Pathology department, CHU de Québec, Laval University, Quebec, Canada, Faculty of Medicine, Laval University, Quebec, Canada, Pathology department, Henri Mondor hospital, AP-HP, 94010 Créteil Cedex, France.
Dermatology department, Henri Mondor hospital, AP-HP, 94010 Créteil Cedex, France.
Eur J Dermatol. 2021 Jun 1;31(3):372-380. doi: 10.1684/ejd.2021.4051.
The clinical and pathological aspects of fixed drug eruption (FDE) have been described based on a few case series. To compare bullous FDE (BFDE) and non-bullous FDE (NBFDE) and to determine whether BFDE can be histologically distinguished from other dermatoses presenting with an apoptotic pan-epidermolysis. In this retrospective monocentre study (2005-2016), FDE was classified as BFDE or NBFDE and localized (one anatomical site) or generalized (≥ two sites; GBFDE). Clinical data were extracted from charts, and images were reviewed. Skin biopsies were analysed and compared to the clinical presentation. Three dermatopathologists, blinded to the final clinical diagnosis, evaluated a subset of BFDE cases (n = 8) and 25 biopsies of other bullous diseases known to have an epidermal necrolysis (EN)-like pattern. In total, 73 patients were included in the study. Patients with BFDE (n = 58; GBFDE n = 48) were significantly older (p < 0.001). All patients with GBFDE were hospitalized; 25 had a complication (infectious; n = 19), and eight died (median age: 80). Histology revealed spongiotic (6.7%), interface dermatitis (48.3%) and EN-like (66.3%) patterns. The EN-like pattern was more frequent in BFDE than NBFDE (74% vs 27%; p = 0.008). Melanophages (100% vs 66%; p = 0.02) and massive dermal melanosis (40% vs 4%; p = 0.0005) were more prominent in NBFDE than BFDE. BFDE could not be reliably distinguished from other bullous diseases with EN-like patterns. BFDE belongs to the spectrum of skin conditions with an EN pattern, for which the concept of acute syndrome of apoptotic pan-epidermolysis (ASAP) was previously introduced. Clinical-pathological correlation is mandatory for a diagnosis of BFDE.
基于少数病例系列，已经描述了固定性药物疹（FDE）的临床和病理学方面。本研究旨在比较大疱性 FDE（BFDE）和非大疱性 FDE（NBFDE），并确定 BFDE 是否可以从其他表现为全表皮凋亡性表皮松解的皮肤病中在组织学上区分开来。在这项回顾性单中心研究（2005-2016 年）中，FDE 被分为 BFDE 或 NBFDE，并分为局限性（一个解剖部位）或广泛性（≥两个部位；GBFDE）。从病历中提取临床数据，并对图像进行了回顾。分析皮肤活检并与临床表现进行比较。三位皮肤科病理学家在不知道最终临床诊断的情况下，对一组 BFDE 病例（n=8）和 25 例已知具有类似表皮坏死（EN）模式的其他大疱性疾病的活检进行了评估。共纳入 73 例患者。BFDE 患者（n=58；GBFDE n=48）年龄明显较大（p<0.001）。所有 GBFDE 患者均住院治疗；25 例有并发症（感染；n=19），8 例死亡（中位年龄：80 岁）。组织学显示海绵状（6.7%）、界面性皮炎（48.3%）和 EN 样（66.3%）模式。EN 样模式在 BFDE 中比 NBFDE 更常见（74%比 27%；p=0.008）。黑素细胞（100%比 66%；p=0.02）和弥漫性真皮黑色素沉着（40%比 4%；p=0.0005）在 NBFDE 中比 BFDE 更明显。BFDE 无法与其他具有 EN 样模式的大疱性疾病可靠地区分。BFDE 属于具有 EN 模式的皮肤疾病谱，以前引入了急性全表皮凋亡综合征（ASAP）的概念。为了诊断 BFDE，必须进行临床病理相关性分析。
