| Objective: To analysis the clinical characteristics of phytophotodermatitis(PPD)cases in order to further improve clinicians' understanding of the epidemic factors of PPD,thus having a certain guiding value for clinical work.Methods: The epidemic factors,clinical features,diagnosis,treatment and prognosis of 208 patients with PPD reported in the literature domestic and abroad from 1989 to 2019 were analyzed retrospectively.The data of ten patients with PPD admitted to the department of dermatology of the Lanzhou University Second Hospital from June 2010 to September 2020 were summarized.The data were statistically analyzed by SPSS 22.0 software.Results:Part I: Analysis of literature cases1.Gender and age: There were 100 domestic patients,including 30 males(30.0%)and 70 females(70.0%),with a male-to-female ratio of 2.3;108 foreign patients,49 males(45.4%)and 59 females(54.6%),with a male-to-female ratio of 1.2.There were significant differences in gender composition ratio at home and abroad(P<0.05).Among the 208 patients,the youngest age was 1 year old,the oldest age was 87 years old,and the median age was 29.5(14.0,45.0)years old.2.Time of onset: Among the 100 domestic patients,62 cases explained the month of onset and 1 case only explained the season of onset.Among them,38 cases occurred in spring(60.3%),20 cases in summer(31.7%),4 cases in autumn(6.3%)and 1 case in winter(1.6%).The number of cases in spring and summer accounted for92.1%,and the whole year was concentrated from March to July(87.3%).In the foreign literature,only 17 cases described the onset season,15 cases in summer,1case in spring and 1 case in autumn.3.Induced plants and regions: Induced plants and species were mentioned in 189 of all patients.Chenopodiaceae(31.1%)and Cruciferae(16.7%)are more common in China,and Chenopodium album L.,Amaranthus mangostanus L.,Brassica campestris L.var.oleifera DC.and Auricularia auricula(L.ex Hook.)Underw.are common plants.Rutaceae(54.6%),Umbelliferae(24.2%)and Moraceae(19.2%)are most common abroad,and common plants include Citrus aurantium L.,Ficus carica L.,Heracleum mantegazzianum Sommier & Levier,Ruta graveolens L.and Citrus limon Burm.Of the 100 domestic patients,there were 48 cases in the eastern part of the country(48.0%),27 cases in the central region(27.0%)and 25 cases in the western region(25.0%).Of the 108 foreign patients,107 indicated the location of the disease,including 51 in Europe(47.7%),34 in the Americas(31.9%),17 in Asia(15.9%)and5 in Oceania(4.7%).4.Skin lesions and location: All 141 patients had two or more multi-site skin lesions,most of which were head and face(52.4%),hands(69.7%)and arms(40.9%).177 cases(85.1%)showed symmetrical distribution of skin lesions.Compared with the patients with skin contact,there were significant differences in the site of skin lesions(head and neck,trunk)and the symmetry of skin lesions(P<0.05),but there was no significant difference in the location of skin lesions(limbs)(P>0.05).There was no significant difference in the location and symmetry of skin lesions among adolescent,adult and elderly patients with PPD(P>0.05).Erythema(77.9%),swelling(71.2%)and blisters(54.8%)were the most common lesions in all patients.There were significant differences in erythema and swelling,petechiae and ecchymosis,ulcer and necrosis,vesicle,bulla and blood blister and pigmentation between edible group patients and skin contact patients(P<0.05).There was no significant difference in the characteristics of skin lesions among adolescent,adult and elderly groups(P>0.05).5.Misdiagnosis: There were 28 cases of misdiagnosis mentioned in all patients,including 7 cases of allergic dermatitis,6 cases of angioedema,6 cases of contact dermatitis,3 cases of eczema,1 case each of systemic lupus erythematosus,urticaria,porphyria,cutaneous larva migration,chickenpox,staphylococcal scalded skin syndrome and herpes simplex.6.Treatment and prognosis: The rates of accepting glucocorticoids,vasodilators,antihistamines and diuretics in the diet patients were significantly higher than those in the skin contact patients(P<0.001),but there was no difference in the use of antibiotics(P>0.05).Except that patients with skin contact were more likely todevelop pigmentation than edible group patients(P<0.05),there was no difference in recovery,scar formation and necrosis between the two groups(P>0.05).There was no difference in treatment and prognosis among adolescent,adult and elderly groups(P<0.05).Part ?: Analysis of 10 casesThe 10 patients were all female,with a median age of 48.5(45.3,63.5)years old;9 cases were farmers;9 cases were affected in spring and summer.The types of induced plants are as follows: 6 cases of Chenopodium album L.,1 case each of Chenopodium quinoa Willd.,Taraxacum mongolicum Hand.-Mazz.,Spinacia oleracea L.,Zea mays L.;2 cases each were misdiagnosed as allergic dermatitis and contact dermatitis,1 case was atopic dermatitis.Conclusion: The incidence of PPD at home and abroad was mostly female(70.0% at home and 54.6% abroad),and the rate of male patients abroad(45.4%)was higher than that at home(30.0%).The median age of all patients is 29.5(14.0,45.0)years old.The time of onset in China is mainly concentrated from March to July(87.3%),and mainly in spring and summer(92.1%).Chenopodiaceae(31.1%)and Cruciferae(16.7%)are the most common in China,and Chenopodium album L.,Amaranthus mangostanus L.,Brassica campestris L.var.oleifera DC.and Auricularia auricula(L.ex Hook.)Underw.are common plants.Rutaceae(54.6%),Umbelliferae(24.2%)and Moraceae(19.2%)are most common abroad,and common plants include Citrus aurantium L.,Ficus carica L.,Heracleum mantegazzianum Sommier & Levier,Ruta graveolens L.and Citrus limon Burm.The eastern part of China(48.0%)is significantly more than the central region(27.0%)and the western region(25.0%).Foreign countries are mainly distributed in Europe and America(79.4%).The misdiagnosis rate of the disease is 13.5%,and it is easy to be misdiagnosed as allergic dermatitis,angioedema and contact dermatitis.There were some differences in the location,characteristics,treatment and prognosis of skin lesions between the edible group patients and the skin contact patients,but there was no difference among the adolescent,adult and elderly groups. |
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