Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA.
Department of Dermatology, University of Florida College of Medicine, Gainesville, FL 32610, USA.
Medicina (Kaunas). 2021 Sep 23;57(10):1004. doi: 10.3390/medicina57101004.
The similarity between pustular psoriasis (PP) and acute generalized exanthematous pustulosis (AGEP) poses problems in the diagnosis and treatment of these two conditions. Significant clinical and histopathologic overlap exists between PP and AGEP. PP is an inflammatory disorder that has numerous clinical subtypes, but all with sterile pustules composed of neutrophils. AGEP is a severe cutaneous adverse reaction that is also characterized by non-follicular sterile pustules. Clinical features that suggest a diagnosis of PP over AGEP include a history of psoriasis and the presence of scaling plaques. Histologically, eosinophilic spongiosis, vacuolar interface dermatitis, and dermal eosinophilia favor a diagnosis of AGEP over PP. Importantly, PP and AGEP vary in clinical course and treatment. PP treatment involves topical steroids, oral retinoids, and systemic immunosuppressants. Newer therapies targeting IL-36, IL-23, IL-1, and PDE-4 have been investigated. The removal of the offending agent is a crucial part of the treatment of AGEP.
脓疱型银屑病(PP)和急性泛发性发疹性脓疱病(AGEP)之间的相似性给这两种疾病的诊断和治疗带来了问题。PP 和 AGEP 在临床和组织病理学上存在显著重叠。PP 是一种炎症性疾病,有许多临床亚型,但都有由中性粒细胞组成的无菌脓疱。AGEP 是一种严重的皮肤不良反应,也以非滤泡性无菌脓疱为特征。提示诊断为 PP 而非 AGEP 的临床特征包括银屑病病史和鳞屑斑块的存在。组织学上,嗜酸性海绵状水肿、空泡界面性皮炎和真皮嗜酸性粒细胞增多支持 AGEP 的诊断而非 PP。重要的是,PP 和 AGEP 在临床病程和治疗上有所不同。PP 的治疗包括局部类固醇、口服维甲酸和全身免疫抑制剂。针对 IL-36、IL-23、IL-1 和 PDE-4 的新型治疗方法已经在研究中。去除致病药物是治疗 AGEP 的关键部分。