每日一题_2024.07.19

A 29-year-old woman with a history of systemic lupus erythematosus presented to the dermatology clinic with a 2-week history of an itchy, painful rash on her nose and hands. The rash had first appeared 1 day after the weather had turned cold. The patient reported no sun exposure. The physical examination was notable for erythematosus macules and papules with punched-out ulcers on the nose. Scattered papules were seen on the palms, and edematous erythrocyanosis of the fingertips with ulcerations on the lateral aspects was noted. Blood tests were positive for antinuclear antibodies, anti–double-stranded DNA antibodies, rheumatoid factor, anti-Ro antibodies, and antiphospholipid antibodies, and hypergammaglobulinemia was present. Cryoglobulin and cold agglutinin testing was negative. Histopathological examination of a biopsy specimen of the right nasal sidewall revealed vacuolar interface dermatitis and perivascular lymphocytic infiltrate. Which of the following is an important intervention to prevent this finding?

一位29岁女性，有系统性红斑狼疮的病史，因鼻部和手部出现2周的瘙痒、疼痛性皮疹而前往皮肤科诊所就诊。皮疹首次出现在天气变冷后的第一天。患者报告没有日晒。体格检查显示鼻部有红斑性斑疹和丘疹，伴有穿孔性溃疡。手掌上可见散在的丘疹，指尖有水肿性红紫病和侧面溃疡。血液检测显示抗核抗体、抗双链DNA抗体、类风湿因子、抗Ro抗体和抗磷脂抗体阳性，并且存在高γ球蛋白血症。冷球蛋白和冷凝集素检测为阴性。对右侧鼻翼的活检标本进行组织病理学检查，发现有泡状界面性皮炎和血管周围淋巴细胞浸润。以下哪项是预防这一发现的重要干预措施？

A. Avoidance of exacerbating drugs避免使用加重药物

B. Cold avoidance避寒

C. Photoprotection光

D. Smoking abstinence戒烟

E. Vitamin D supplementation补充维生素D

答案解析：

答案是避免寒冷。诊断为寒冷性红斑狼疮，这是一种不常见的皮肤红斑狼疮形式。炎症性皮肤病变是由寒冷暴露引起的，通常发生在手和脚上；鼻子的受累是不常见的。受影响的患者应该被建议穿足够保暖的衣服作为管理和预防措施。

正确答案：B