(九)白癜风
白癜风是一种获得性皮肤色素脱失的自身免疫性疾病,全球0.5%~2%的人受其影响(Ortonne,2003),任何年龄均可发生,确切的发病机制不详。病变皮肤表现为较大的斑片状黑色素脱失。虽然皮肤看起来呈白色,但完全不正常,且与正常皮肤边界清晰(图23-45G)。这种病变在肤色较深的人群及身体上颜色较深的部位尤其明显。约<0.3%的男性人群中发现生殖器白癜风(Moss and Stevenson,1981)。病变有随着时间周期性扩大的倾向,亦有可能在原发部位进展(克伯纳现象)。生殖器白癜风须与炎症后色素减退区别开来(Margolis,2002)。治疗包括局部化妆品色素沉着,紫外线照射,PUVA疗法和皮肤移植。使用准分子激光诱导生产黑色素非常适合于生殖器白癜风。诊断白癜风需筛查自身免疫性甲状腺疾病。
要点
•外生殖器皮肤病的诊断主要依靠全面的病史和体格检查。外生殖器的体检为诊断提供关键依据。泌尿科医师应进行彻底的皮肤检查,而不应仅把注意力局限在受累的生殖器皮肤。
•外用皮质激素的不良反应明显,无论是全身吸收还是局部作用。如果在包皮内使用这类药物,可能会加重不良反应。通常,治疗生殖器皮肤病仅使用低强度局部用皮质激素进行短疗程治疗。
•外生殖器皮肤病可分为变态反应类、丘疹鳞屑类、水疱大疱类、溃疡类、感染类、肿瘤类和其他类。
•活检标本组织病理学分析在鉴别临床特征相似的疾病和排除恶性病变方面起重要作用。
•局部治疗方式包括应用激光、光动力、紫外线放射和冷冻疗法,已成功应用于多种生殖器皮肤病的治疗,在有些病例可替代手术切除。
参考文献
完整的参考文献列表通过www.expertconsult.com在线获取。
推荐阅读
Bhattacharya M,Kaur I,Kumar B.Lichen planus:a clinical and epidemiological study.J Dermatol 2000;27:576-82.Bolognia JL,Jorizzo JL,Schaffer JV.Dermatology.3rd ed.Edinburgh:Saunders;2012.
Criteria for diagnosis of Behçet’s disease.International Study Group for Behçet’s Disease.Lancet 1990;335:1078-80.
Czymek R,Kujath P,Bruch HP,et al.Treatment,outcome and quality of life after Fournier’s gangrene:a multicentre study.Colorectal Dis 2013;15:1529-36.
Denby KS,Beck LA.Update on systemic therapies for atopic dermatitis.Curr Opin Allergy Clin Immunol 2012;12:421-6.
Eke N.Fournier’s gangrene:a review of 1726 cases.Br J Surg 2000;87:718-28.
Ellinghaus D,Baurecht H,Esparza-Gordillo J,et al.Highdensity genotyping study identifi es four new susceptibility loci for atopic dermatitis.Nat Genet 2013;45:808-12.
Hatemi G,Yazici Y,Yazici H.Behçet’s syndrome.Rheum Dis Clin North Am 2013;39:245-61.
Krueger G,Koo J,Lebwohl M,et al.The impact of psoriasis on quality of life:results of a 1998 National Psoriasis Foundation patient-membership survey.Arch Dermatol 2001;137:280-4.
Leibovitch I,Huilgol SC,Selva D,et al.Cutaneous squamous carcinoma in situ (Bowen’s disease):treatment with Mohs micrographic surgery.J Am Acad Dermatol 2005;52:997-1002.
Mallon E,Hawkins D,Dinneen M,et al.Circumcision and genital dermatoses.Arch Dermatol 2000;136:350-4.
Morpurgo E,Galandiuk S.Fournier’s gangrene.Surg Clin North Am 2002;82:1213-24.
Rompel R,Petres J.Long-term results of wide surgical excision in 106 patients with hidradenitis suppurativa.Dermatol Surg 2000;26:638-43.
Ruocco E,Wolf R,Ruocco V,et al.Pemphigus:associations and management guidelines:facts and controversies.Clin Dermatol 2013;31:382-90.
Sanchez-Ortiz R,Huang SF,Tamboli P,et al.Melanoma of the penis,scrotum and male urethra:a 40-year single institution experience.J Urol 2005;173:1958-65.
Scheinfeld N.Hidradenitis suppurativa:a practical review of possiblemedical treatments based on over 350 hidradenitis patients.Dermatol Online J 2013;19:1.
Stern RS,PUVA Follow-Up Study.The risk of squamous cell and basal cell cancer associated with psoralen and ultraviolet A therapy:a 30-year prospective study.J Am Acad Dermatol 2012;66:553-62.
Wolf R,Orion E,Marcos B,et al.Life-threatening acute adverse cutaneous drug reactions.Clin Dermatol 2005;23:171-81.
Wollenberg A,Bieber T.Atopic dermatitis:from the genes to skin lesions.Allergy 2000;55:205-13.
Worswick S,Cotliar J.Stevens-Johnson syndrome and toxic epidermal necrolysis:a review of treatment options.Dermatol Ther 2011;24:207-18.
(董治龙 编译 陈宏翔 毛向明 张贤生李宏军 党 宏 审校)