Mullans E A, Cohen P R
Department of Dermatology, University of Texas-Houston Medical School, 77030, USA.
J Am Acad Dermatol. 1998 May;38(5 Pt 2):866-73. doi: 10.1016/s0190-9622(98)70478-5.
Necrolytic migratory erythema is characterized by waves of irregular erythema in which a central bulla develops, and subsequently erodes and becomes crusted. It usually occurs in patients with an alpha-islet cell tumor of the pancreas. However, necrolytic migratory erythema has also been observed in patients without an associated glucagonoma. We describe a woman with iatrogenic necrolytic migratory erythema. She received intravenous glucagon for hypoglycemia associated with an insulin-like growth factor II-secreting hemangiopericytoma. After chemotherapy, she developed necrolytic migratory erythema. The characteristics of the previously reported patients with nonglucagonoma-associated necrolytic migratory erythema are reviewed. In patients with nonglucagonoma-associated necrolytic migratory erythema, the dermatosis-related conditions most commonly observed were celiac disease or malabsorption, cirrhosis, malignancy, and pancreatitis; less common conditions included hepatitis, inflammatory bowel disease, heroin abuse, and odontogenic abscess. Although the pathogenesis of necrolytic migratory erythema remains unknown, hyperglucagonemia appears to have had a causative role in the development of this dermatosis in our patient. Patients who develop necrolytic migratory erythema should be evaluated for the presence of a glucagonoma; if a glucagonoma is ruled out, evaluation for other conditions known to occur with necrolytic migratory erythema, such as liver disease, malabsorptive disorders, and nonislet-cell tumors is warranted.
坏死松解性游走性红斑的特征为出现不规则红斑，红斑中央形成水疱，随后水疱破溃、结痂。该病通常发生于胰腺α胰岛细胞瘤患者。然而，在无胰高血糖素瘤的患者中也观察到坏死松解性游走性红斑。我们报告一例医源性坏死松解性游走性红斑的女性患者。她因分泌胰岛素样生长因子II的血管外皮细胞瘤伴发低血糖而接受静脉注射胰高血糖素治疗。化疗后，她出现了坏死松解性游走性红斑。本文回顾了既往报道的非胰高血糖素瘤相关性坏死松解性游走性红斑患者的特征。在非胰高血糖素瘤相关性坏死松解性游走性红斑患者中，最常观察到的皮肤病相关情况为乳糜泻或吸收不良、肝硬化、恶性肿瘤和胰腺炎；较少见的情况包括肝炎、炎症性肠病、海洛因滥用和牙源性脓肿。虽然坏死松解性游走性红斑的发病机制尚不清楚，但高胰高血糖素血症似乎在我们患者的这种皮肤病发生中起了致病作用。发生坏死松解性游走性红斑的患者应评估是否存在胰高血糖素瘤；如果排除了胰高血糖素瘤，则有必要评估其他已知与坏死松解性游走性红斑相关的情况，如肝脏疾病、吸收障碍性疾病和非胰岛细胞瘤。
