Department of Dermatology, Ehime University Graduate School of Medicine, Toon, Japan.
Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan.
J Dermatol. 2019 May;46(5):399-408. doi: 10.1111/1346-8138.14850. Epub 2019 Mar 28.
Palmoplantar pustulosis (PPP) and pompholyx are both chronic and relapsing diseases occurring on the palms and soles. Although these two diseases have been considered completely different from each other, it is sometimes very difficult even for dermatologists to differentiate them from each other because of their similarities in clinical presentation. In this study, we aimed to analyze the histopathological features of PPP and pompholyx and find out "clues" to differentiate between PPP and pompholyx by their histopathological features. The histopathology of 11 PPP and six pompholyx patients, who were diagnosed with typical clinical history and histopathology, were carefully observed. PPP cases were divided into three phases (vesicle, pustulovesicule and pustule) and pompholyx cases were divided into two phases (vesicle and pustule), and histopathological findings and a 4-point checklist to distinguish between PPP and pompholyx were preliminarily established. To confirm whether the checklist establishes the clues for diagnosis, biopsy samples from 43 patients (32 PPP and 11 pompholyx) who had been already diagnosed at five hospitals were examined according to our checklist without any additional clinical information. According to our 4-point checklist, 31 of 32 PPP patients and all 11 pompholyx patients were diagnosed histopathologically consistent with their clinical diagnosis. In conclusion, histopathological findings of "vesicles without spongiosis" and "microabscess on the edges of vesicles" would be impact points for the differential diagnosis between PPP and pompholyx. The 4-point checklist was trustworthy to distinguish between PPP and pompholyx.
掌跖脓疱病（PPP）和汗疱疹均为慢性复发性疾病，发生于手掌和足底。尽管这两种疾病在临床上被认为是完全不同的，但由于其临床表现相似，有时即使是皮肤科医生也很难将它们区分开来。在本研究中，我们旨在分析 PPP 和汗疱疹的组织病理学特征，并通过其组织病理学特征找到区分 PPP 和汗疱疹的“线索”。仔细观察了 11 例 PPP 和 6 例汗疱疹患者的组织病理学特征，这些患者均具有典型的临床病史和组织病理学诊断。PPP 病例分为三个阶段（水疱、脓疱水疱和脓疱），汗疱疹病例分为两个阶段（水疱和脓疱），初步建立了区分 PPP 和汗疱疹的组织病理学发现和 4 分检查表。为了确认检查表是否建立了诊断线索，根据我们的检查表，对来自五家医院已确诊的 43 例患者（32 例 PPP 和 11 例汗疱疹）的活检样本进行了检查，而没有任何其他临床信息。根据我们的 4 分检查表，32 例 PPP 患者中的 31 例和所有 11 例汗疱疹患者的组织病理学诊断均与临床诊断一致。总之，“无海绵形成水疱”和“水疱边缘微脓肿”的组织病理学发现将是 PPP 和汗疱疹鉴别诊断的关键点。4 分检查表可可靠地区分 PPP 和汗疱疹。
