文献简介

出版社:Journal compilation

作  者:T Yamamoto

编  号:10.1111/j.1468-3083.2009.03296.x

关键字:Koebner phenomenon | palmoplantar pustulosis | pathogenesis |pustular psoriasis |pustulotic arthro-osteitis

年  份:2009   点击量:792

文献摘要

Palmoplantar pustulosis (PPP) is a chronic inflammatory disorder characterized by sterile pustules predominantly involving the palms and soles of middle-aged women. In contrast, regions other than the palms and soles are occasionally affected, manifesting scaly erythemas which resemble psoriasis, and solitary pustules are also seen. Some of these extra-palmoplantar lesions are induced by the Koebner phenomenon or occur after focal infections like tonsillitis. The tenderness and inflammation of the extra-palmoplantar lesions in PPP are milder than in psoriasis. Histological features show mild acanthosis of the epidermis with parakeratosis and mild infiltration of inflammatory cells in the upper dermis. On the other hand, severe pustular lesions are occasionally seen in the palms and soles of the patients with pustular psoriasis. These findings suggest a close relationship between PPP and psoriasis; however, different genetic, environmental, and immunological factors are likely to be involved. Recently, understanding of psoriasis pathophysiology has greatly progressed, and the concept of psoriasis pathogenesis is currently viewed as complicated responses between infiltrating leucocytes and the resident skin, via a number of inflammatory cytokines, chemokines, and mediators produced in the skin under regulation of cellular immune systems. By contrast, the pathogenesis of PPP has been poorly investigated. This paper reviews findings of the clinicopathophysiology of PPP, making a focus on the extra-palmoplantar  lesions.

掌跖脓疱病(PPP)是一种慢性炎症性疾病,以主要累及在中年女性的手掌和脚掌的无菌性脓疱为特征的。与之相反,除手掌和脚掌以外的其它区域偶尔也会受到影响,表现为类似于银屑病的鳞屑性红疹,有时也能看到单独的脓疱。一些掌跖以外的病变是由克布纳现象诱发或病灶感染后发生的,如扁桃体炎。与银屑病相比,掌跖脓疱病中掌跖以外皮损的压痛和炎症较轻。组织学特征显示表皮层有轻微的棘层肥厚,伴有真皮上部炎症细胞的角化不全和轻度浸润。另一方面,在脓疱性银屑病患者的手掌和脚掌中也偶尔可见严重的脓疱皮损。这些研究结果显示掌跖脓疱病和银屑病之间存在着密切联系,但这可能也与不同的基因、环境和免疫因素有关。近期,人们对于银屑病病理生理学的认识有了很大的进步,并且银屑病发病机制的概念目前被认为是浸润白细胞和其所在皮肤之间的复杂反应,通过许多炎症细胞因子、趋化因子以及在细胞免疫系统调节下皮肤产生的介质起作用。相比之下,关于掌跖脓疱病的发病机制研究较少。本文回顾了掌跖脓疱病临床病理生理学的研究结果,主要集中在掌跖以外的病变上。