Bullous Prurigo Pigmentosa-A Case Report and Review of the Literature

水泡性色素癢疹－病例報告與文獻回顧

蔡坤穎(Kun-Ying Tsai) ； 邱健群(Chien-Chun Chiou) ； 許仲瑤(Rosaline Chung-Yee Hui)

《中華皮膚科醫學雜誌》 27卷2期 (2009/06) Pp. 103-110

https://doi.org/10.29784/DS.200906.0004

摘要

色素性癢疹是一種發炎性的皮膚病，它的特徵是在身上產生對稱性的紅色丘疹性癢疹，並在急性病灶消失後遺留下網狀色素斑。在比較嚴重的病例中可以看到較為浸潤的水腫斑塊，但一般不會看到水泡的產生。我們在此報告一位32歲胰島素依賴性糖尿病女性，在她的臉、頸、胸、背的紅色浸潤丘疹與斑塊上產生了許多嚴重的水泡，之後併發了糖尿病酮酸中毒。病理報告顯示在表皮層內的水泡充滿了嗜中性白血球的聚集、萎縮的表皮層、血球的趨外性，以及在真皮層血管周圍與毛囊周圍的淋巴球與嗜中性白血球浸潤。以皮下注射胰島素控制酮酸中毒後，皮膚水泡與丘疹斑塊也隨之緩解。我們將此病例診斷為水泡性色素癢疹。我們使用去氧經四環素(doxycycllne)來完成療程，並發現它對於退紅與發炎後色素沈著有幫助。水泡性色素癢疹是一個鮮為報告的皮膚疾病，我們在此報告－病例並回顧相關文獻。

並列摘要

Prurigo pigmentosa is a type of inflammatory dermatosis characterized by symmetrical pruritic erythematous papules that normally resolve with reticular pigmentation. In severe cases, edematous infiltrative plaques may be found, but usually no vesicles or bullae. We presented a 32-year-old Taiwanese female, a case of insulin dependent diabetis mellitus with sudden onset of vesicobullae upon erythematous papuloplaques over the face, neck and upper trunk, preceding an episode of diabetic ketoacidosis. Histopathology of the skin lesion revealed an intraepidermal bulla filled with neutrophils, atrophic epidermis, exocytosis, perivascular mononuclear cells and neutrophils infiltration involving dermis and hair follicles. The vesicobullae subsided after control of ketoacidosis by subcutaneous insulin injection. Our final diagnosis was bullous prurigo pigmentosa. Doxycycline was then added to complete the treatment and it was found to be effective in resolving erythema and post-inflammatory hyperpigmentation. Bullous prurigo pigmentosa is a rarely documented entity, we herein report a case and review the literature.

並列關鍵字

Bullae ； Diabetes mellitus ； Ketosis ； Prurigo pigmentosa ； Vesicles