| Objective To discuss the diagnosis and treatment strategies of hypereosinophilic dermatitis.Methods Clinical features and data were retrospectively analyzed in 30 cases of hypereosinophilic dermatitis from the department of dermatology, the first affiliated hospital of Guangxi Medical University, dated from January 2011 to August 2015. In December 2013 to August 2015 in hospital during the period of performance for eczema skin lesions of 22 patients with curative effect evaluation and follow-up.Reference the domestic and international research progress of HED, to summarize and analyze the diagnosis and treatment of the disease.Result 1.There were 30 cases,19 males and 11 females. Male and female ratio was 1.73:1, the average morbidity age as 55.07.Course of disease was 1 month to 20 years.16 cases misdiagnosed as "eczema",1 case was misdiagnosed as "atopic dermatitis", and 1 case was misdiagnosed as "deputy psoriasis".2. The triggers:1 case of seafood;2 cases of long-term exposure to pesticides, decorate;4 cases with a history of repeated hair dye.3. The clinical features were only skin damage, characterized by recurrent, polymorphism, itch skin lesions. Bureau confined to limbs stretch side of 2 cases, pan body of 28 cases. The skin lesions included urticaria, angioedema, invasive erythema, papules, papulovesicles, plaques, nodules, fine dust, scratches, scabby, moss and pigmentation.Few leakage,erosion and ulcer.4.17 cases peripheral blood leukocyte count increased peripheral eosinophil count in 30 cases were significantly increased, moderate increased in 27 cases, severe increased in 3 patients, blood sedimentation, c-reactive protein increased in 19 cases.25 cases lactate dehydrogenase, alpha hydroxy butyric acid decarboxylase increased.1 case of creatine kinase, creatine kinase isoenzyme increased.30 cases were no parasitic infection of laboratory examination, tumor and autoimmune disease evidence,and no imaging abnormal performance.5.Skin lesions in 30 cases were characterized by corium shallow middle perivascular inflammatory cell infiltration mainly eosinophils and lymphocytes.6.Bone marrow eosinophils ratio in 30 cases are increased, and accounts for 3.0%-33.5%, not seen heterocyst.7.7 cases F1P1L1-PDGFRa blend genetic tests are negative.8. On the basis of using antihistamine drug treatment,11 cases of small, medium dose oral glucocorticoid therapy alone (prednisone 0.5～1 mg/(kg·d)) and 11 cases of small, medium dose glucocorticoid combined immune inhibitors such as tripterygium wilfordii, thalidomide that oral treatment were more effective than 8 cases of oral cyclosporin A alone (3～5 mg/(kg·d)) in decrease eosinophils.22 cases of corticosteroids alone or with immunosuppressant therapy effect on decrease eosinophils was no difference. In 22 cases of eczema skin lesions of patients, there was no difference between three kinds of treatments for skin to improve the efficient.9. With followed up for 6 months to 18 months,7 cases of corticosteroids alone or combined rule reduction in patients with immune inhibitors,stop drug sustain 9-18 months,no recurrence;7 cases with ciclosporin A, stop drug sustain 3～6 months,no recurrence.10.7 cases of patients during taking corticosteroids appeared a full moon face, fatigue, insomnia, menstrual disorders, high blood pressure, blood glucose and other side effects;5 cases patients during taking cyclosporin a appeared headache, high blood pressure.After discontinuation of drug or reducing side effects can be gradually ease.Conclusion 1.Hypereosinophilic dermatitis is easy to be misdiagnosed as eczema diseases.2.Small or medium dose of glucocorticoid alone or combined immunosupp ressor, by gradually reduced, then keep in small dose of glucocorticoid is the most effective treatment for HED. |
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