Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
J Allergy Clin Immunol. 2012 Feb;129(2):589-94. doi: 10.1016/j.jaci.2011.07.033. Epub 2011 Aug 24.
A 21-year-old man presented with multiple erythematous nonfollicular papules partially confluent to plaques on his breast and lower abdomen that had been present for 1 month. Grouped pustules were present under the right breast. The patient had been taking finasteride over the past 3 months for androgenetic alopecia. His medical history was negative for psoriasis. Our initial differential diagnosis included dyskeratosis follicularis Darier, allergic contact dermatitis, infectious folliculitis, varicella zoster virus infection, fixed drug eruption, and IgA pemphigus. The white blood cell count and differential were within the normal limits. Results of viral cultures and PCR, as well as bacterial and fungal cultures of skin lesions proved negative. A lesional biopsy specimen showed a slight psoriasiform acanthosis in association with spongiosis and infiltration of both the epidermis and dermis by neutrophils and eosinophils, resulting in formation of subcorneal, intraepidermal, and subepidermal pustules. The results of direct immunofluorescence were negative, excluding an IgA pemphigus. The result of a lymphocyte transformation test was positive for finasteride. On the basis of the time relationship between the administration of finasteride and the development of the skin disease in combination with symptoms resolution on cessation of the drug, the histologic findings, and the positive lymphocyte transformation test result, we consider this to be an unusual type of acute generalized exanthematous pustulosis defined as acute localized exanthematous pustulosis caused by finasteride. Within 4 weeks after withdrawal of finasteride, the rash resolved without any specific therapy. Transient discrete residual hyperpigmentation and scaling were present. The patient refused an oral provocation challenge.
一位 21 岁男性，因多发性红斑性非滤泡性丘疹部分融合为斑块，出现在胸部和下腹部，已存在 1 个月。右乳房下有成群脓疱。患者在过去 3 个月因雄激素性脱发一直服用非那雄胺。他的病史无银屑病。我们最初的鉴别诊断包括滤泡性角化不良 Darier 病、变应性接触性皮炎、传染性毛囊炎、水痘带状疱疹病毒感染、固定性药物疹和 IgA 天疱疮。白细胞计数和分类在正常范围内。病毒培养和 PCR 以及皮肤病变的细菌和真菌培养结果均为阴性。皮损活检显示轻微银屑病样棘层肥厚，伴海绵形成和表皮和真皮内中性粒细胞和嗜酸性粒细胞浸润，导致形成角质下、表皮内和表皮下脓疱。直接免疫荧光检查结果为阴性，排除 IgA 天疱疮。淋巴细胞转化试验结果阳性，提示与非那雄胺有关。根据非那雄胺的给药时间与皮肤病的发生时间之间的关系，结合药物停止后症状的缓解、组织学发现和阳性淋巴细胞转化试验结果，我们认为这是一种不寻常的急性全身性泛发性脓疱病，定义为非那雄胺引起的急性局限性泛发性脓疱病。在停用非那雄胺的 4 周内，皮疹未经任何特定治疗而消退。短暂存在离散的残余色素沉着和鳞屑。患者拒绝口服激发试验。
