Beylot C, Bioulac P, Doutre M S
Ann Dermatol Venereol. 1980 Jan-Feb;107(1-2):37-48.
Acute generalized exanthematic pustuloses supervening without a genetic psoriatic predisposition are not exceptional if the literature over the last few years is taken into account. Such observations are published under a wide range of names. Beside exanthematic pustular psoriasis as defined by Baker and Ryan, there exists in fact a whole scale of amicrobial pustulosis: acute generalized pustular bacterid; acute generalized pustulosis manifestation of leukocytoclastic vasculitis; pustular necroziting angeitis; pustular eruption with eosinophilic abscesses; generalized pustular drug rash; subcorneal pustules in erythema multiforme and in Sweet's syndrome. Thus, it appears that pustuloses exist in many forms, although they have certain common points that justify a synthetic perspective:--their occurrence, after a bout of infection and/or after taking drugs in subjects with no previous known psoriasis;--a single outbreak occurring spontaneously or with corticoid therapy and which heals by itself;--the existence of a marked vasculitis which occurs before the epidermal pustules. Sometimes this takes the form of a leucocytoclastic vasculitis or a polymorphic infiltrate which is rich in intact eosinophils. Direct immunofluorescence shows deposits of C3 and occasionally IgM at the vascular wall. The circulating antibody-antigen complex produced by an infection and/or by a drug may be responsible of the pustulosis by a hypersensibility mechanism (type Arthus phenomen). From the existing literature and the personal observations of four cases, the authors have made a general review of these pustuloses. They believe that in the majority of cases, pustulosis should not be considered as being psoriatic. However, the authors discuss the rare but possible occurrence of such a pustulosis in patients with a genetic psoriatic predisposition. They feel it would be preferable to avoid the publication of observations under a too wide a range of names, and propose the common heading of "acute generalized exanthematic pustulosis".
如果考虑过去几年的文献，在没有遗传性银屑病易感性的情况下发生急性泛发性脓疱病并非罕见。此类观察结果有多种名称。除了贝克和瑞安所定义的发疹性脓疱性银屑病外，实际上还存在一系列无微生物脓疱病：急性泛发性脓疱性细菌疹；白细胞破碎性血管炎的急性泛发性脓疱病表现；脓疱性坏死性血管炎；伴有嗜酸性脓肿的脓疱性皮疹；泛发性脓疱性药疹；多形红斑和斯威特综合征中的角层下脓疱。因此，脓疱病似乎有多种形式，尽管它们有某些共同点，这证明可以从综合角度来看待：——在既往无银屑病的患者感染和/或服药后发生；——单次发作，可自发出现或在使用皮质类固醇治疗后出现，且可自行愈合；——在表皮脓疱出现之前存在明显的血管炎。有时表现为白细胞破碎性血管炎或富含完整嗜酸性粒细胞的多形性浸润。直接免疫荧光显示血管壁有C3沉积，偶尔还有IgM沉积。感染和/或药物产生的循环抗体 - 抗原复合物可能通过超敏反应机制（阿瑟斯现象）导致脓疱病。根据现有文献和对4例病例的个人观察，作者对这些脓疱病进行了全面综述。他们认为在大多数情况下，脓疱病不应被视为银屑病性的。然而，作者讨论了在有遗传性银屑病易感性的患者中这种脓疱病罕见但可能的发生情况。他们认为最好避免以过于宽泛的名称发表观察结果，并提议采用“急性泛发性脓疱病”这一通用名称。
