外阴硬化性苔藓伴发外阴恶性肿瘤的研究进展

外阴硬化性苔藓是一种淋巴细胞介导的慢性炎症性疾病,病因不明,可能与免疫、遗传、感染、创伤、性激素等多种因素有关.虽然外阴硬化性苔藓是一种炎症性疾病,但近几年不断有外阴硬化性苔藓伴发外阴恶性肿瘤的报道,目前仍缺乏证据证明两者之间的相关性.本文总结了国内外的最新研究,对外阴硬化性苔藓伴发外阴恶性肿瘤相关的文献进行综述.     

82例女性外阴慢性单纯性苔藓患者斑贴试验分析

目的：检测女性外阴慢性单纯性苔藓（VLSC）患者接触性过敏原情况。方法：对2017年3月至2018年3月就诊于我科的VLSC患者行60项变应原斑贴试验。结果：82例患者中53例患者(64.73%)呈阳性反应。60项变应原中共有29种变应原呈阳性反应,其中阳性率排前三位变应原种类为金属盐（32例）、防腐剂（18例）、芳香剂（16例）,阳性率排前四位变应原分别为硫酸镍（24例）、氯化钴（15例）、芳樟醇氢过氧化物（10例）、甲基异噻唑啉酮（6例）。结论：VLSC可能与接触过敏原有关,金属盐、防腐剂、芳香剂是最常见变应原种类。     

光动力治疗外阴硬化性苔藓的临床疗效

目的 了解光动力在外阴硬化性苔藓(VLS)中的治疗价值.方法 收集2015年1月-2018年9月本院经治VLS患者100例.根据抽签法将患者分为观察组(50例)与对照组(50例).对照组仅给予复方丙酸氯倍他索软膏应用.观察组给予光动力联合复方丙酸氯倍他索软膏.光动力治疗结束12周后对2组分别进行患者症状自评及手持式皮肤...     

误诊为慢性单纯性苔藓的苔藓样型皮肤淀粉样变2例

报告误诊为慢性单纯性苔藓的苔藓样型皮肤淀粉样变2例。例1,女性,44岁;例2,男性,60岁,皮疹分别位于前额和肩胛部。该两种疾病临床表现相似,容易误诊,通过组织病理检查可鉴别。     

女性外阴硬化性苔藓与甲状腺功能和抗体的相关性研究

目的:探讨女性外阴硬化性苔藓患者甲状腺功能或抗体指标异常发生率及其影响因素。方法:收集2016年1月～2018年6月于我院就诊的136例女性外阴硬化性苔藓患者作为观察组,60例体检健康人员为对照组,分析并比较两组受试者甲状腺功能或抗体指标的差异,采用Logistic回归分析外阴硬化性苔藓患者发生甲状腺功能或抗体指标异常的影响因素。结果:女性外阴硬化性苔藓患者发病年龄以50岁以上居多,平均病史为(6. 83±1. 28)年,皮损部位常位于大小阴唇及阴道口,且皮损形态多呈现色素脱失或减退并伴有一定程度萎缩,临床症状多以瘙痒为主。外阴硬化性苔藓患者甲状腺功能或抗体异常发生率为16. 91%(23/136),明显高于对照组且差异具有统计学意义(χ2=5. 13,P=0. 02)。外阴硬化性苔藓患者的病程(OR=4. 27)、复发(OR=3. 56)及合并自身免疫性疾病(OR=8. 11)是发生甲状腺功能或抗体异常的影响因素。结论:外阴硬化性苔藓患者甲状腺功能或抗体异常发生率明显升高,临床医生应对外阴硬化性苔藓患者行甲状腺激素和抗体水平检查,对继发性甲状腺疾病进行提早干预,以避免不良事件的发生。     

外阴硬化性萎缩性苔藓伴先天性皮肤异色症1例

报告1例外阴硬化性萎缩性苔藓伴先天性皮肤异色症。患者女性，17岁，因外阴白斑伴瘙痒8年就诊。皮损主要表现为外、会阴及肛周有呈哑铃状角化白色斑片，胸背及双上肢伸侧有网状色素沉着斑，伴毛细血管扩张和轻度萎缩性白斑，家庭中有皮肤异色症患者。组织病理改变符合硬化性萎缩性苔藓。     

女性外阴硬化性苔藓患者血清性激素水平与疾病严重程度的相关性分析

目的:探讨女性外阴硬化性苔藓(VLS)患者血清性激素水平与疾病严重程度的相关性。方法:收集2016年1月～2018年6月我院确诊的49例女性外阴硬化性苔藓患者作为VLS组,45例健康志愿者为对照组进行回顾性分析,比较两组受试者血清性激素水平间的差异,采用Pearson相关分析探讨血清性激素水平与外阴白斑面积及瘙痒程度积分的相关性。结果:外阴硬化性苔藓患者外阴白斑多位于大小阴唇、尿道口和阴蒂,外阴白斑面积严重程度为轻度的患者占67.35%(33/49),轻度瘙痒患者占65.30%(32/49),外阴白斑面积和瘙痒程度评分分别为(4.12±0.53)分和(1.18±0.67)分。外阴硬化性苔藓患者血清DHT和E_2水平分别为(0.13±0.01) nmol/L和(20.53±4.17) pg/mL,明显低于健康对照组DHT(0.52±0.06) nmol/L和E_2(27.45±6.63) pg/mL水平,且差异均具有统计学意义(t值分别为-33.35,-6.11,P值均<0.05)。复发的外阴硬化性苔藓患者血清DHT(0.09±0.01) nmol/L和E_2(17.35±6.13) pg/mL水平明显低于初发外阴硬化性苔藓患者血清DHT(0.15±0.07) nmol/L和E_2(23.58±3.48) pg/mL水平,且差异均具有统计学意义(t值分别为4.33、4.17,P值均<0.05)。外阴硬化性苔藓患者血清DHT和E_2水平与外阴白斑面积积分呈负相关性,相关系数r分别为-0.78和-0.21,且差异均具有统计学意义(P值均<0.05)。结论:外阴硬化性苔藓患者血清性激素水平与病情严重程度具有负相关性,低水平的DHT和E_2与其复发有关。     

带状疱疹后发生慢性单纯性苔藓1例

带状疱疹愈后在原皮损区可发生多种皮肤病,包括环状肉芽忡、类肉瘤佯肉芽肿、结核样肉芽肿、淋巴瘤、假性淋巴瘤、肉芽忡佯血管炎和Kaposi肉瘤等,现报告1例在带状疱疹愈后原皮损处发生的慢性单纯性苔藓。     

女阴硬化性苔藓诊疗专家共识

女阴硬化性苔藓是一种反复发作的慢性炎症性疾病,几乎各年龄阶段均可发生,绝经期、围绝经期和青春期前女性更常见。典型损害为象牙白/瓷白色硬化萎缩斑,晚期可发生外阴、尿道、肛门结构畸变,造成性生活、排尿及排便困难。中国医疗保健国际交流促进会皮肤科分会组织多位专家在借鉴国内外临床研究和诊疗指南的基础上,补充了中国专家的经验和观...     

【开放获取】儿童外阴硬化性苔藓79例皮肤镜特征分析

【摘要】 目的 探讨儿童外阴硬化性苔藓的皮肤镜特征。方法 回顾2019年1月至2021年5月昆明市儿童医院79例外阴硬化性苔藓初诊及复诊时的皮肤镜特征。结果 外阴硬化性苔藓女性患儿79例,年龄2.4 ~ 12岁,发病年龄（5.6 ± 2.12）岁,病程（14.23 ± 12.36）个月,其中30例规律复诊及治疗。初诊329处皮损中,149处（45.3％）可见特征性血管形态,包括线状血管（129处）、点状血管（25处）、盘绕状血管（19处）、发夹样血管（12处）等;207处（62.92%）可见退行性结构及色素异常,包括蓝灰色色素结构（136处）、褐色色素结构（51处）、胡椒粉样模式（15处）等;280处（85.1％）见黄白色无结构区,97处（29.5％）毛囊角栓,66处（20％）紫红色小球、斑片等。复诊238处皮损中,100处（42％）可见特征性血管形态,其中线状血管87处、树枝状血管21处、点状血管4处,未见发夹样血管;154（64.70%）处见退行性结构及色素异常,其中褐色色素结构93处、蓝灰色色素结构57处、胡椒粉样模式4处;165处（69.3％）见黄白色无结构区,62处（26.1％）毛囊角栓,8处（3.4％）紫红色小球、斑片。复诊皮损中观察到的蓝灰色色素结构、黄白色无结构区、紫红色小球、斑片及点状血管、发夹样血管、盘绕状血管比例均低于初诊（均P < 0.05）,而褐色色素结构高于初诊（均P < 0.05）。结论 儿童硬化性苔藓皮肤镜下黄白色无结构区具较高特异性,监测镜下褐色色素结构及蓝灰色色素结构、黄白色无结构区、紫红色小球、斑片及血管结构等特征可反映疗效,在辅助诊断及随访观察中有一定应用价值。     

Lupus vulgaris mimicking lichen simplex chronicus

Cutaneous tuberculosis is not an uncommon entity but it often remains undiagnosed and is inappropriately treated due to its varied presentation. We present a 42-year-old male with lupus vulgaris in the perianal area, who was treated as lichen simplex chronicus with steroids for two years. With four drug antitubercular treatment, the patient had a dramatic response. The case is being reported because in this HIV era with the resurgence of tuberculosis, not only will there be an increase in incidence but also more involvement of atypical sites.     

Prurigo nodularis and lichen simplex chronicus

ABSTRACT:  Emotional tensions in predisposed subjects may play a key role in inducing a pruritic sensation, leading to a scratching that, becoming a self-perpetuating pathomechanism, may represent the main feature of two distinct cutaneous clinical entities: prurigo nodularis and lichen simplex chronicus. Psychogenic factors play a relevant role in both conditions, and they are often associated with depression and dissociative experiences. Hence, the importance of the evaluation of these patients from the point of view of psychodermatology, which may analyze the relationship between skin disease and psychological factors. Patients with real or perceived imperfections in particular areas of the body (face, scalp, hands, and genital area) are more prone to psychologic distress, whereas cutaneous diseases may lead to experience a heightened level of distress. As psychosomatic factors have been estimated to be present in at least one-third of dermatologic patients, effective management of skin conditions involves consideration of the associated emotional factors.     

Efficacy of treatment with oral alitretinoin in patient suffering from lichen simplex chronicus and severe atopic dermatitis of hands

Lichen simplex chronicus (LSC) is a skin disorder characterized by chronic itching and scratching, which can lead to thick, leathery, brownish skin, sometimes with papules and can be associated with atopic eczema. We report the case of a 52‐year‐old man with a 45‐year atopic condition and presenting LSC in his dorsum. After a 3‐month treatment with alitretinoin at the daily dosage of 30 mg, we have observed a moderate improvement of the hand eczema together with a substantial clinical improvement of LSC and an almost complete resolution of pruritus. We want to report this peculiar case to suggest the use of oral alitretinoin for LSC.     

Clinical and histopathological findings of ''psoriatic neurodermatitis'' and of typical lichen simplex chronicus

BACKGROUND: We have seen several patients with itchy lichenified plaques located bilaterally on the elbows and/or knees and have named this condition 'psoriatic neurodermatitis' (PN). OBJECTIVE: The purpose of this study was to compare clinical and histopathological characteristics of these patients to those of patients with typical lichen simplex chronicus (LSC). METHODS: Nineteen patients with PN and 34 patients with typical LSC were included. Besides clinical dermatological evaluation, the prick test was carried out on 49 patients; the Phadiatop test on 40 patients; the patch test with European standard series on 47 patients; histopathological evaluation on 39 patients; and clinical psychiatric examination on 38 patients. RESULTS: Almost exclusively, PN was seen in females and was located on the extremities. It caused more plaques than typical LSC did. In PN, the plaques were smaller, sharper, more keratotic and less excoriated, and had fewer lichenoid papules around them. Itching was usually more severe in the evening, while resting and in a hot environment in typical LSC, but not in PN. In plaques of PN, microabscesses in the horny layer, hypogranulosis, regular acanthosis and thinning of the suprapapillary plates were more frequent, and hyperpigmentation in the basal layer was less. In patients with PN, depressive disorder was found more frequently; and generalized anxiety disorder or psychosomatic characteristics, less. There were no significant differences in the results of prick, Phadiatop and patch tests between patients with PN and those with typical LSC. CONCLUSION: In our opinion, it is most likely that the so-called PN is itchy psoriasis superimposed by LSC.     

Therapeutic Hotline: Treatment of prurigo nodularis and lichen simplex chronicus with gabapentin

Psychocutaneous conditions are frequently encountered in dermatology practice. Prurigo nodularis and lichen simplex chronicus are two frustrating conditions that are classified in this category. They are often refractory to classical treatment with topical corticosteroids and antihistamines. Severe, generalized exacerbations require systemic therapy. Phototherapy, erythromycine, retinoids, cyclosporine, azathiopurine, naltrexone, and psychopharmacologic agents (pimozide, selective serotonin reuptake inhibitor antidepressants) were tried with some success. Here five cases with lichen simplex chronicus and four cases with prurigo nodularis, who responded well to gabapentin, are presented.     

Allergic contact dermatitis from hair dye and development of lichen simplex chronicus

Those who dye their hair frequently manifest allergic contact dermatitis (ACD) from p-phenylenediamine (PPD)-containing hair dye. PPD is known to be the most frequent sensitizer in hair dye, but there has been no documentation of this sensitizer having a role in chronic dermatologic conditions. Our department experienced a case of a 62-year-old woman with lichen simplex chronicus (LSC), who complained of aggravation after hair dyeing and made such an association. We conducted a prospective and retrospective study to further evaluate the clinical associations between the two. In our prospective study, patch testing was performed in selected patients who regularly carried out hair dyeing and also had clinical manifestations of LSC. Also a retrospective examination was conducted in cases where patch testing had been performed with PPD in the past for suspected ACD and further selected cases with concurrent LSC and/or other neurodermatitis. 11 and 14 patients in our prospective and retrospective study, respectively, presented with both LSC and positive findings to PPD. 5 (45.5%) and 4 (28.6%) patients in our prospective and retrospective study showed clinical relevance from clinical improvement after stopping use and rechallenge. We report several cases of patients diagnosed as having LSC and/or prurigo nodularis who showed clinical improvement after discontinuing the use of hair dye. The suggestion can therefore be made that hair dye could be a possible aetiologic agent causing LSC in those using hair dyes.     

诱生型一氧化氮合酶和血管内皮生长因子在皮肤血管瘤中的表达及其与血管增生的关系

目的：研究诱生型一氧化氮合酶（iNOS）及血管内皮生长因子（VEGF）在增生期皮肤血管瘤组织中的表达及相关性。探讨它们与增生期血管瘤血管生成的关系,研究iNOS产生的一氧化氮（NO）和VEGF的相互作用及NO在介导VEGF促血管瘤间质内血管生成中的作用机制。方法：应用免疫组化法检测51例增生期皮肤血管瘤标本中iNOS、VEGF和第Ⅷ因子相关抗原（FⅧRAg）,血管内皮细胞特异性染色计数肿瘤微血管密度（MVD）。结果：①42例血管瘤组织表达VEGF,32例表达iNOS,血管畸形表达较弱或不表达iNOS和VEGF;②VEGF与iNOS的表达呈正相关性：③VEGF、iNOS的表达与血管瘤组织MVD呈正相关性,血管瘤MVD明显高于血管畸形。结论：①VEGF表达与iNOS表达具有明显的相关性,提示iNOS对VEGF的表达和调节血管生成过程中可能具有重要作用;②MVD随着VEGF和iNOS表达的增强而增加,说明两者对血管瘤血管生成具有促进作用。