扁平型生殖器疣1例

报告1例扁平型生殖器疣。患者男，31岁，包皮内侧出现肉色斑丘疹3个月，5％醋酸白试验阳性，HPVl6—DNA阳性。皮损组织病理示：棘层肥厚，表皮上部可见典型的空泡细胞；给予液氮冷冻治疗3次后皮损消退。     

色素丘疹性尖锐湿疣1例

报告1例色素丘疹性尖锐湿疣,患者男,35岁,阴阜部深褐色丘疹2个月,无自觉症状,5%醋酸白试验阳性,皮损组织病理检查显示,棘层肥厚,表皮上部可见典型的凹空细胞,基底层色素增加,表皮细胞无明显异形性,聚合酶链反应(PCR)检测皮损HPV6.11 DNA阳性,给予手术切除治疗,随访1个月无复发.     

疣状表皮发育不良继发鳞状细胞癌

报告1例疣状表皮发育不良继发鳞状细胞癌。患者男,33岁。全身泛发扁平疣状皮损10年,鼻部复发性溃疡9个月。皮肤科检查：全身密集扁平疣状丘疹;鼻部一3cm×4cm的移植皮瓣,左侧鼻翼上方有一约1．5cm×2cm溃疡。皮损组织病理检查示棘细胞层上部见空泡化细胞伴少量角化不良细胞;真皮内有团块状细胞,灶内可见较多核大异形的鳞状细胞。     

表现特殊的二期梅毒疹二例

例1 男,59岁。因全身结节、斑块1月余就诊。患者1个月前无明显诱因背部出现红色结节,无自觉症状,未予特殊处理。之后皮损逐渐增多,累及全身,为进一步明确诊断和治疗来我院就诊。既往体健,无外伤手术史及药物过敏史,家族中无类似病史。2个月前有非婚性接触史。体检：各系统检查未见明显异常。皮肤科检查：躯干及四肢见数10个0.3 ~ 2.0 cm暗红色丘疹、结节及斑块（图1）,质地中等,部分边缘隆起,中央有脐形凹陷;多数皮损表面结厚的黄痂,压之无脓性分泌物。肛周及阴囊部见多个铜红色扁平斑块,表面潮湿。皮损组织病理检查：浅表结痂,表皮细胞水肿,呈明显假上皮瘤样增生,表皮内见弥漫性中性粒细胞小脓肿。真皮内见弥漫性以浆细胞和组织细胞为主的炎症浸润。实验室检查：血尿粪常规、肝肾功能均在正常范围。快速血浆反应素环状卡片试验（RPR）1 ∶ 64阳性,梅毒螺旋体血凝试验（TPHA）阳性。诊断：二期梅毒……     

光动力疗法成功治疗女童外阴鲍恩样丘疹病1例及文献复习

患儿女,9岁。因外阴出现黑色丘疹1个月余,渐加重1周。患儿外阴散在或聚集分布黑色扁平丘疹,部分融合成斑块。外阴皮损组织病理检查显示,角化过度,棘层增厚和表皮突增宽,细胞结构紊乱,全层可见非典型细胞,但基膜完整。皮损免疫组化结果示人乳头瘤病毒(HPV)阳性。PCR-反向点杂交法检测结果 HPV-16(高危型)阳性。依据临床及实验室检查确诊为由HPV-16感染引起的鲍恩样丘疹病。给予5-氨基酮戊酸(ALA)光动力疗法(PDT)治疗3次,外阴皮损全部消退。之后外用咪喹莫特软膏维持治疗3个月,随访6个月无复发。ALA-PDT是治疗儿童鲍恩样丘疹病的一种安全、有效、无明显痛苦和不良反应的新疗法。     

HPV43／66感染致疣状表皮发育不良一例

患者男,37岁。因全身多发疣状丘疹、斑片20年,外阴和腹股沟糜烂、渗出2个月就诊。皮肤科检查：全身多发、蚕豆大疣状丘疹,部分融合成片。双侧腹股沟及外阴皮损处糜烂、渗液和结痂。外周血淋巴细胞亚群分析示：CD4＋T细胞37．2％,CD8＋T细胞43．6％,CD4＋／CD8＋细胞比值0．85。斑点杂交示：HPV43和66DNA阳性。皮损组织病理：角化过度,表皮疣状增生及假上皮瘤样增生,可见部分凹空细胞,真皮浅层中度淋巴细胞浸润。诊断为疣状表皮发育不良、皮肤感染和细胞免疫功能低下。治疗给予抗感染、肌内注射免疫增强剂和口服阿维A胶囊,治疗15d后外阴和腹股沟皮损表面干燥、变平,并有大量痂屑脱落,而躯干和四肢皮损无明显变化。目前患者仍在随访中。     

外阴疣状黄瘤

报告1例外阴疣状黄瘤.患者女,47岁.外阴丘疹6个月.皮损组织病理学检查示:表皮呈乳头瘤样增生,真皮乳头较多泡沫细胞;免疫组化染色示CD68阳性.手术切除后随诊9个月无复发.     

发疹性黄瘤伴高脂蛋白血症1例

患者女,26岁。面颈及躯干散在分布橘黄色丘疹半年,迅速增多2个月。查体见面颈、躯干密集分布淡黄色或橘黄色扁平丘疹,粟粒至绿豆大,表面光滑,质软,无压痛,互不融合,与皮下组织无粘连。皮损组织病理示:表皮轻度萎缩,真皮见较多泡沫细胞呈球状浸润。实验室检查符合高脂蛋白血症。诊断:发疹性黄瘤;高脂蛋白血症。     

扁平寻常狼疮1例

报告1例扁平寻常狼疮。患者男,82岁。因"左下颌暗红斑片1年余"就诊。皮肤科检查:左下颌见一大小约8 cm×5 cm暗红色斑片,表面平滑,上覆少许细薄鳞屑,无破溃,边界尚清,触之有轻度浸润感。皮损组织病理:表皮变薄,真皮内见大量由上皮样细胞组成的结核样结节,其中见较多朗格汉斯巨细胞,外周较多淋巴细胞浸润。特殊染色:抗酸染色阳性。分支杆菌培养:见抗酸杆菌生长。PPD皮试强阳性,结核干扰素释放实验(T-SPOT)阳性。结合临床表现、实验室检查结果及组织病理,诊断:扁平寻常狼疮。患者予异烟肼和利福平二联抗结核治疗6个月,临床治愈,随访4个月无复发。     

二期梅毒疹1例

临床资料患者,女,22岁。主因肛周、外阴、腋下、颈部扁平丘疹2个月于2011年1月来我院皮肤科就诊。患者缘于2个月前肛周出现数个绿豆大小扁平丘疹,皮损渐增大、增多并扩展至外阴,无明显自觉症状。1个月前腋下出现类似皮损,起初为数个扁平丘疹,后丘疹扩大融合,中央渐愈合形成一环状皮损。同时颈部出现环形斑丘疹,少许鳞屑。患者一般情况可,     

Parthenium dermatitis presenting as photosensitive lichenoid eruption. A new clinical variant

Parthenium hysterophorus is the commonest cause of airborne contact dermatitis (ABCD) in India. The disease usually manifests as itchy erythematous, papular, papulovesicular and plaque lesions on exposed areas of the body. Rarely, however, the disease may present as actinic reticuloid or photocontact dermatitis. We have observed a different clinical variant of this disease where certain patients with Parthenium dermatitis have presented with discrete, flat, violaceous papules and plaques on exposed areas of the body closely simulating photosensitive lichenoid eruption. We had 8 patients, 6 males and 2 females between 30 and 62 years of age, with itchy, violaceous, papules and plaques on the face, neck, ears, upper chest and dorsa of the hands for 6 months to 6.5 years. Four of these patients had a history of improvement of the lesions up to 30% in winter and aggravation of lesions on exposure to sunlight. There was no personal or family history of atopy. Cutaneous examination in all patients revealed multiple flat, violaceous, mildly erythematous papules and plaques on the forehead, sides and nape of neck, ears, 'V' area of the chest, and extensor aspects of the forearms and hands. Skin biopsies from these lesions showed features of chronic non-specific dermatitis. Patch testing with standardized plant antigens showed a positive patch test reaction to Parthenium hysterophorus in all patients, with a titre of contact hypersensitivity (TCH) varying from undiluted to 1 : 100. We conclude that Parthenium dermatitis may occasionally present with lesions very similar to the lesions of photosensitive lichenoid eruption in morphology and distribution. This clinical presentation of Parthenium dermatitis needs to be recognized to avoid misdiagnosis.     

发疹型扁平苔藓1例

  报告1例发疹型扁平苔藓。患者男,69岁。全身暗红斑、丘疹伴瘙痒5个月。血糖升高9年余。皮肤专科检查：头面部、躯干及四肢可见暗红斑,部分融合成片,部分苔藓样肥厚明显,伴扁平丘疹及斑块,上覆细薄鳞屑,头部皮肤脱屑明显,未见束状发。口腔颊黏膜可见Wickham纹,生殖器黏膜见白色斑疹。皮损组织病理：表皮缺损,真皮浅层见带状的淋巴组织浸润,见色素失禁。PAS染色阴性。诊断:发疹型扁平苔藓;2型糖尿病。予小剂量激素联合羟氯喹治疗1个月后,遗留色素沉着斑,无新发皮疹。     

面部扁平湿疣1例

患者女,48岁。面部扁平丘疹、斑块5个月,加重伴肛周丘疹1个月。皮肤科情况:面部见30余个暗红色直径1.0～2.0cm的扁平丘疹。鼻周和下颏部丘疹融合成环状斑块,表面覆黄色脓痂,浸润。其间散在分布少许豆粒大小暗红色丘疹。肛周见一扁豆大小的暗红色丘疹,上覆灰白色膜。TRUST1:32,TPPA1:1280。皮损组织病理示:表皮增生,真皮血管内皮细胞肿胀,真皮层大量淋巴细胞、浆细胞、中性粒细胞浸润。诊断:二期梅毒。予苄星青霉素240万U分两侧臀部肌注,1次/周,连续3周。3周后皮疹大部分消退。     

Pseudoacne of the Nasal Crease: A New Entity?

In this article we describe a clinical entity appearing in seven preadolescent patients who presented with chronic red papules within a prominent nasal crease. Milia were also noted in the nasal crease, but there was no evidence of acne vulgaris. The duration of symptoms was 4 months to 2 years, and lesions ranged from inflamed red papules, which were treated with topical antiinflammatory medications, to scarred white papules requiring excision. Histologic evaluation of two lesions revealed keratin granulomas that were likely derived from ruptured, inflamed milia. Due to its similarity in appearance to acne vulgaris, but different pathogenesis and clinical course, we suggest naming this newly described entity "pseudoacne of the nasal crease."     

Spontaneous resolution of facial papular mucinosis in a transplant patient

A 37-year-old male developed facial papules 6 months post renal–pancreatic transplant. Histological findings were consistent with localized papular mucinosis; electrophoresis showed no paraprotein. A trial of erbium and aura lasers, at ablative doses, produced no improvement. Independent treatments with oral doxycycline, itraconazole, acitretin, and isotretinoin also had no effect. The facial papules improved spontaneously, 2 years after first presentation and 8 months after treatment ceased. The patient remains clear of lesions.     

黑色丘疹性皮病一例

患者女,36岁,胸腹部多发黑褐色丘疹10余年,逐渐增多。体检：前胸、腹部皮肤可见散在数十个黑褐色扁平丘疹,直径1 ～ 3 mm,表面光滑,部分呈乳头瘤样,无融合。腹部皮损组织病理检查：表皮轻度角化过度,棘层增厚,皮突延长,互相连接成网状,棘层内可见假性角囊肿形成,基底层色素增加,真皮浅层血管周围稀疏淋巴组织细胞浸润。诊断：黑色丘疹性皮病。     

恶性萎缩性丘疹病一例

患者，女，58岁。躯干四肢散在红斑丘疹4个月余。皮肤科检查：躯干四肢散在红斑丘疹，丘疹中央可见瓷白色萎缩性斑片，边缘隆起伴红晕，伴腹痛。皮损组织病理示：表皮萎缩变薄，真皮浅中层胶原变性，血管周围散在小片状的淋巴细胞及组织细胞浸润。诊断：恶性萎缩性丘疹病。给予阿司匹林、双嘧达莫、雷贝拉唑钠、美沙拉嗪、阿嗪米特口服治疗1个月后腹痛症状缓解，全身皮疹颜色变淡。2个月后患者腹痛加重诊断为肠穿孔，术后无明显改善。4个月后去世。     

Truncal lesions do not exclude a diagnosis of Gianotti-Crosti syndrome

A boy aged 2 years and 10 months had a pruritic eruption and low-grade fever for 1 week. Examination revealed discrete erythematous papules and papulovesicles on his buttocks and extensor surfaces of four limbs. Several papules were also present on his back. No lymphadenopathy and no hepatosplenomegaly were noted. Investigations failed to identify a single viral aetiology. Topical calamine lotion and a sedating oral antihistamine to be taken at night were prescribed. The truncal lesions subsided in 3 weeks. Complete remission of all lesions was seen after 6 weeks. Although most patients with Gianotti-Crosti syndrome only have the typical acrally distributed eruption, additional truncal lesions, if few in number, do not exclude the diagnosis.     

Generalized lichen nitidus

Lichen nitidus is a rare chronic condition of unknown etiology. Generalized lichen nitidus is even rarer. We report here a 5-year-old girl who had multiple, asymptomatic, discrete, 1 to 2 mm flesh-colored, shiny, flat, papules on her face, upper limbs, and thighs with relative sparing of the trunk. Resolution of these papular lesions was followed by hyperpigmented macules in those areas. Histopathologic examination of a papular lesion revealed a localized granulomatous lymphohistiocytic infiltrate in an expanded dermal papilla with thinning of overlying epidermis and downward extension of the rete ridges at the lateral margin of the infiltrate, producing a typical "claw clutching a ball" picture, confirming our clinical diagnosis of lichen nitidus. The pigmented macules showed melanin pigmentation on histology. There was no response to oral astemizole treatment for 3 months. However, the lichen nitidus lesions resolved spontaneously without any further treatment over the next year, leaving behind a prominent pigmentary disturbance.     

局灶性肢端角化过度

报告1例局灶性肢端角化过度.患者女,45岁.双手淡黄色扁平丘疹10余年,无自觉症状.组织病理检查可见表皮明显角化过度,颗粒层及棘层增厚,未见典型空泡细胞.弹性纤维染色示真皮弹性纤维大致正常.