砷角化病患者皮肤临床表现及病理分析并文献复习

发布时间：2019-03-20 13:04

【摘要】：目的探讨砷角化病患者的皮肤临床表现、实验室检查、病理学检查特点、治疗及转归。方法收集2010年3月—2015年1月天津市第三中心医院收治的砷角化病患者20例为研究对象,回顾性分析其皮肤临床表现、实验室检查、病理学检查结果、治疗及转归并复习相关文献。结果 20例患者中14例患者出现掌跖角化过度,12例患者躯干四肢出现散在点状、疣状、皮角样、角化斑片样皮损,其中6例出现鲍温病、6例出现鳞状细胞癌、2例出现反复难愈性皮肤溃疡,11例患者出现皮肤疣状增生物,8例患者全身皮肤颜色加深,6例患者指、趾甲变色,部分伴有白色横纹,6例患者出现瘙痒、针刺样疼痛等症状,3例患者出现口腔溃疡,4例患者出现其他系统症状;18例血砷及尿砷水平均升高,3例患者血小板计数(PLT)下降,2例患者血肌酐水平升高;掌跖角化区域皮损病理学检查可出现多样性变化;二巯基丙磺酸钠、阿维A治疗有效,伴发鲍温病及鳞状细胞癌患者行Mohs'显微外科手术治疗,复发率较低。结论砷角化病患者少见且接触途径多样,皮损特点及皮肤临床表现多样化,实验室检查具有特异性,诊断主要依靠病史询问、皮肤临床表现及实验室检查;药物联合手术治疗预后较佳。
[Abstract]:Objective to investigate the clinical manifestation, laboratory examination, pathological features, treatment and outcome of arsenic keratosis. Methods from March 2010 to January 2015, 20 patients with arsenical keratosis who were admitted to Tianjin third Central Hospital from March 2010 to January 2015 were collected. The results of clinical manifestation, laboratory examination and pathological examination of the skin were analyzed retrospectively. Treatment and outcome and review of relevant literature. Results among the 20 cases, 14 cases showed palmoplantar hyperkeratosis, 12 cases showed scattered spot, verrucous, keratoid, keratotic patchy lesions in the trunk and limbs, 6 cases had Bowen's disease and 6 cases had squamous cell carcinoma. There were 2 cases with recurrent refractory skin ulcers, 11 cases with verrucous skin hyperplasia, 8 cases with deep skin color, 6 cases with finger and toenail discoloration, some with white cross striae, 6 cases with pruritus. The symptoms of acupuncture-like pain were 3 cases with oral ulcer and 4 cases with other systemic symptoms. Blood arsenic and urine arsenic increased in 18 cases, platelet count (PLT) decreased in 3 cases, serum creatinine level increased in 2 cases, the pathological changes of the lesions in palmoplantar keratosis area showed diversity changes, while platelet count decreased in 3 cases and serum creatinine level increased in 2 cases. The treatment of sodium dimercaptopropionate and acitretin was effective. Mohs' microsurgical treatment was performed in patients with Bowen's disease and squamous cell carcinoma. The recurrence rate was lower. Conclusion the patients with arsenical keratosis are rare and have various ways of contact, the characteristics of skin lesions and clinical manifestations of the skin are diverse, the laboratory examination is specific, the diagnosis mainly depends on the inquiry of the history, the clinical manifestation of the skin and the laboratory examination. The prognosis of combined operation was better.
【作者单位】：天津市第三中心医院皮肤科;天津中医药研究院附属医院病理科;天津市第三中心医院病理科;
【分类号】：R751

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