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首页> 外文期刊>American Journal of Dermatopathology >Histopathologic features of exanthematous drug eruptions of the macular and papular type.
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Histopathologic features of exanthematous drug eruptions of the macular and papular type.

机译：黄斑型和丘疹型发疹性药疹的组织病理学特征。

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摘要

Although exanthematous drug eruptions of the macular and papular type are common and often cause diagnostic problems, histopathologic features are not precisely defined in the literature. We present the first prospective histopathologic study of maculopapular drug eruption in 48 patients in whom the diagnosis had been made on the basis of clinical examination, history of a known offending drug, and follow-up. Because more than 1 biopsy was taken in 11 patients, 60 biopsy specimens could be examined. The most consistent epidermal features were mild spongiosis mainly of the lower layers (97% of biopsies), some hyperplasia (72%), a few lymphocytes (82%), and neutrophils (32%). The dermoepidermal junction revealed discrete vacuolization (97%), scattered lymphocytes (75%), and rare necrotic keratinocytes (32%). All cases showed a dermal perivascular inflammatory infiltrate that was superficial only in 72% of biopsies and superficial and deep in 28% of biopsies. An interstitial infiltrate in the papillary dermis could be found in 93%, more often patchy than lichenoid. In general, the perivascular infiltrate was mild and composed of lymphocytes (100%), eosinophils (60%), and neutrophils (50%). In the papillary dermis, neutrophils often outnumbered the eosinophils. Another feature were the clusters of neutrophils (38%) and eosinophils (20%) in the lumina of dilated, otherwise normal, blood vessels. Rashes induced by anticonvulsants and anxiolytics were characterized by predominance of neutrophils and largish lymphocytes. Edema of the papillary dermis was encountered frequently (85%), whereas wiry collagen bundles were an exceptional finding. In conclusion, our study defined a constellation of histopathologic findings highly suggestive of the diagnosis of exanthematous drug eruption of the macular and papular type.
机译：尽管黄斑型和丘疹型发炎性药疹很常见，并经常引起诊断问题，但文献中并未明确定义组织病理学特征。我们提供了对48名因临床检查，已知违规药物史和随访已做出诊断的患者进行的斑丘疹药疹的前瞻性组织病理学研究。因为在11位患者中进行了1次以上的活检，所以可以检查60个活检标本。最一致的表皮特征是轻度海绵状变，主要是下层（活检的97％），一些增生（72％），一些淋巴细胞（82％）和中性粒细胞（32％）。真皮表皮交界处显示离散的空泡（97％），分散的淋巴细胞（75％）和稀有的坏死角质形成细胞（32％）。所有病例均显示真皮血管周围炎性浸润，仅在72％的活检组织中是浅表的，而在28％的活检组织中是浅表的和深的。乳头状真皮中的间质浸润可以发现为93％，通常比地衣样为片状。通常，血管周围浸润是轻度的，由淋巴细胞（100％），嗜酸性粒细胞（60％）和嗜中性粒细胞（50％）组成。在乳头状真皮中，嗜中性粒细胞经常超过嗜酸性粒细胞。另一个特征是在扩张的血管（正常情况下）的腔内有嗜中性粒细胞（38％）和嗜酸性粒细胞（20％）的簇。抗惊厥药和抗焦虑药引起的皮疹以嗜中性粒细胞和较大的淋巴细胞为主。乳头状真皮水肿经常发生（85％），而胶原蛋白线束则是一个例外。总而言之，我们的研究定义了一组组织病理学结果，高度提示黄斑和丘疹型皮炎性皮疹的诊断。

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