获得性反应性穿通性胶原病1例

患者男,50岁,躯干、四肢丘疹、结节伴痒6个月,加重半月。皮肤科情况:躯干、四肢多发绿豆至黄豆大小红丘疹,表面抓痕、结痂,双肘部散在、暗红色蚕豆大小结节,中等硬度,大部顶端见溃疡,中央有脐凹;皮损组织病理示:HE染色见杯状下陷表皮,内含大量破碎角质、中性粒细胞及变性胶原纤维,见断裂、卷曲的胶原纤维束垂直从表皮穿过;真皮浅层见中性粒细胞、淋巴细胞浸润。Masson染色可见蓝染破碎、变性胶原纤维穿出表皮,穿透部位弹力纤维染色阴性。诊断:获得性反应性穿通性胶原病。

A Case of Acquired Reactive Perforating Collagenosis

A 50-year-old male presented with itchy papules and nodules over trunk and limbs for six months,with aggravation for half a month.Dermatological examination showed multiple red papules and nodules,approximately the size of a mung bean or soybean with surface scratches and scabs,located on the trunk and limbs.There were scattered dark-red bean-sized nodules on the elbows with moderate firm.Lesions appeared central umbilication with keratotic plug.Some lesions were ulcerated;Histopathological examination revealed curly and broken collagen bundles eliminated vertically through a cup-shaped crater in epidermis,over degenerative collagen and leucocye patches;other histological features included lymphocytic and neutrophil infiltrates in the upper dermis,denaturation and irregular arrangement of collagen fibers.Masson staining showed that blue stained broken and denatured collagen fibers penetrated out of the epidermis,but elastic fibers were negative.The classical presentation is that of a solitary discrete,round to oval,flesh-colored umbilicated nodule with a central keratin-filled crater umbilicated nodule with a central keratin.The diagnosis of acquired reactive perforating collagenosis was made.