类天疱疮样扁平苔藓一例

患者男,17岁.全身红斑水疱痒1个月.双小腿散发米粒大红色丘疹,痒,外用复方地塞米松软膏无好转.皮疹渐融合,疹间及丘疹上出现米粒人紧张水疱逐渐泛发全身,无发热、关节痛等.在当地以副银屑病口服非索非那定、克银丸,外用丁酸氢化可的松软膏、他卡西醇等无效.体检:各系统检查无异常.     

类天疱疮样扁平苔藓一例

患者男,77岁。以四肢紫红色斑1年,全身起水疱,伴痒2个月为主诉入院。患者1年前无明显诱因,四肢出现豆粒大小紫红色斑,其上可见白色薄膜,自觉瘙痒,就诊于我院门诊并做组织病理检查,提示扁平苔藓。     

类天疱疮样扁平苔藓一例

患者男,77岁.以四肢紫红色斑1年,全身起水疱,伴痒2个月为主诉入院.患者1年前无明显诱因,四肢出现豆粒大小紫红色斑,其上可见白色薄膜,自觉瘙痒,就诊于我院门诊并做组织病理检查,提示扁平苔藓.给予地氯雷他定片、维生素AD、维生素E口服,糠酸莫米松乳膏及维A酸乳膏外用,皮疹好转,部分消退.     

类天疱疮样扁平苔藓

患者男,65岁. 主诉:全身出现瘙痒性紫红色丘疹伴大疱5周. 现病史:患者5周前无明显诱因左足第一、二趾间出现蚕豆大水疱,并逐渐增至乒乓球大,疱壁不易破裂,伴轻度灼痛,无瘙痒.水疱干涸处出现片状紫红色斑丘疹,表面有少量鳞屑,伴剧烈瘙痒.此后,皮损逐渐波及躯干和四肢.发病10 d后曾在当地医院就诊,诊断为湿疹,给予雷公藤多苷30 mg/d口服,西替利嗪10 mg每晚1次口服,以及外用糠酸莫米松乳膏(艾洛松)、丁酸氢化可的松乳膏(尤卓尔)等治疗2周,病情无明显好转.为进一步诊治于2006年8月16日就诊于我科.患者既往体健,无食物、药物过敏史,家族中无类似疾病患者.     

类天疱疮样扁平苔藓

扁平苔藓患者伴有水疱、大疱时常称之为大疱性扁平苔藓、类天疱疮样扁平苔藓或扁平苔藓与大疱性类天疱疮并发。长期以来分类模糊,命名混乱,一直有争议。近来研究发现类天疱疮样扁平苔藓不同于大疱性扁平苔藓和大疱性类天疱疮,可能是一个独立的疾病。     

类天疱疮样扁平苔藓

本文报告了一例类天疱疮样扁平苔藓(LPP)的临床,病理和免疫荧光所见,并讨论了该病的发病机理和疾病分类学的地位。患者62岁,男性。躯干、双臂和腿部发生小而弥漫成簇的紫蓝色扁平丘疹,在皮损和外观正常的皮肤上可见到很多浅表的糜烂和大疱,颊粘膜上可见网状白色条纹,临床诊断LPP。扁平丘疹的病理检查为典型的扁平苔藓,取自大疱及其附近皮肤的病理表现为伴扁平苔藓的表皮下水疱。扁平丘疹、疱周皮肤和左上肢内侧的正常皮肤直接免疫荧光检查均可见沿基底膜的线状C_3和IgG沉积,并可见C_3、IgG、IgM、IgA染色均阳性的胶样小体。间接免     

类天疱疮样扁平苔藓

扁平苔藓患者伴有水疱、大疱时常称之为大疱性扁平苔藓、类天疱疱样扁平苔藓或扁平苔藓与大疱性类天疱疮并发。长期以来分类模糊，命名混乱，一直有争议。近来研究发现天疱疮样扁平苔藓不同大疱性扁平苔藓和大疱性类天疱疮，可能是一个独立的疾病。     

类天疱疮样扁平苔藓1例

临床资料患者女,46岁。口腔溃疡7个月,全身丘疹伴瘙痒3个月。患者7个月前无明显诱因口腔黏膜出现水疱,疱液清,进食时容易破溃,伴有明显疼痛,当地医院给予外用药物漱口（具体药物不详）,未见明显好转。3个月前先于躯干出现粟粒至黄豆大红色丘疹、斑丘疹、丘疱疹,皮损逐渐增多,发展至全身,自觉瘙痒剧烈,无发热及关节痛。我科门诊拟“扁平苔藓”行皮肤病理检查及天疱疮抗体测定,并收入院。起病以来,因口腔内水疱破溃引起疼痛进而进食少,半年来体重下降约5kg。患者平素体健,无肝炎、结核病病史,无药物及食物过敏史,家族中无类似病例。     

类天疱疮样扁平苔藓1例

扁平苔藓有多种临床类型,其中包括类天疱疮样扁平苔藓,后者具有扁平苔藓和大疱性类天疱疮的双重特征,有学者认为是一种独立的疾病,相对少见,现将我们诊治的1例报告如下。     

扁平苔藓样类天疱疮1例

患者男,25岁。全身皮疹伴瘙痒2个月。皮肤科情况:双侧颊黏膜见网状白斑,躯干、四肢可见散在大小不等的暗紫红色斑疹、斑丘疹,部分皮疹表面见细小鳞屑,可见Wickham纹,全身见较多散在分布的糜烂、结痂,双侧前臂、手足背部少许散在分布的紧张性水疱,尼氏征阴性。组织病理及免疫荧光检查符合扁平苔藓样类天疱疮的诊断。给予地塞米松5 mg/d抗炎,钙剂、抗组胺药止痒,激素药膏局部外涂等对症处理,患者皮损明显好转。     

Ramipril-associated lichen planus pemphigoides

We report the first case of lichen planus pemphigoide (LPP) secondary to ingestion of ramipril, an angiotensin-converting enzyme inhibitor. Clinical, histological and immunofluorescent findings were all consistent with a diagnosis of LPP. Linear basement membrane zone (BMZ) staining with IgG and C3 was only seen at the rood of split-skin preparations and circulating autoantibody to the BMZ was present at a titre of 1/100. Controlled immunoblotting of epidermal extracts detected the bullous pemphigoid antigens of 230 and 180 kDa.     

Erythrodermic lichen planus pemphigoides

Lichen planus pemphigoides is a clinico-histological subtype of lichen planus in which there are bullous lesions similar to those of bullous pemphigoid. Lichen planus is included among the rare causes of erythroderma. We present a case of erythrodermic lichen planus pemphigoides in a 49-year-old female patient who satisfactorily responded to treatment with cyclosporine. A detailed physical examination and immunofluorescence study are key to the diagnosis of lichen planus pemphigoides.     

PUVA-induced lichen planus pemphigoides

A 72-year-old woman had suffered from parapsoriasis en plaque (large plaque type) controlled by topically applied psoralen ultraviolet A (PUVA) therapy. The parapsoriasis lesions gradually disappeared, but numerous tiny red papules with pruritus appeared over the forearms and lower legs 120 days after starting PUVA therapy. These papules developed to form violaceous plaques. Histological findings demonstrated the characteristics of lichen planus. Two months later, tense bullae developed on the plaques and on uninvolved skin of the limbs. These were subepidermal, with linear deposits of IgG and C3 along the basement membrane zone (BMZ) in immunofluorescence of peribullous skin, and immunodeposits of type IV collagen along the floor of the bullae. We therefore, diagnosed lichen planus pemphigoides (LPP). Using systemic and topical steroid therapy, the lesions rapidly resolved and there has been no recurrence. This case suggests that the combination of basal cell injuries caused by chronic inflammation and PUVA therapy could expose BMZ components to autoreactive lymphocytes and induce LPP.     

扁平苔藓合并假性指断症一例

摘要：报告一例扁平苔藓合并假性指断症。患者女,21岁,双手红斑、指甲萎缩16年,右拇指环状缩窄12年。皮肤科检查见双手指、手背皮肤红斑,多甲萎缩,右拇指见环状缩窄带。皮肤病理检查符合扁平苔藓样改变。     

Captopril-induced lichen planus pemphigoides with pemphigus-like features. A case report

We report a case of a bullous lichenoid eruption due to the intake of captopril. Clinical, histological, direct immunofluorescence and ultrastructural features were consistent with the diagnosis of lichen planus pemphigoides. In addition, the in vivo immunological study also revealed an intercellular fluorescence, similar to that seen in pemphigus. Complex drug-induced cutaneous reactions have been previously reported with other drugs, especially with D-penicillamine, which bears chemical similarities with captopril. However, such a drug-induced mixed pattern of lichen planus pemphigoides with pemphigus-like features has never been reported.     

Coexisting lichen planus and bullous pemphigoid or lichen planus pemphigoides?

A patient with lichen planus pemphigoides is reported. Initial pathologic and immunopathologic evaluation was consistent with coexisting bullous pemphigoid and lichen planus. However, further immunologic evaluation suggested that the circulating antibody was not directed toward bullous pemphigoid antigen but another basement membrane zone antigen. This finding indicates a need for immunologic re-evaluation of lichen planus pemphigoides.     

Heterogeneous disease: a child case of lichen planus pemphigoides triggered by varicella

Lichen planus pemphigoides (LPP) is a rare and controversial disease. It is characterized clinically by tense bullae arising both on lichen planus papules and on uninvolved skin, histologically by the demonstration of subepidermal bullae and by linear deposits of immunoglobulin G and C3 along the basement membrane zone on immunofluorescence of peribullous skin. Some authors consider LPP as the combination of lichen planus and bullous pemphigoid. Others think that it most likely encompasses a heterogeneous group of subepidermal autoimmune blistering disorders occurring in association with lichen planus. We present a child case that supports the heterogeneous condition of this disease triggered by varicella.