疣状肢端角化症的临床及病理特点研究

目的：探讨疣状肢端角化症的临床及病理特点。方法：分析本文及近40年来13篇文献报道的17例肢端角化症先证者的临床及病理资料。结果：发病年龄，10例（59％）〈20岁，7例（41％）〉25岁；有家族史者10例（59％）。皮损主要分布于双手背、足背及前臂、小腿伸侧。皮损表现16例（94％）为扁平疣样损害，1例表现为寻常疣样损害，6例（35％）伴有掌跖角化，5例（29％）伴有指趾甲受累，3例（18％）伴有毛囊角化病。皮损组织病理均表现为表皮明显角化过度、颗粒层及棘层增厚、乳头瘤样增生及塔尖样表皮局限性隆起等特征性变化，无角化不全及空泡化细胞。结论：疣状肢端角化症大部分患者有家族史，常于加岁前发病。皮损主要分布四肢伸侧，基本皮疹为扁平疣样的褐色扁平丘疹。皮损病理显示表皮明显角化过度、乳头瘤样增生及塔尖样表皮局限性隆起等特征性变化，是诊断疣状肢端角化症的主要依据。     

播散性浅表性光线性汗孔角化症21例临床病理分析

目的探讨播散性浅表性光线性汗孔角化症临床和组织病理学特点。方法回顾性分析本科1995年1月～2012年1月间断收治的21例播散性浅表性光线性汗孔角化症患者的临床和组织病理学资料。结果 21例患者中男女比例为1.1∶1(男11例,女10例)。20岁前发病者13例(61.91%),(20～50)岁7例(33.33%),>50岁1例(4.76%),平均发病年龄18.36岁。皮损位于曝光部位,累及面部者10例(47.62%),累及颈部者9例(42.86%),累及上肢者19例(90.48%),累及下肢者7例(33.33%),累及躯干者6例(28.57%)。其中4例有家族史(占19.05%)。3例合并有系统疾病。组织病理资料分析均可见典型的角化不全柱,其下方颗粒层减少或消失。结论播散性浅表性光线性汗孔角化症20岁前发病多见,男女发病率大致相当,皮损位于暴露部位。组织学上以表皮角质层内典型的角化不全柱伴其下方颗粒层减少或消失为特征。     

液氮冷冻与Q开关激光治疗脂溢性角化病的疗效比较

目的：比较液氮冷冻与Q开关激光治疗脂溢性角化病的临床疗效。方法：选取2017年6月至2020年2月间我科就诊的脂溢性角化病患者,随机分为液氮冷冻组和Q开关激光治疗组。结果：共治疗170例患者,其中液氮冷冻组85例245枚皮损痊愈238枚（97.14%）,显效7枚（2.86%）,总有效率为100%,治疗后6个月继发性色素沉着12枚（4.90%）;Q开关激光治疗85例218枚皮损痊愈213枚（97.71%）,显效5枚（2.29%）,总有效率为100%,治疗后6个月继发性色素沉着8枚（3.67%）。两组间痊愈率、总有效率及色素沉着率比较,差异均无统计学意义（均P>0.05）。结论：液氮冷冻与Q开关激光治疗脂溢性角化病的临床疗效相当,均未见明显不良反应。     

204例皮角患者组织病理与临床分析

【摘要】 目的 分析皮角的组织病理与临床特征，探讨两者的相互关系。方法 回顾分析2014年1月至2020年5月在上海市皮肤病医院病理科经临床和组织病理检查确诊的204例皮角患者的临床和组织病理资料。结果 204例患者中，男88例，女116例，年龄（70.47 ± 14.76）岁，病程［M（P25，P75）］为6（6，24）个月。皮角单发201 例，多发3 例，共207个皮角，位于头面颈部163个（78.74%），躯干18个（8.70%），四肢26个（12.56%）。按皮角基底损害组织病理性质分类，良性皮角154个（74.40%），基底病变包括病毒疣129个，脂溢性角化病15个，内翻性毛囊角化病3个，毛鞘瘤皮角5个，化脓性肉芽肿1个和钙化上皮瘤1个；癌前皮角40个（19.32%），基底病变是光线性角化病；恶性皮角13个（6.28%），基底病变包括鲍恩病5个和鳞状细胞癌8个。癌前及恶性皮角患者平均年龄明显高于良性皮角（H = 4.05、3.16，均P < 0.01）。恶性皮角基底宽度大于癌前皮角及良性皮角（H = 2.74、3.49，P < 0.05、0.01），后两者之间差异无统计学意义（H = 0.73，P > 0.05）。癌前及恶性皮角高基比明显低于良性皮角（H = 4.06、3.72，均P < 0.01）。癌前皮角和恶性皮角基底红晕发生率明显高于良性皮角（χ2 = 29.57、6.23，P < 0.01或0.05）。恶性皮角出血结痂发生率明显高于良性皮角（χ2 = 4.89，P < 0.05）。结论 大部分皮角基底是良性病变，以病毒疣为主，癌前和恶性皮角约占1/4。男性、高龄、宽基底、低高基比、基底红晕、出血结痂可以作为早期识别恶性皮角基底的线索。     

应用海姆泊芬光动力疗法治疗鲜红斑痣67例疗效观察

目的 观察应用海姆泊芬光动力疗法（HMME-PDT）治疗鲜红斑痣（PWS）的临床疗效。方法 对临床上确诊为PWS的患者67例,应用HMME-PDT治疗。记录治疗前、治疗后3个月、治疗6个月后不同年龄患者皮损改善情况,包括皮损的面积、皮损颜色及厚度。结果 治疗后6个月,患者治疗总有效率达76.12%,其中1～2岁患者总有效率为89.47%,3～10岁患者总有效率为79.41%,11～14岁患者总有效率为50%;14岁以下患者总有效率为80.70%,14岁以上患者总有效率为50%。治疗后不同年龄阶段患者皮损面积均有明显改善（P<0.05）。结论 应用HMME-PDT治疗PWS疗效较好,且14岁以下患者的总有效率明显高于14岁以上患者。早期治疗非常重要。HMME-PDT的不良反应较少。     

异维A酸治疗毛发红糠疹8例临床分析

毛发红糠疹是以局限性毛囊角化、掌跖角化为特征的慢性皮肤病，该病病因尚不十分清楚，临床上治疗较为困难。本文总结了近2年来收治的8例毛发红糠疹患者的治疗情况，现总结如下。临床资料患者来源：8例毛发红糠疹患者均为本所门诊患者，病史1～5年，平均3．75年。其中男6例，女2例，年龄10～36岁。大部分患者有典型的毛囊性角化丘疹，多发于四肢伸侧，伴有鳞屑性斑片。皮损呈轻度弥漫性增殖性红斑，其中6例有明显的掌跖过度角化。全部患者均经过不同程度的治疗，无明显疗效，所有患     

阴囊汗孔角化病6例

报告6例阴囊汗孔角化病.6例患者发病年龄分布于24～59岁,其中5例发病年龄在24～34岁.临床均表现为阴囊斑块,2例为单发皮疹,4例为多发皮疹,其中1例同时累及阴囊及臀部;临床无症状者2例,伴瘙痒者4例.组织病理均表现为角化过度伴柱状角化不全,角化不全柱下方可见角化不良细胞,棘层增生肥厚;真皮浅层见淋巴细胞、组织细胞...     

靶样含铁血黄素沉积性血管瘤10例临床、组织病理及免疫组化分析

目的：总结靶样含铁血黄素沉积性血管瘤（THH）的临床、组织病理及免疫组化特点。方法：对该院皮肤科门诊2014年1月—2018年12月经临床及组织病理确诊为THH的10例患者的临床、组织病理及免疫组化资料进行回顾性分析。结果：10例THH患者中,男女各5例（50%）,发病年龄9～30岁,平均20.60±6.33岁;其中21～30岁者7例（70%）。发病部位最多见于躯干（7例,70%）,其次为下肢（2例,20%）及上肢（1例,10%）;临床均表现为红黑色丘疹伴外周紫红色晕。临床诊断为血管瘤者最多见（4例,40%）,正确诊断者3例（30%）,另有诊断为色素痣、汗孔瘤及化脓性肉芽肿者（各1例,10%）。皮损组织病理均可见真皮浅层小血管楔形增生、扩张,部分内皮细胞似鞋钉样突向管腔,真皮浅层可见红细胞外溢。免疫组化显示全部患者CD31呈强阳性表达,8例患者（80%）肿瘤胚胎性抗原M2A(D2-40)呈阳性表达,7例患者（70%）血管内皮细胞生长因子受体（VGEFR）-3呈阳性表达,1例患者（10%）CD34呈局灶性、弱阳性表达,仅1例患者抑癌基因Wilms tumor 1(WT-1)呈可疑阳性表达...     

73例女性硬化性苔藓临床及病理分析

 目的:分析73例女性硬化性苔藓患者的临床表现及组织病理特征。方法:回顾性分析本科诊治的73例女性硬化性苔藓患者的临床资料。结果：73例患者中，50岁以上者34例（46.58%），14～50岁者28例（38.36%），小于14岁者11例（15.07%)。皮损好发于外阴部位。基本病理改变为角化过度、基底层空泡变性、真皮浅层水肿，伴胶原均质化透明样变性,其下方常有不同程度的淋巴细胞及组织细胞浸润。结论:临床表现及组织病理学检查为诊断本病的依据，可根据组织病理表现选择相应的治疗。医务人员应加强对早期硬化性苔藓的认识，减少误诊率，并根据疾病时期选择相应的治疗。     

他扎罗汀凝胶治疗三种皮肤病疗效观察

我们于2001年12月至2002年6月,用0.05%他扎罗汀凝胶(重庆华邦制药股份有限公司生产)治疗寻常性斑块状银屑病、寻常痤疮、毛囊周角化病共58例,取得了较满意的临床疗效,现报道如下。一、对象与方法1.病例选择:58例中寻常性斑块状银屑病35例、寻常痤疮10例、毛囊周角化病13例。男38例,女20例;年龄15～71岁;病程6个月至28年。35例银屑病患者皮疹均在四肢及背部,10例痤疮皮疹5例在面部,5例在背部,13例毛囊周角化病皮疹均在四肢。所有患者用药前2周均未使用其他药物,外用他扎罗汀凝胶期间不使用其他药物。2.治疗方法:银屑病及毛囊周角化病患者每晚…     

Dermoscopic changes in melanocytic naevi in children during digital follow-up

The aim of this study was to investigate the dermoscopic changes in acquired melanocytic naevi in a large paediatric population over an interval of several years. Images of 717 melanocytic naevi were obtained from 160 consecutive patients. Dermoscopic pigment pattern changes were observed in one of two lesions after a follow-up of one year, in 34 of 295 lesions (11.5%) after 2 years, in 40 of 190 lesions (21.1%) after 3 years, in 40 of 141 lesions (28.4%) after 4 years, in 5 of 37 lesions (13.5%) after 5 years, in 12 of 31 lesions (38.8%) after 6 years, and in 7 of 21 lesions (33.3%) after 7 years. Dermoscopic changes were detected in 25.3% of the lesions in patients aged 3-6 years, in 21% of the lesions in patients aged 7-12 years, and in 15.5% of the lesions in patients over 13 years. Main pattern changes consisted of transition from globular to globular-reticular (35 naevi), from globular to reticular (14 naevi) and from globular-reticular to reticular (24 naevi). These results are consistent with the view that melanocytic naevi generally undergo a characteristic transition from a globular pattern to a reticular pattern. Most of the changes are observed in the 3-6 years age group when hormonal and/or environmental factors are not thought to play a role in pattern alterations.     

皮肤混合瘤12例

对我院2008年至2020年6月12例皮肤混合瘤患者资料进行回顾性分析。12例患者中男7例,女5例,发病年龄为22~77岁。12例均发生于面部 (上唇部最多见),其中11例表现为单发无自觉症状的淡红色或肤色坚韧肿物,1例因外界因素出现破溃。组织病理示9例向大汗腺分化,3例向小汗腺分化。12例患者中,临床诊断为皮肤混合瘤仅1例,诊断为皮肤纤维瘤和表皮样囊肿的各3例,诊断为钙化上皮瘤、附属器肿瘤和皮角各1例,皮疹待查2例。12例患者均行手术切除,随访2个月~6年,均无复发。     

Reed痣26例临床病理特征分析

【摘要】 目的 分析总结Reed痣的临床病理特点。方法 分析2015年1月至2019年6月于第四军医大学西京皮肤医院确诊的26例Reed痣患者的临床病理特征。结果 男15例,女11例,平均发病年龄17.35岁,中位发病年龄13.85岁。发病部位：下肢12例,面部6例,上肢5例,躯干3例。皮疹颜色均呈黑色,7例为斑疹,19例为扁平丘疹,22例皮疹形态类圆形,4例皮疹形态不规则。皮疹直径2 ~ 10 mm,23例直径 ≤ 5 mm。组织病理：15例为交界痣,11例为混合痣,26例黑素细胞形态均呈梭形,细胞色素明显,4例痣细胞巢与周围表皮融合,22例与周围表皮形成明显的裂隙,均未见明显细胞异型性及有丝分裂象,6例可见Kamino小体。皮损均予手术切除,随访1 ~ 5年无复发。结论 Reed痣皮疹形态可不规则,组织病理可出现呈Paget样分布的大小不一梭形细胞,需与黑素瘤鉴别。     

Histopathology of skin lesions with warty appearance in renal allograft recipients

Warts are common in renal allograft recipients, with a reported incidence of warts ranging from 24% to 100%. These patients also demonstrate an accelerated course from wart to carcinoma. Although the histologic appearance of common warts is predictable in immunocompetent patients, this has not been shown in renal allograft recipients. The purpose of the study was to evaluate the histopathologic findings of warty lesions in renal allograft recipients and to determine the degree of dysplasia or malignant transformation in such lesions. We examined 55 renal allograft recipients for warty lesions. We obtained biopsy specimens from 50 lesions that appeared on clinical examination to be common warts and evaluated their histopathologic features. Median time from transplantation was 49 months (<5 years). All patients were treated with cyclosporine, azathioprine, and prednisolone. Among 55 renal allograft recipients, 17 patients (30.9%) had warty lesions. Forty-seven lesions (94%) showed changes of verruca vulgaris on histologic examination, and only three lesions (6%) showed warts with mild dysplasia. No malignant transformation was reported. Our findings were in contrast to a previous, similar study. This may be attributable to the relatively short period from transplantation to biopsy in our patients.     

Atypical spitzoid melanocytic neoplasms with angiotropism: a potential mechanism of locoregional involvement

Atypical spitzoid melanocytic neoplasms (ASMN) may prove difficult to distinguish microscopically from melanoma, and their biological behavior may be unpredictable. ASMN may result in regional lymph node (LN) metastases and frequent sentinel lymph node (SLN) deposits. Angiotropism and extravascular migratory metastasis may account for locoregional metastases in melanoma and thus may potentially explain such locoregional involvement in ASMN. Nine ASMN with angiotropism from 2006 to 2010 were studied. Angiotropism was defined as melanocytes closely opposed to the external surfaces of microvascular channels without intravasation. There were 5 women and 4 men aged 6-40 (mean 18.7) years with ASMN involving the head and neck (5), the extremities (3), and the trunk (1), and the lesions ranged in diameters from 3.5 to 10 (mean 6.2) mm. Breslow thicknesses ranged from 0.66 to 5.35 (mean 3.21) mm, 5 lesions Clark level IV and 4 level V, and dermal mitotic rates varied from 1 to 5 (mean 2.4) per square millimeter. Despite follow-up of 6 months or less in 4 subjects, 5 patients showed regional tumor spread based on detection of SLN deposits, local recurrence, or clinical satellite and LN metastases. Four of 5 patients (80%) undergoing SLN biopsy showed nodal positivity with 2 SLN deposits of >6 mm. Among 4 patients not having SLN biopsy, 1 patient developed local LN metastases after 2 years. We report for the first time angiotropism in ASMN and suggest that such angiotropism seems to correlate with and may explain regional tumor spread in this neoplastic system.     

Acquired atrophic pigmented band-like lesions following Blaschko's lines]

Over a seventeen years period we observed 5 patients presenting with very similar lesions the equivalent of which we could not find in the literature. These were pigmented and more or less atrophic bands which exactly followed Blaschko's lines. The lesions appeared during childhood or adolescence, between the ages of 6 and 20 years and always were unilateral. In all cases they were located on the trunk where they formed a recumbent "S" pattern characteristic of Blaschko's lines. They often started 3 to 6 cm away from the posterior midline and ended precisely on the anterior midline. These bands varied in number and in 3 out of 5 cases they were associated with pigmented atrophic bands or lines on the limbs of the same side. The intensity of pigmentation and atrophy was variable. The lesions were asymptomatic and only caused a cosmetic prejudice. They were perfectly fixed, and during a 2 to 30 years observation period they remained unmodified. The five skin biopsies performed on 3 patients showed no abnormality of the epidermis other than irregular and moderate hyperpigmentation of its deep part. In the dermis, there was no distinct pigment incontinence, no inflammation and no alteration of connective tissue texture; the elastic network was invariably normal. The impression of skin atrophy was not due to true dermal hypoplasia and perhaps corresponded to atrophy of the subcutaneous cellular tissue. No biological disturbance was observed. These lesions can easily be distinguished from epidermic naevi, incontinentia pigmenti and areas of hypoplastic dermis.(ABSTRACT TRUNCATED AT 250 WORDS)     

葡萄球菌烫伤样皮肤综合征27例临床分析

目的：探讨葡萄球菌烫伤样皮肤综合征发病的影响因素、发病机制、临床表现和治疗。方法：回顾分析1999-2002年住院的27例葡萄球菌烫伤样皮肤综合征患儿临床资料。结果：27例均有典型皮损；18例发病前有明显诱因；5例患儿的皮肤疖肿或脓疱处培养出金黄色葡萄球菌；10例患儿咽拭子培养有6例阳性，为金黄色葡萄球菌；对其中15例作血细菌培养均为阴性；27例经6-15d抗生素治疗均痊愈。结论：葡萄球菌烫伤样皮肤综合征好发于7岁以下的儿童，发病诱因多为感染．皮损主要由毒血症所致；早期采用足量有效的抗生素是治疗成功的关键。     

97例儿童尖锐湿疣基因型检测及临床分析

分析97例（男40例,女57例）儿童尖锐湿疣患者的临床特征和基因型。平均年龄5.57±3.79岁,发病年龄5岁以内者55例,占56.7%,其中男30例,女25例。皮损分布于肛周者29例患者（52.7%）,分布于外阴,合并肛管感染6例。患者多为单一的低危型HPV感染（HPV6型17例,HPV11型13例）。     

Lichen striatus: clinical features and follow-up in 12 patients

Lichen striatus (LS) is an uncommon disease of unknown origin characterised by a linear inflammatory papular eruption with spontaneous regression. We here review a series of 12 consecutive cases of LS. Diagnosis was supported by histological examination. Ten of our 12 patients were children aged 6 months to 12 years. The male gender predominated by 9:3. The lower limb was involved more often than the upper limb and trunk. The duration of the disease until regression ranged from 4 months to 4 years (median, 12 months). Postinflammatory hypopigmentation was noted in 5, and hyperpigmentation in 4 patients. Two patients showed nail involvement (onychodystrophy, longitudinal ridging) which appeared simultaneously with the skin lesions and resolved completely. A personal history of atopic disorders was found in 7 of 12 patients. From this series we can confirm that LS mainly affects children. Both skin and nail lesions disappear completely even if they last longer than one year. Compared with other studies, our series showed differences with regard to sex ratio, predilection sites and after effects.     

Renal biopsy findings in long-term cyclosporin treatment of psoriasis

Renal biopsies were performed in 30 psoriatics during long-term low-dose cyclosporin (CsA) therapy (range 2·5–6 mg/kg per day) of from 6 months to 8 years. The study included pretreatment biopsies in 25 of the patients. After 2 years all biopsies shared features consistent with CsA nephropathy despite completely normal pretreatment morphology in 17 of the 25 patients. The severity of the findings which consisted of arteriolar hyalinosis, focal interstitial fibrosis and sclerotic glomeruli increased with length of therapy. Mild renal lesions were seen durhig the first 2 years. After 4 years all but one had arteriolar hyalinosis. with interstitial fibrosis pronounced in live and moderate in six of 11 patients. At the same time glomerular sclerosis had become significant. A decrease in glomerular filtration rate (GFR) correlated with severity of structural lesions. The data from our study together with experiences from cardiac-transplanted patients treated with CsA indicate that patients with psoriasis after 2 years therapy with CsA should be rotated to other treatments or be followed carefully by GFR and sequential renal biopsies.