Watsky K L, Orlow S J, Bolognia J L
Department of Dermatology, Yale University School of Medicine, New Haven, Conn. 06510.
Arch Dermatol. 1990 May;126(5):649-52.
We describe a patient with two coexistent cutaneous eruptions: (1) trauma-induced bullae of the distal extremities and elbows and (2) multiple concentric gyrate lesions on the trunk and extremities, some of which became bullous. The gyrate lesions were stationary and nonpruritic. Biopsy of both types of lesions showed a subepidermal blister and a minimal inflammatory infiltrate. Direct immunofluorescence revealed linear deposition of IgG and C3 at the dermoepidermal junction and indirect immunofluorescence was negative. By immunoelectron microscopy, these immune deposits were localized to the lower lamina lucida. The eruption was not controlled despite high-dose (80 mg/d) oral administration of prednisone and required the addition of an oral administration of methotrexate (20 mg weekly). On further evaluation, an intraductal mammary carcinoma was detected. Following radiation therapy, the methotrexate and prednisone therapy were tapered without recurrence of the eruption during a follow-up period of 18 months.
（1）创伤性远端肢体和肘部大疱，以及（2）躯干和四肢上的多个同心回旋状损害，其中一些发展为大疱。回旋状损害静止且无瘙痒。两种类型损害的活检均显示表皮下水疱和少量炎症浸润。直接免疫荧光显示IgG和C3在真皮表皮交界处呈线性沉积，间接免疫荧光为阴性。通过免疫电子显微镜检查，这些免疫沉积物定位于透明层下部。尽管口服高剂量（80mg/d）泼尼松，皮疹仍未得到控制，需要加用口服甲氨蝶呤（每周20mg）。进一步评估发现了导管内乳腺癌。放疗后，甲氨蝶呤和泼尼松治疗逐渐减量，在18个月的随访期内皮疹未复发。
