Ahmed Iftikhar
Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, MN 55902, USA.
Int J Dermatol. 2006 Oct;45(10):1172-5. doi: 10.1111/j.1365-4632.2006.02870.x.
We describe a 70-year-old White female on maintenance high-flux hemodialysis for chronic renal insufficiency with an abrupt onset of asymptomatic palmoplantar blisters. The lesions were tense, noninflamed and 0.2-1.0 cm in dimension. Concomitant photo-distributed blistering of the dorsal hands and forearms was not present. A cutaneous biopsy demonstrated nonspecific histological and direct immunofluorescent findings. Serum indirect immunofluorescence and tissue cultures for bacteria, fungi and viruses were negative. Fecal porphyrins were normal but an elevated plasma uroporphyrin level of 17.0 microg/dL (normal: < 1.0 microg/dL) was observed. The duration of each hemodialysis treatment, which the patient had continued to receive three times per week, was changed from 2 to 2.5 h. Within 2 weeks no new blisters occurred. Within 6 weeks complete clinical and biochemical remission was noted. During this time course no topical steroid or antifungal therapy was employed nor was the patient's oral medication regimen altered.
我们描述了一名70岁的白人女性，因慢性肾功能不全接受维持性高通量血液透析，突然出现无症状的掌跖水疱。皮损为紧张性、无炎症，大小为0.2 - 1.0厘米。双手背和前臂未出现伴有光分布的水疱。皮肤活检显示非特异性组织学和直接免疫荧光结果。血清间接免疫荧光以及细菌、真菌和病毒的组织培养均为阴性。粪便卟啉正常，但观察到血浆尿卟啉水平升高至17.0微克/分升（正常：<1.0微克/分升）。患者继续每周接受三次的每次血液透析治疗时长从2小时改为2.5小时。2周内未出现新的水疱。6周内实现了完全的临床和生化缓解。在此期间，未使用局部类固醇或抗真菌治疗，患者的口服药物治疗方案也未改变。
