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皮肤水疱性疾病患者的评估与诊断

Authors
Christopher Hull, MD
John J Zone, MD
Section Editor
Erik Stratman, MD
Deputy Editor
Abena O Ofori, MD
Translators
孙仁山, 主任医师，教授

引言

皮肤水疱可发生在多种临床情况下，包括自身免疫性疾病、药物反应、感染、遗传性疾病和物理损伤。缩小水疱皮肤损伤的鉴别诊断范围的能力对于迅速识别危及生命的疾病和适当处理其他水疱性疾病至关重要。

表现为皮肤水疱的疾病诊断的临床方法和用于辅助诊断的常见实验室检测总结将在此讨论。新生儿水疱疾病和特殊类型的水疱疾病将会单独作更详细的讨论。 (参见“新生儿水疱大疱性和脓疱性病变”)

定义

水疱性皮肤疾病的特征是皮肤上存在液体填充的病灶，是表皮内细胞间失去黏附(棘层松解)、表皮细胞间水肿(海绵形成)或表皮与真皮间解离的结果。可能导致水疱形成的病理事件包括以下：

●细胞或细胞外黏附分子的破坏，例如：自身免疫性水疱疾病、先天性大疱性表皮松解症

●表皮细胞损伤或死亡，例如：中毒性表皮坏死松解症(toxic epidermal necrolysis, TEN)、多形红斑

                                 

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Literature review current through: 2017-06 . | This topic last updated: 2017-07-10.
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References
Top
  1. Weedon D. The vesicobullous reaction pattern. In: Weedon's Skin Pathology, 3rd ed, Elsevier Limited, Edinburgh 2010. p.123.
  2. Gerull R, Nelle M, Schaible T. Toxic epidermal necrolysis and Stevens-Johnson syndrome: a review. Crit Care Med 2011; 39:1521.
  3. Sebaratnam DF, Murrell DF. Bullous systemic lupus erythematosus. Dermatol Clin 2011; 29:649.
  4. Frew JW, Murrell DF. Paraneoplastic pemphigus (paraneoplastic autoimmune multiorgan syndrome): clinical presentations and pathogenesis. Dermatol Clin 2011; 29:419.
  5. Anhalt GJ. Paraneoplastic pemphigus. J Investig Dermatol Symp Proc 2004; 9:29.
  6. Czernik A, Camilleri M, Pittelkow MR, Grando SA. Paraneoplastic autoimmune multiorgan syndrome: 20 years after. Int J Dermatol 2011; 50:905.
  7. Ioannides D, Lazaridou E, Rigopoulos D. Pemphigus. J Eur Acad Dermatol Venereol 2008; 22:1478.
  8. Schmidt E, della Torre R, Borradori L. Clinical features and practical diagnosis of bullous pemphigoid. Dermatol Clin 2011; 29:427.
  9. Tran JT, Mutasim DF. Localized bullous pemphigoid: a commonly delayed diagnosis. Int J Dermatol 2005; 44:942.
  10. Venning VA. Linear IgA disease: clinical presentation, diagnosis, and pathogenesis. Dermatol Clin 2011; 29:453.
  11. Bolotin D, Petronic-Rosic V. Dermatitis herpetiformis. Part I. Epidemiology, pathogenesis, and clinical presentation. J Am Acad Dermatol 2011; 64:1017.
  12. Bolotin D, Petronic-Rosic V. Dermatitis herpetiformis. Part II. Diagnosis, management, and prognosis. J Am Acad Dermatol 2011; 64:1027.
  13. Caux F. Diagnosis and clinical features of epidermolysis bullosa acquisita. Dermatol Clin 2011; 29:485.
  14. Sami N, Yeh SW, Ahmed AR. Blistering diseases in the elderly: diagnosis and treatment. Dermatol Clin 2004; 22:73.
  15. Toonstra J. Bullosis diabeticorum. Report of a case with a review of the literature. J Am Acad Dermatol 1985; 13:799.
  16. Romano C, Rubegni P, Ghilardi A, Fimiani M. A case of bullous tinea pedis with dermatophytid reaction caused by Trichophyton violaceum. Mycoses 2006; 49:249.
  17. Bleasel NR, Varigos GA. Porphyria cutanea tarda. Australas J Dermatol 2000; 41:197.
  18. Green JJ, Manders SM. Pseudoporphyria. J Am Acad Dermatol 2001; 44:100.
  19. McGovern TW. Dermatoses due to plants. In: Dermatology, 2nd ed, Bolognia JL, Jorizzo JL, Rapini RP (Eds), Elsevier Limited, 2008. p.243.
  20. Uzun S, Durdu M. The specificity and sensitivity of Nikolskiy sign in the diagnosis of pemphigus. J Am Acad Dermatol 2006; 54:411.
  21. Pohla-Gubo G, Hintner H. Direct and indirect immunofluorescence for the diagnosis of bullous autoimmune diseases. Dermatol Clin 2011; 29:365.
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