疣状斑块型汗孔角化症1例

疣状斑块型汗孔角化症是一种少见的特殊类型的汗孔角化症,笔者诊治1例,现报道如下. 临床资料 患者男,47岁.臀部疣状增生性斑块10余年.10年前双侧臀部开始出现数个米粒至黄豆大的角化性丘疹.     

电灼治疗单侧线状型伴显著角化过度型汗孔角化症1例

患者女,20岁。2年前左手3、4指及手背面出现点状褐色丘疹,逐渐扩大,边缘高起,呈线状分布,左足有同样皮损,无自觉症,否认家族中有同患。体检:左侧肩、上肢伸侧、左腋至左肋缘、颈部至左耳后、发际部、左膝关节以下有散在扁豆至指盖大小角化性褐色环状丘疹,境界清楚,部分融合成片,边缘呈堤状隆起角化,中央轻度萎缩,断续呈带状分布,符合单侧线状型汗孔角化症。左手、足背面及中、无名指趾背面有同样皮损沿经络走行,皮损宽约0.8ｃｍ,符合显著角化过度型汗孔角化症。无家族史。治疗　采用ＧＸⅢ型多功能电离子手术治疗机。患处常规消毒,1%利多卡…     

掌跖及泛发性汗孔角化症一家系报道

报告我国首例掌跖及泛发性汗孔角化症一家系调查。先证者10岁时右手中指掌尺侧出现一油菜籽大小的圆形角化性丘疹，继后发现面部出现相似丘疹，且皮损逐渐扩大并泛发全身；组织病理检查可见角化不全柱，符合汗孔角化症；家系调查为5代共90人，结果患病26例，其中男性17例，女性9例，符合常染色体显性遗传特点。诊断为显性遗传性掌跖及泛发性汗孔角化症。对该病的临床特征、组织病理、遗传方式及鉴别诊断等进行了讨论。     

混合型汗孔角化病

报告1例混合型汗孔角化病.患者男,45岁.面部、背部及四肢出现角化性丘疹20余年,腹股沟、外阴及肛周出现结节5年.皮损组织病理检查符合汗孔角化病表现.     

显著角化过度型汗孔角化症1例

显著角化过度型汗孔角化症１例徐标，叶发舜，王昌志江西南昌皮肤病院（邮政编码３３０００１）Ｍｉｋｈａｉｌ等将汗孔角化症分为６型，其中一型为显著角化过度型，临床上较为少见，现将我们所遇正例报告如下。患者男，２５岁。因面、颈、躯干、臀部出现褐色斑及疣状增生...     

疣状斑块型汗孔角化症16例临床病理分析

汗孔角化症是一种较少见的角化性皮肤病 ,可有多种不同的临床类型 ,典型皮损临床易诊断 ,但某些不典型皮损常易误诊。主要发生于臀部的疣状斑块型汗孔角化症临床较少见 ,也易误诊。近年国内陆续有作者报告疣状斑块型汗孔角化症 ［１～３］。我科从１９９０年～１９９８年经组织病理学检查共诊断汗孔角化症６８例 ,其中结合临床诊断疣状斑块型汗孔角化症１６例。本文主要对这型汗孔角化症进行临床病理分析。１临床资料１６例患者中男１４例 ,女２例 ,男女之比为７∶１ ;发病年龄９岁～７５岁 ,平均为３９岁 ;病程２年～１５年 ,平均７年 ;１…     

疣状汗孔角化症1例

报告1例疣状汗孔角化症。患者男，53岁。25岁始双下肢出现黄豆大丘疹并逐渐增多、增大、波及全身。臀部和双下肢皮损呈高度疣状增殖性斑块。临床症状和皮损组织病理学改变符合疣状汗孔角化症。给予角质剥脱剂外用及阿维A口服治疗2周后，疣状皮损全部消退。     

偏侧性汗孔角化症1例

报告1例偏侧性汗孔角化症。患者男，49岁，自出生后于左膝关节伸侧出现多个环状褐色斑，逐渐扩大，渐波及左侧躯体，部分皮损为线条状角化性斑块，伴瘙痒。无家族史。皮肤组织病理检查结果符合汗孔角化症。     

国外新病名介绍

面部浅表性汗孔角化症[1]汗孔角化症通常出现在躯干和四肢，面部皮损罕见。对一些作者的165 000活检标本作了回顾性分析，发现仅7例病人面部出现汗孔角化症[2]。而局限在面部的浅表性汗孔角化症连同下面要介绍的1例在内，至今文献仅报道过2例。临床表现：本例为一18岁男性患者，于3年前面部出现无症状的皮损，逐渐发展，无论是服药、外伤、感染，还是日光照射，皮损均不加重。家庭中无类似疾病患者。皮肤科检查见面部有数个肤色、略带蓝色、浅表、环形的皮损，针头至1.0cm大小，表面干燥，有的皮损中央轻度萎缩。放大镜下见皮损边缘清楚，无…     

巨大型疣状增生性汗孔角化症2例

报告2例巨大型疣状增生性汗孔角化症。患者均为臀部出现巨大疣状增殖性斑块。临床症状和皮损组织病理学改变符合疣状汗孔角化症。     

Recurrent herpes simplex virus type 2 infection of the hand complicated by persistent lymphoedema

A 33-year-old, immunocompetent woman had recurrent herpes simplex virus reactivation of the right hand presenting with a cellulitis-like picture. She continued to have monthly debilitating recrudescences for more than 3 years until an adequate dosage of prophylactic antiviral therapy was achieved. After 2 years of repeated episodes she had chronic dull pain and developed persistent acquired lymphoedema of the left hand and forearm, which is an extremely rare complication. This case highlights the need for herpes simplex infection of the hand to be included in the differential diagnosis of bacterial cellulitis in order for appropriate and prompt therapy to be achieved.     

Squamous cell carcinoma in a patient with Netherton's syndrome

A 29-year-old white woman with a history of Netherton's syndrome presented with two squamous cell carcinomas on the right dorsal hand and the left upper arm. She reported a 2-year history of these lesions, which were originally treated as warts. She denied excessive sun exposure, immunosuppressive therapy, or a previous history of skin cancer. Her past medical history included acute renal failure, multiple urinary tract infections, meningitis, and recurrent otitis media as a child. In addition, she had an ovarian abscess at 4 years of age with resulting salpingo-oophorectomy. She also reported a history of severe myopia, glaucoma, and multiple ocular infections with a resulting corneal scar. In addition to atopic dermatitis, she had a 10-year history of psoriasis. Her medications included topical steroids and emollients for atopic dermatitis and psoriasis, in addition to Timolol ophthalmic drops for glaucoma. Her family history was significant for a 22-year-old sister with Netherton's syndrome (Fig. 1). She denied any history of skin cancer in her sister or other members of her family. On physical examination, she had an exfoliative erythroderma, madarosis, and diffuse patchy alopecia. In the bilateral axilla, she had well-defined pink scaly plaques which were confirmed as psoriasis by biopsy. On the right dorsal hand, she had a 1.5 x 1.0 cm pink verrucous plaque (Fig. 2). On the left upper arm, she had a 1.5 x 0.8 cm pink scaly plaque. Biopsies of both sites confirmed squamous cell carcinomas. Both lesions were completely excised with 4 mm margins.     

Generalized linear porokeratosis

A 23-year-old woman was seen for widespread skin lesions present since the age of 2.5 years. Twenty years ago, she developed a brown macular lesion on her right buttock. The lesion became hyperkeratotic and subsequently spread through the posterior aspect of her right leg. It later spread to the right side of the trunk and to the right arm. When she was 9 years old, she developed similar lesions on her left arm and leg. After she was 13 years old, no new skin lesions appeared. There was no family history of similar lesions. On examination, there were numerous linear and whorled, reddish-brown, hyperkeratotic plaques, with central atrophy and raised borders, following Blaschko's lines on all of the extremities. These lesions on the extremities extended to the dorsum of the hands and feet (Fig. 1). She had hyperkeratotic lesions on the pressure points of both of the soles, but no palm involvement. The number of lesions on the right side was greater than that on the left. Reddish-brown annular plaques with central atrophy and raised borders, appearing in zosteriform configuration, and numerous individual 2-3-mm erythematous lichenoid papules were observed on the right side of the thorax and the right inguinal region (Fig. 2). No face, scalp, or mucous membrane involvement was seen. The nails of the second and fifth fingers of the right hand and the nail of the third finger of the left hand showed nail dystrophy with longitudinal ridges and pterygium. All the nails of the right foot and the nails of the first and fifth toes of the left foot showed dystrophic changes with subungual keratosis. The patient was otherwise in good health. Two biopsy specimens taken from a hyperkeratotic plaque and a lichenoid papule showed an epidermal invagination with angulated parakeratotic tier, denoting cornoid lamella. The epidermis just underneath the cornoid lamella displayed vacuolization and the granular layer was absent. The adjacent epidermis was atrophic, and hydropic degeneration within the basal cell layer was seen. In the dermis, a nonspecific, mild, chronic, inflammatory cell infiltrate, telangiectatic vessels, and pigment-laden macrophages were present. These findings were consistent with linear porokeratosis (Fig. 3). Microscopic examinations and mycologic cultures of the nails were negative. We decided to treat our case systemically with retinoids, but the patient refused this therapy. So, topical tretinoin 0.05% was started once a day. A marked improvement was observed in hyperkeratosis through the first 4 weeks of treatment and plateaued at 8 weeks. After 10 weeks, the lesions had almost disappeared. We planned to continue the applications every other day. One year later, she remains stable with application of topical tretinoin 0.05% twice a week and is satisfied with the final appearance. She is under regular follow-up.     

Unilateral cutaneous emboli of Aspergillus

A 40-year-old white woman with acute nonlymphocytic leukemia, which relapsed despite bone marrow transplantation and various chemotherapeutic regimens, developed fever and neutropenia. Her fever was unresponsive to broad-spectrum antibiotics, and on hospital day 53 she developed purpuric macules with necrotic centers on her left hand and forearm. Frozen sections of lesional skin were stained with Grocott's methenamine-silver and showed hyphae consistent with a species of Aspergillus; culture of the skin biopsy specimen yielded a pure culture of Aspergillus flavus. Localization of the emboli to the left upper extremity was subsequently explained by magnetic resonance imaging scan of the chest demonstrating invasion of the left subclavian artery by a pulmonary aspergilloma.     

Dermatitis artefacta induced in a patient by one of her multiple personalities

A young woman suffered for 5 weeks with an inexplicable, severe dermatitis limited to her left arm. During hospitalization it was found that she had multiple personalities, one of whom had been applying the leaves of the poison ivy plant each night to her left arm, using 'his' gloved right hand. The factitial nature of the dermatitis was further documented by the fact that when the 'responsible personality' was cut off from supplies of poison ivy in the hospital, 'he' produced factitious haematomas by trauma to her left hand. Although this appears to be the first report of dermatitis artefacta associated with the multiple personality disorder, it is suggested that psychiatric study of other dermatitis artefacta patients might reveal the presence of unsuspected occult multiple personalities, responsible for skin lesions that patients cannot explain.     

A case of early onset confluent and reticulated papillomatosis with an unusual localization

Confluent and reticulated papillomatosis is a relatively rare dermatosis of unknown origin. It is characterized by papules that become confluent in the center and reticulated at the periphery. The sites of predilection are the neck, interscapular region, inframammary area and abdomen. In a 15-year-old girl diagnosed with confluent and reticulated papillomatosis, the lesions first appeared on her knees and elbows when she was 4-years-old, and on the interscapular area when she was 13. Similar lesions arose on the left hand a few weeks previous to her visit. Two biopsy specimens were taken from the interscapular and elbow areas. The histopathological findings of this case fit the diagnosis of confluent and reticulated papillomatosis. We expect good results from azithromycin therapy.     

Partial lipodystrophy in a patient with systemic lupus erythematosus

A 54-year-old woman developed partial lipodystrophy on the left side of her face. She had been suffering from systemic lupus erythematosus (SLE) since 1985 when she was 45 years old, and she had been treated with 30 mg/day of oral prednisolone as an initial dose. Partial lipodystrophy appeared on her left lower jaw in 1994 when the SLE was inactive, and the dose of prednisolone was reduced to 5 mg/ 3 days. Gradually, the lipodystrophy spread toward her left cheek and her left forehead without any preceding skin symptoms. Histological examination showed a loss of fat tissue and mild lymphocytic infiltrations mainly around cutaneous appendages and vessels in the dermis and subcutaneous tissue. The dose of prednisolone was increased to 10 mg/day and the lesions stopped spreading. Such partial lipodystrophy is distinct from lipoatrophy of lupus profundus.     

炎性线状疣状表皮痣1家系

先证者女,1岁,左侧上下肢分布红色斑丘疹伴瘙痒1年。患者出生10 d后发现左下肢可见散在分布红色斑丘疹,后逐渐增多至左侧上下肢、会阴部,呈线性分布,伴有明显瘙痒。患者外祖母及母亲均有类似皮疹,无银屑病家族史。体检未见其他异常。皮肤科情况:左足背、足底、左足大拇指、左足第四拇指与第五拇指之间、左侧腘窝、左侧会阴部及腹股沟、左手第四指与第五指之间散在的线状鳞状红斑丘疹,部分指甲受累。左足组织病理示:角化过度伴局灶角化不全,棘皮症,表皮突延长,乳头瘤状增生,真皮浅层及血管周围炎性细胞浸润。诊断:炎性线状疣状表皮痣。患者左足部及左侧腘窝接受手术治疗,术后恢复良好,目前正在随访中。     

威尼克何德霉致儿童掌黑癣2例

例1女,4岁,左手掌心及左手小鱼际肌处棕褐色斑片2年,患儿2年前因"左手掌腱鞘炎手术"后出现掌心及小鱼际肌处棕褐色斑片,无自觉症状,皮损逐渐增大,未予以诊治。例2男,8岁,右手掌心褐色斑片3年。患儿3年前开始出现右手掌心褐色斑片,无明显自觉症状,逐渐增大,未予以治疗。2例患儿皮屑培养分离菌株经分子生物学鉴定为威尼克何德霉。诊断:威尼克何德霉致掌黑癣。     

继发性皮肤浆细胞瘤

报告1例继发于多发性骨髓瘤（multiple myelonm,MM)的皮肤桨细胞瘤，患者女，44岁，皮损为多发性，来源于MM直接蔓延和血行转移，组织病理检查示瘤细胞呈结节状浸润，免疫组化染色结果示IgG阳性表达，患者于皮损出现后78d死亡。