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脓疱型银屑病：发病机制、临床表现及诊断

Author
Robert E Kalb, MD
Section Editor
Kristina Callis Duffin, MD
Deputy Editor
Abena O Ofori, MD
Translators
罗素菊, 副主任医师

引言

银屑病是一种常见的皮肤病，特征为皮肤出现红斑性鳞屑性斑块，临床表现范围很广。银屑病最常见的表现是慢性斑块型银屑病，表现为皮肤上出现边界清楚的炎症性红色鳞屑性斑块。脓疱型银屑病是一种比较少见的银屑病类型，表现为急性、亚急性或慢性脓疱性发疹。脓疱型银屑病主要累及成人，但儿童也可以发生。

脓疱型银屑病可独立发生或在原有的银屑病基础上发生，分布可为泛发性或局限性。泛发性脓疱型银屑病(generalized pustular psoriasis, GPP)为急性或亚急性起病，表现为在发炎的红斑性皮肤上广泛分布有脓疱性皮疹(图片 1A-C)。局限性脓疱型银屑病主要累及手掌、足底或指(趾)。

本专题将总结脓疱型银屑病的流行病学、发病机制和临床表现。脓疱型银屑病的治疗以及其他类型的银屑病见其他专题。 (参见“银屑病的流行病学、临床表现及诊断”和“点滴型银屑病”和“脓疱型银屑病的治疗”)

分型

脓疱型银屑病的临床表现传统上分为泛发型和局限型。GPP的主要临床变异型包括急性GPP(也称为von Zumbusch型泛发性脓疱型银屑病)和泛发性环形脓疱型银屑病(也称为亚急性GPP)[1]。急性GPP的特征是突然出现大量脓疱、广泛分布的红斑和全身症状。“妊娠期脓疱型银屑病”和“疱疹样脓疱病”指的是妊娠期间发生的急性GPP。泛发性环形脓疱型银屑病是起病相对慢性的GPP，表现为广泛分布的环形或图案状的红斑性斑块基础上布满脓疱。 (参见“妊娠皮肤病”，关于‘妊娠脓疱型银屑病’一节)

有关局限性脓疱型银屑病的描述包括Hallopeau连续性肢端皮炎(acrodermatitis continua of Hallopeau, ACH)和掌跖脓疱病。前者是一种主要累及指(跖)的慢性脓疱性疾病，后者是一种主要局限于手掌和足底的慢性脓疱性发疹。有关掌跖脓疱病是银屑病的一种变异型还是一种独立的疾病尚存在争议[2,3]。掌跖脓疱病的其他名称还包括掌跖脓疱型银屑病、掌跖性脓疱病，以及掌和跖脓疱病。 (参见下文‘局限性脓疱型银屑病’和“掌跖脓疱病的流行病学、临床特征及诊断”)

                  

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-30.
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