Piqué-Duran E, Pérez-Cejudo J A, Cameselle D, Palacios-Llopis S, García-Vázquez O
Sección de Dermatología, Hospital Dr. José Molina Orosa, Lanzarote, Spain.
Actas Dermosifiliogr. 2012 Jan;103(1):51-8. doi: 10.1016/j.adengl.2011.05.003. Epub 2012 Mar 27.
In the developed world, pellagra is a rare condition that is restricted to a small number of at-risk groups. It mainly affects alcoholic patients and those with dietary deficiencies, with intestinal malabsorption, or in treatment with certain drugs. The aim of this study was to analyze the clinical, histopathological, and epidemiological characteristics of patients diagnosed with pellagra in our hospital and to compare the results with the findings traditionally described for this disease.
We undertook a retrospective study of patients with clinical or pathological evidence of pellagra who were seen in our hospital between 1998 and 2009.
Seven patients met the inclusion criteria. All were men and the most common predisposing factors were alcoholism and dietary deficiency. All exhibited photosensitivity mainly affecting the forearms and the upper surface of the feet, where the lesions were more severe. The most consistent histopathological findings were the presence of dilated blood vessels with extravasation and little or no inflammatory infiltrate. Various changes were observed in the epidermis, including those suggestive of mild pellagra, such as epidermal pallor and some degree of ballooning of the keratinocytes. Other abnormalities such as epidermal necrosis and hyperkeratosis were also observed. In most patients, pellagra was not initially suspected. Additional noncutaneous findings were observed in almost all cases.
Pellagra should be ruled out in patients with lesions on sun-exposed areas. Predisposing factors for pellagra should be assessed along with the social situation of patients and the presence of digestive or neurological abnormalities.
在发达国家，糙皮病是一种罕见疾病，仅限于少数高危人群。它主要影响酗酒者以及那些有饮食缺乏、肠道吸收不良或正在使用某些药物进行治疗的人。本研究的目的是分析在我院被诊断为糙皮病的患者的临床、组织病理学和流行病学特征，并将结果与该疾病传统描述的发现进行比较。
我们对1998年至2009年间在我院就诊的有糙皮病临床或病理证据的患者进行了一项回顾性研究。
7名患者符合纳入标准。所有患者均为男性，最常见的诱发因素是酗酒和饮食缺乏。所有患者均表现出光敏性，主要影响前臂和足部上表面，这些部位的病变更为严重。最一致的组织病理学发现是存在血管扩张伴外渗，且炎症浸润很少或没有。在表皮观察到各种变化，包括提示轻度糙皮病的变化，如表皮苍白和角质形成细胞一定程度的气球样变。还观察到其他异常，如表皮坏死和角化过度。在大多数患者中，最初并未怀疑为糙皮病。几乎在所有病例中都观察到了非皮肤方面的其他表现。
对于暴露于阳光下部位有病变的患者，应排除糙皮病。应评估糙皮病的诱发因素以及患者的社会状况和是否存在消化或神经方面的异常。
