掌蹠膿疱症に罹患した顎変形症患者のチタンプレート固定後に出現した皮膚症状：症例報告

Skin Symptoms That Appeared after Fixation with a Titanium Plate in a Jaw Deformity Patient Suffering from Palmoplantar Pustulosis: A Case Report.

抄録

掌蹠膿疱症（PPP）は、掌や足の裏に無菌性の小さな膿疱を繰り返す頑固な皮膚疾患で、金属や歯科の病巣感染が誘因となり増悪する。顎矯正手術後にPPP症状が増悪したという報告は少ない。患者は40歳の女性で、上顎前突と不正咬合を訴え、当院の矯正医を受診した。骨格性前突症の診断のもと、顎変形症の手術を受けた。手術前の矯正治療ではアレルギー症状は認められなかったが、術後に手のひらと足の裏の鱗屑が悪化し、皮膚、特に骨片を固定するためのチタンプレートにかゆみが認められた。金属アレルギーの診断のもと、ステロイドとビタミンD軟膏による治療では改善しなかったため、術後3ヶ月目に金属プレートを非金属吸収性プレートに交換する手術を行った。その後、そう痒症は消失し、手掌と足底の紅斑と鱗屑はほぼ消失した。本症例では、口腔内細菌感染、喫煙歴、手術によるストレスなどもPPP増悪の原因として考えられたが、骨片固定に使用したプレートやスクリューによる金属アレルギーがPPP増悪の原因のひとつであると結論した。

Palmoplantar pustulosis (PPP) is a stubborn skin disease involving repeated aseptic small pustules on the palms and soles of the feet, which is triggered and exacerbated by metals and dental focal infections. There are few reports of an exacerbation of PPP symptoms after orthognathic surgery. The patient is a 40-year-old female who consulted an orthodontist at our hospital, complaining of a protruding maxilla and malocclusion. Under the diagnosis of skeletal prognathism, she underwent surgery for jaw deformity. Although no allergic symptoms were observed during the orthodontic treatment prior to surgery, postoperative scaling on the palms and soles of her feet worsened, and itching was observed on the skin, especially on the titanium plate used to secure the bone fragments. Under the diagnosis of metal allergy, treatment with steroids and vitamin D ointment failed to improve the condition, so surgery was performed to replace the metal plate with a non-metallic absorbable plate in the third postoperative month. Afterwards, the pruritus resolved, and erythema and scale on the palms and soles nearly disappeared. In the present case, though, oral bacterial infection, a past history of smoking, and stress from surgery were also considered to be possible causes of PPP exacerbation, and we concluded that one of the causes of PPP exacerbation was metal allergy from the plates or screws used to fix the bone fragments.