中毒性表皮壞死剝離症

Toxic Epidermal Necrolysis

林清淵(Chin-Yuang Lin) ； 黃富源(Fu-Yuan Huang)

《Acta Paediatrica Sinica》 18卷2期 (1977/05) Pp. 112-119

摘要

馬偕醫院自1972到1975年，4年間共經歷11個中毒性表皮壞死剝離症(toxic epidermal necrolysis)之病例。其主要臨床症狀是在嘴唇周圍開始發生痂皮樣鱗屑，繼生皮膚紅腫，爾後擴大至全身四肢，最後形成水泡及潰爛，Nikolsky氏徵象陽性，後有小葉狀落屑，如未併發菌血症則完全康復。11例中有5例曾作皮膚活體切片，均見有表皮生發層(Stratum Malpighi)嗜酸性壞死，與表皮內裂開。11例中有6例由皮膚水泡抽出液培養出凝固酶陽性之金黃色葡萄球菌，1例是麻疹後的併發症。另1例是藥物引起的，其餘3例原因不詳。除2例死於菌血症外，其餘9例均完全康復，治療包括局部類固醇之塗敷及全身性抗生素之給予。

並列摘要

There were 11 cases of toxic epidermal necrolysis encountered in the MackayMemorial Hospital from 1972 to 1975. In 5 patients the disease began with conjunctivitis and in 5 it began with rhinorrhea. The discharge was frequent. They were characterized by development of exudation and scaly crustings around the mouth, followed by skin erythema spreading then to the whole body. Bullae were noted concurrently. At the slight pressure, the epidermis was displaced from its base, and rubbed off like the skin of a ripe peach (called positive Nikoisky's sign). In the course of. a few days, the whole body surface peeled off. A flaky, scaly, desquamation preceded restoration to normal, if sepsis had not developed. A skin biopsy was done in five of the eleven cases, which showed acidophilic necrosis in the stratum Malpighi and intraepidermal separation. Coagulase-positive Staphylococcus aureus was isolated from the aspirates of the bullae content in six cases. There was one case in whom the disease occurred as the complication of measles, and in another case was caused by drugs. The causes in the rest of 3 cases were unknown. Two cases died of Klebsiella sepsis. Nine cases recovered. The treatment included local application of the steroids and parenteral antibiotics.

並列關鍵字

Toxic epidermal necrolysis ； staphylococcal scalded skin syndrome ； Nikolsky's sign ； exfoliation