硬化性苔藓合并局限性硬皮病1例
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摘要
患者女,41岁,躯干及双前臂泛发性硬化萎缩性斑片不伴瘙痒5年余。肩颈部皮肤镜示:高度延长的树枝状血管扩张,局部见黄白无结构区、茧样结构及纤维化条带,未见毛囊角栓。左肩部组织病理示:表皮角化过度,萎缩变薄,基底细胞灶状液化变性,真皮乳头层可见均一化变性。真皮中下层胶原纤维增生、致密、红染,轻度玻璃样变,真皮小血管周围少许淋巴细胞及浆细胞浸润,附属器减少。根据临床表现、皮肤镜及组织病理诊断:硬化性苔藓合并局限性硬皮病。
A 41-year-old female presented with generalized sclerotic and atrophic patches on the trunk and forearms without itching for more than 5 years. Upon dermoscopy showed linear branching vessels,patchy structureless white-yellow areas,chrysalis structures and fibrotic beams. Keratotic plugs were not observed. A biopsy specimen obtained from her left shoulder revealed hyperkeratosis, atrophy and thinning of epidermis, hydropic degeneration of the basement membrane and hyalinization in papillary layer of dermis. Proliferated,dense,and hyalinized collagen fibers were observed in medium and lower dermis,accompanied by a perivascular inflammatory infiltrate and a reduced number of appendages. Based on clinical,dermoscopy and histopathological findings,the diagnosis of lichen sclerosus with morphea was made.
A 41-year-old female presented with generalized sclerotic and atrophic patches on the trunk and forearms without itching for more than 5 years. Upon dermoscopy showed linear branching vessels,patchy structureless white-yellow areas,chrysalis structures and fibrotic beams. Keratotic plugs were not observed. A biopsy specimen obtained from her left shoulder revealed hyperkeratosis, atrophy and thinning of epidermis, hydropic degeneration of the basement membrane and hyalinization in papillary layer of dermis. Proliferated,dense,and hyalinized collagen fibers were observed in medium and lower dermis,accompanied by a perivascular inflammatory infiltrate and a reduced number of appendages. Based on clinical,dermoscopy and histopathological findings,the diagnosis of lichen sclerosus with morphea was made.
引文
[1] 赵辨.中国临床皮肤病学[M].2版.南京:江苏凤凰科学技术出版社,2017:1151-1155.
[2] Stavrianeas NG,Katoulis AC,Kanelleas AI,et al. Extragenital lichen sclerosus of childhood presenting as erythematous patches[J].Indian J Dermatol Venereol Leprol,2008,74(1):59-60.
[3] Fistarol SK,Itin PH. Diagnosis and treatment of lichen sclerosus[J].Am J Clin Dermatol,2013,14(1):27-47.
[4] Rose AE,Boyd KP,Meehan SA,et al. Lichen sclerosus et atrophicus[J].Dermatol Online J,2013,19(12):20714.
[5] Kreuter A,Wischnewski J,Terras S,et al. Coexistence of lichen sclerosus and morphea: a retrospective analysis of 472 patients with localized scleroderma from a German tertiary referral center [J].J Am Acad Dermatol,2012,67(6):1157-1162.
[6] López SR,García YH,Díez SG,et al. Morphea and extragenital lichen sclerosus et atrophicus after influenza vaccination[J].Actas Dermosifiliogr,2018,109(1):86-88.
[7] 冉立伟,兰东,贾红侠,等.硬化萎缩性苔藓并发局限性硬皮病1例并文献复习[J].实用皮肤病学杂志,2016,9(3):161-164.
[8] Shim WH,Jwa SW,Song M,et al. Diagnostic usefulness of dermatoscopy in differentiating lichen sclerous et atrophicus from morphea[J].J Am Acad Dermatol,2012,66(4):690-691.
[9] Larre Borges A,Tiodorovic-Zivkovic D,Lallas A,et al. Clinical,dermoscopic and histopathologic features of genital and extragenital lichen sclerosus[J].J Eur Acad Dermatol Venereol,2013,27(11): 1433-1439.
[10] 石晶,孔祥君,聂振华.硬化萎缩性苔藓15例皮肤镜特征[J].中华皮肤科杂志,2016,49(3):206-208.
[2] Stavrianeas NG,Katoulis AC,Kanelleas AI,et al. Extragenital lichen sclerosus of childhood presenting as erythematous patches[J].Indian J Dermatol Venereol Leprol,2008,74(1):59-60.
[3] Fistarol SK,Itin PH. Diagnosis and treatment of lichen sclerosus[J].Am J Clin Dermatol,2013,14(1):27-47.
[4] Rose AE,Boyd KP,Meehan SA,et al. Lichen sclerosus et atrophicus[J].Dermatol Online J,2013,19(12):20714.
[5] Kreuter A,Wischnewski J,Terras S,et al. Coexistence of lichen sclerosus and morphea: a retrospective analysis of 472 patients with localized scleroderma from a German tertiary referral center [J].J Am Acad Dermatol,2012,67(6):1157-1162.
[6] López SR,García YH,Díez SG,et al. Morphea and extragenital lichen sclerosus et atrophicus after influenza vaccination[J].Actas Dermosifiliogr,2018,109(1):86-88.
[7] 冉立伟,兰东,贾红侠,等.硬化萎缩性苔藓并发局限性硬皮病1例并文献复习[J].实用皮肤病学杂志,2016,9(3):161-164.
[8] Shim WH,Jwa SW,Song M,et al. Diagnostic usefulness of dermatoscopy in differentiating lichen sclerous et atrophicus from morphea[J].J Am Acad Dermatol,2012,66(4):690-691.
[9] Larre Borges A,Tiodorovic-Zivkovic D,Lallas A,et al. Clinical,dermoscopic and histopathologic features of genital and extragenital lichen sclerosus[J].J Eur Acad Dermatol Venereol,2013,27(11): 1433-1439.
[10] 石晶,孔祥君,聂振华.硬化萎缩性苔藓15例皮肤镜特征[J].中华皮肤科杂志,2016,49(3):206-208.