JEADV:糖皮质激素所致“类固醇痤疮”的诊疗研究

2021-11-09 医路坦克 MedSci原创

糖皮质激素可能会引起面部和躯干的炎症损害被称为“类固醇痤疮”。临床表现类似毛囊炎,普通抗痤疮治疗对其疗效有限,促使我们考虑病原体的致病因素。

    糖皮质激素可能会引起面部和躯干的炎症损害,通常被称为“类固醇痤疮”。临床表现类似毛囊炎,但普通抗痤疮治疗对其疗效有限,促使我们考虑感染病原体马拉色菌和/或蠕形螨是否为其致病因素。

     为了研究马拉色菌和类固醇痤疮的作用,该研究将使用糖皮质激素治疗并诊断为“类固醇痤疮”的患者进行皮肤科检查。对于每个患者,系统地从10个不同的皮损中提取皮肤刮片,并在光学显微镜下进行检查。如果每个地点可以发现两个以上的马拉色丝螨和/或五个或五个以上的蠕形螨,则样本被认为是阳性的。所有样本(包括脓疱)之前都要进行消毒皮肤去污,以避免外部污染。经特异性鉴定后,口服伊维菌素、外用克罗米松和/或酮康唑。

    纳入7例患者,中位年龄49岁(24-61岁),均为男性,接受全身(n=5)和/或局部(n=4)糖皮质激素治疗,中位时间为3年(5周-22年)。临床表现为单形性皮疹(丘疹,n=5,和/或脓疱疹,n=5),分布于躯干(n=6)、面部(n=2)和颈部(n=2;图1A-c)。未见粉刺或结节。真菌学和寄生虫学分析显示,所有7名马拉色菌患者都存在这种情况。酵母菌(n=4;图1D)、蠕形菌(n=1;图1E)或两者兼而有之(n=2)。相应地选择治疗方案。7名患者中有6名在平均持续5.5周(1-23周)后进行了重新评估。其中2例患者停用糖皮质激素治疗:1例在治疗4周后完全缓解,2例在治疗1周后部分缓解。其余四名病人,一名痊愈,两名部分痊愈,一名在症状初步消退后复发。

     在这个研究中当用适当的抗感染疗法治疗时,所有患者均显示完全或亚完全缓解。这表明这些病变与糖皮质激素诱导的感染性毛囊炎更为一致,而不是与“真正的”痤疮相一致,强化了疟原虫/蠕形螨直接致病作用的假设

      这种病因学上的混乱可以用临床上与炎症性寻常型痤疮(但没有粉刺)和这两种感染性毛囊炎的相似之处来解释,即影响上躯干、颈部和面部的单形性丘疹及脓疱疹。综上所述,这表明糖皮质激素治疗促进了这些病原体的增殖。虽然皮肤的常见定植仍然合理,但在充分的抗感染治疗和严格的取样和微生物分析下的临床改善支持了疟原虫/蠕形螨的直接致病作用。

      总之,该研究认为“类固醇痤疮”的诊断是不准确的,因为它与感染性毛囊炎更相关。因此,应通过对糖皮质激素治疗中发生的任何丘疹脓疱皮疹进行微生物学分析,系统地搜索微生物的存在,并应对患者进行相应的治疗。

文献来源:Melin A,  Chosidow O,  Foulet F,  Don't Judge a Book by its Cover. "Steroid Acne": an Unrecognized Role of Malassezia and Demodex?J Eur Acad Dermatol Venereol 2021 Oct 17

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    2021-11-10 30397604
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