。下唇缘皮损组织病理学检查：表皮轻度增厚伴中性粒细胞微脓肿,真皮密集混合性炎症细胞浸润,可见中性粒细胞和嗜酸性粒细胞微脓肿;下唇皮疹边缘正常皮肤直接免疫荧光检查阴性。血常规检查示嗜酸性粒细胞比例增高。脓疱细菌、真菌培养阴性。诊断：增殖性脓性皮炎-脓性口炎。 【关键词】 增殖性脓性皮炎-脓性口炎     

棘状秃发性毛囊炎

报告1例棘状秃发性毛囊炎.患者男,41岁.头面部反复出现红色脓疱性丘疹伴疼痛、脱发近41年.家族中其大姐有类似疾病.毛囊性丘疹和脓疱在青春期加重,并伴有畏光、结膜干燥、睑缘炎.皮肤科检查:头皮弥漫性秃发,可见网状瘢痕形成和色素脱失.眉弓、上唇和下颌散在分布许多红色丘疹,有的丘疹顶端有脓疱.双侧眉毛、腋毛和阴毛大部分缺失,局部可见散在毛囊角化性丘疹.皮损组织病理检查:表皮萎缩,真皮可见毛囊,其周围有较多淋巴细胞、组织细胞浸润,并有纤维组织增生.结合临床和组织病理表现,符合棘状秃发性毛囊炎的诊断.     

梅毒性脱发合并HIV感染1例

  报告1例梅毒性脱发合并HIV感染。患者男,44岁,弥漫性斑状脱发伴白发增多11个月余。查体可见前额发际线“M型”上移,全头散在圆形、类圆形脱发斑,边界欠清,白发增多,拉发试验（-）,双手掌、足底红斑、鳞屑。头皮脱发斑处皮肤镜检查示：头皮无毛区内毛囊开口存在,毛干变细,少量黑点。实验室检查:TRUST定性（+）,TRUST定量（1: 128）,TPPA试验＞1:1 280,HIV抗体（+）。头皮脱发区病理组织活检示：真皮毛囊周围少量淋巴组织细胞,见休止期毛囊,周围纤维包绕,毛球部见浆细胞。诊断：梅毒性脱发合并HIV感染。经青霉素治疗5个月后,脱发斑消退,手足红斑、鳞屑消失,无再发脱发斑。     

头皮糜烂性脓疱性皮病1例

  报告1例头皮糜烂性脓疱性皮病。患者女,82岁,因右侧头皮颞部反复出现红斑、脓疱、糜烂、结痂3个月就诊。皮肤科检查：右侧头皮颞部见大片红斑、糜烂、结痂,中间部分毛发脱落,皮肤轻度萎缩,浅表疤痕形成。皮损组织病理示：浅表糜烂结痂,表皮不规则增生,部分表皮轻度萎缩,真皮浅层可见以淋巴、组织细胞、浆细胞及少量中性粒细胞为主的混合炎症细胞浸润,毛囊萎缩,数量减少,局部仅见立毛肌,毛囊结构消失,部分区域胶原纤维增生硬化,PAS染色与抗酸染色均阴性。诊断：头皮糜烂性脓疱性皮病。治疗：予以口服异维A酸,外涂他克莫司与卡泊三醇软膏,皮疹较前稍好转。现随访观察中。     

秃发性毛发角化症

报告1例秃发性毛发角化症。患者女，22岁。因全身泛发毛囊性红色丘疹8年，头皮瘢痕性秃发伴瘙痒4年就诊。临床表现为头部毛发稀疏，部分秃发区可见毛囊萎缩。面颊部毛细血管扩张，密集毛囊性粉刺样丘疹，四肢、躯干泛发粟米大毛囊性丘疹。枕部头皮组织病理检查：表皮角化过度，表皮突局灶性延长，毛囊口有角质栓，毛囊内外根鞘灶性萎缩或消失，局部多核巨细胞反应性增生，毛囊周围及真皮血管周围见较多淋巴细胞浸润。诊断：秃发性毛发角化症。     

寻常性银屑病合并结节性类天疱疮1例并文献复习

报告1例寻常性银屑病合并结节性类天疱疮。患者男，56岁，既往有银屑病病史8年。全身红斑、风团反复发作1年余，双上肢丘疹伴瘙痒1个月。皮肤科检查：头皮散在红斑，上覆鳞屑；背部及四肢散在红色斑块，边界清楚，上覆银白色鳞屑；躯干及四肢大片红斑、风团；头部、背部及四肢暗褐色丘疹、结节，未见水疱、大疱及脓疱。皮损组织病理检查：角化过度，角化不全，表皮不规则增生，表皮下可见裂隙，真皮浅层血管周围可见淋巴细胞及少量嗜酸性粒细胞浸润。间接免疫荧光：IgG沉积于真表皮交界处。酶联免疫吸附试验（ELISA）：抗大疱性类天疱疮抗原1(BP230)抗体和抗大疱性类天疱疮抗原2(BP180)抗体阳性。诊断：寻常性银屑病合并结节性类天疱疮。     

头皮糜烂性脓疱性皮病

报告1例头皮糜烂性脓疱性皮病.患者女,50岁.因头皮反复出现脓疱、糜烂、破溃、结痂8年就诊.实验窜检杳、皮损分泌物细菌和真菌学检查及皮损组织病理检查均无特殊异常.抗生素治疗无效,口服或外用糖皮质激素治疗后皮损明显好转.符合头皮糜烂性脓疱性皮病的诊断.     

Eosinophilic pustular folliculitis in infancy: an unusual case

INTRODUCTION: Eosinophilic pustular folliculitis in children is a follicular inflammatory dermatosis, usually occurring early in life. The disease progresses in flares of prurigenous plaques studded with papules and sterile pustules of the scalp and other areas of the skin. OBSERVATION: A 7 year-old boy presented with itching papular vesicular and pustular plaques on the scalp and the face. Pigmented plaques with pustular border, located on the trunk, were associated with pustular and erosive lesions of the side of the lower lip and in the nostrils. A specimen taken from the pustules did not show bacterial or fungal infection. Histologic examination of a biopsy specimen showed subcorneal pustules with eosinophilic and neutrophilic infiltrates of follicles. Clinical improvement was obtained only by the combination of steroids and dapsone, but recurrence followed withdrawal of treatment. DISCUSSION: Eosinophilic pustular folliculitis in children is rare. Our case report combines features of the infancy form (lesions located on the scalp and face) and the adult form (location on the trunk and limbs with annular distribution), expressing the conceptual confusion that remains between both forms. The mucosal involvement seen in our patient has never been reported in the literature neither in the infancy nor in the adult form.     

A Case of Pustular Ulcerative Dermatosis of the Scalp Associated with Ulcerative Skin Lesions on the Scrotum

A 79-year-old man developed pustules, erosions, and ulcer with severe pain on the parietal regions of the scalp and the scrotum. In another hospital, mycobacterium was detected from the pustules of the scalp at Gaffky scale 1, and this patient was referred to our clinic. In our hospital, repeated cultures of the pus from the skin lesions of the scalp were negative for mycobacterium. Biopsy specimens obtained from the skin lesions on the scalp disclosed ulcerative granulation with infiltration of inflammatory cells. Antibiotics and antituberculotic agents were ineffective. In contrast, the ulcerative skin lesions on the scalp and scrotum responded well to topical and systemic glucocorticosteroids. Although this patient developed pustular ulcerative skin lesions not only on the scalp but also on the scrotum, we considered this case to be pustular ulcerative dermatosis of the scalp developing ulcerative skin lesions on the scrotum.     

Folliculitis spinulosa decalvans: an uncommon entity within the keratosis pilaris atrophicans spectrum

Folliculitis spinulosa decalvans is an uncommon condition characterized by follicular hyperkeratosis, followed by scarring alopecia. We report a 12-year-old boy affected by keratotic papules of the scalp and keratosis pilaris of the limbs who developed erythema, pustules, and scale crusts on the scalp associated with scarring alopecia. Histologic examination showed follicular and interfollicular hyperkeratosis, follicular plugging, mild inflammation, and focal scarring. A transient remission of the inflammatory changes on the scalp was obtained after treatment with isotretinoin. The follicular spinulous hyperkeratosis persisted. A severe relapse of the scalp inflammation was observed during a 2-year follow-up.     

Eosinophilic Pustular Folliculitis In Infancy

Abstract: Five infants under 1 year of age were reported with a syndrome of recurrent crops of pruritic papulopustules of the scalp. In three children there were also intermittent outbreaks on the trunk and extremities. Cultures showed the pustules to be sterile. Biopsies of scalp and skin tissues showed eosinophilic folliculitis. Some patients had eosinophilia during outbreaks of pustules. These cases are similar to the eosinophilic pustular folliculitis reported in a few adult patients with the exception that there was predominant scalp involvement in the children. We propose that eosinophilic pustular folliculitis of infancy is a distinct pustular dermatosis.     

Chronic non-scarring folliculitis of the scalp.

Forty patients with recurrent follicular pustules of the scalp but without obvious necrosis or residual scarring were re-examined (mean 8.3 years after onset of lesions). The most common age at onset was 20-40 years. The sex ratio (M/F) was 3 : 1. Only 7 of 40 patients had concomitant acne vulgaris on the face. All patients still had active, recurring scalp lesions, although 7 out of 40 had had temporary remissions. Post-lesional scarring was not observed. Oral low-dose tetracyclines had a symptomatic effect in 7 of 11 patients. Most of the patients treated topically with steroids and alcoholic lotions experienced little or no effect. Histopathology disclosed a neutrophilic folliculitis. Bacteriological examinations showed only the usual resident microflora of the scalp with P. acnes being the most frequent species. In 3 cases (5 examined pustules), P acnes was isolated from the content of the pustules without being found on the skin surface over the pustule. Chronic non-scarring folliculitis of the scalp probably constitutes a disease entity.     

Erosive pustular dermatosis of the scalp successfully treated with oral prednisone and topical tacrolimus

Erosive pustular dermatosis of the scalp is a rare inflammatory disorder of the scalp, affecting elderly patients after local trauma and leading to scarring or cicatricial alopecia. Case Report: An elderly female patient complained of painful pustules on the parietal region bilaterally with progressive enlargement and ulceration. A biopsy suggested erosive pustular dermatosis of the scalp and the patient was treated with prednisone 40 mg/day and 0.1% topical tacrolimus. After 10 weeks complete closure of the eroded areas was observed and a stable scarring alopecia developed.     

Folliculitis decalvans: the use of dermatoscopy as an auxiliary tool in clinical diagnosis

Folliculitis decalvans is an inflammatory presentation of cicatrizing alopecia characterized by inflammatory perifollicular papules and pustules. It generally occurs in adult males, predominantly involving the vertex and occipital areas of the scalp. The use of dermatoscopy in hair and scalp diseases improves diagnostic accuracy. Some trichoscopic findings, such as follicular tufts, perifollicular erythema, crusts and pustules, can be observed in folliculitis decalvans. More research on the pathogenesis and treatment options of this disfiguring disease is required for improving patient management.     

Sweet syndrome (acute febrile neutrophilic dermatosis) and erythema nodosum in Crohn disease

We report on 2 patients who developed an acute febrile neutrophilic dermatosis (Sweet's syndrome) and erythema nodosum in association with Crohn's disease. The first patient showed symmetrical painful erythemas on her cheeks after hemicolectomy. Additionally, red painful nodules appeared on her lower legs. The second patient disclosed typical Sweet's syndrome-like lesions with pustules and plaques on her face, scalp and extremities after activation of Crohn's disease. Simultaneously, erythema nodosum-like lesions appeared on her lower legs.