Prurigo nodularis as a sweat gland/duct-related disorder: resolution associated with restoration of sweating disturbance.
Prurigo nodularis as a sweat gland/duct-related disorder: resolution associated with restoration of sweating disturbance.
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结节性痒疹作为一种汗腺/导管相关疾病：与出汗障碍恢复相关的缓解。
DOI：
10.1007/s00403-019-01937-6
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
aoyama Y.
中科院分区：
文献类型：
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作者：
Katayama C;Hayashida Y;Sugiyama S;Shiohara T;aoyama Y.
汗腺/汗管在结节性瘙痒(PN)发病机制中的作用尚未引起足够的重视。根据最近的研究，PN可能在皮肤干燥的情况下发生，如特应性皮炎(AD)，这表明皮肤干燥对PN的发展有很大影响。没有一种治疗方法能在不加重的情况下使PN完全消失。我们之前曾报道，出汗干扰导致的皮肤干燥增加可能会引发AD的发生。我们调查了难治性PN病变的出汗反应是否受损；如果是，我们询问PN病变是否可以通过恢复出汗障碍来解决。使用印模技术，可以准确地量化个人汗腺/导管活动，我们检查了在使用保湿剂或局部皮质类固醇治疗前后，相同患者的PN皮损和外观正常的皮肤在静止条件下的基础出汗和对热刺激的诱导出汗反应。治疗前，在与PN丘疹中心相对应的“轮毂”结构中，最深刻地检测到出汗干扰，无论是基础的还是诱导的。这种出汗障碍在免疫组织化学上与汗液渗入真皮有关。用保湿霜治疗后，这种障碍得到了恢复。我们的局限性包括相对较小的患者队列和缺乏盲目性。出汗障碍可能是PN发展的加重因素之一。皮肤水分低的难治性PN可通过恢复出汗障碍来解决。
Little attention has been given to the involvement of sweat glands/ducts in the pathogenesis of prurigo nodularis (PN). According to recent studies, PN is likely to develop under conditions characterized by dry skin, such as atopic dermatitis (AD), suggesting a strong impact of skin dryness on PN development. No therapeutic modalities produced complete resolution of PN without exacerbations. We previously reported that increases in skin dryness by sweating disturbance could initiate the development of AD. We investigated whether sweating responses were impaired in refractory PN lesions; and, if so, we asked whether the PN lesions could resolve by restoring sweating disturbance. Using the impression mold technique, which allows an accurate quantification of individual sweat gland/duct activity, we examined basal sweating under quiescent conditions and inducible sweating responses to thermal stimulus in PN lesions and normal-appearing skin in the same patients before and after treatment with a moisturizer or topical corticosteroids. Sweating disturbance, either basal or inducible, was most profoundly detected in the “hub” structure corresponding to the center of PN papule before the treatment. This sweating disturbance was immunohistochemically associated with the leakage of sweat into the dermis. This disturbance was restored by treatment with a moisturizer. Our limitations include a relatively small patient cohort and lack of blinding. Sweating disturbance could be one of the aggravating factors of PN development. Refractory PN with low skin hydration may resolve by restoring sweating disturbance.