持久性豆状角化过度症的临床、病理及免疫组化特征研究

A clinicopathological and immunohistochemical analysis of Hyperkeratosis Lenticulari Perstans

目的:提高对持久性豆状角化过度症的认识,探讨其临床、病理、免疫组化特征及治疗方法。方法:分析1例持久性豆状角化过度症患者的临床、病理、免疫组化特征及治疗方法。结果:本例为19岁的男性患者,因四肢多发性红棕色角化性丘疹8年就诊。皮肤组织病理检查示:表皮显著角化过度,棘层萎缩变薄,真皮乳头层有致密的淋巴细胞带状浸润。免疫组化检查示:真皮浸润的淋巴细胞绝大部分是CD3+T淋巴细胞,CD4+T淋巴细胞明显多于CD8+T淋巴细胞。患者经异维A酸口服及外用治疗1月后,皮损变平,目前该患者还在随访中。结论:持久性豆状角化过度症是一种临床少见的角化性皮肤病,CD4+T细胞介导的免疫反应在HLP的发病中可能起着重要的作用,异维A酸口服及外用治疗该病有效。

Objective： To explore the clinicopathological, immunohistochemical feature and therapeutic methods of hyperkeratosis lenticularis perstans. Methods：Analyze the clinicopathological, immunohistochemical feature and therapeutic methods of a case of hyperkeratosis lenticularis perstans. Results： A 19 - year - old man developed multiple, reddish - brown, hyperkeratotic papules on his upper and lower extremities for 8 years. Histologic examination showed prominent hyperkeratosis overlying a thinned stratum malpighii and a dense band -like lymphoid infiltrate in the underlying papillary dermis. Immunohistochemical examination showed lymphocytic infiltrate was almost composed of CD3 - positive T cells and the number of CD4 - positive T cells was obviously more than that of CDs - positive T cells. Isotretinoin was used both orally and topically and clinical improvement of the skin lesion was noticed after 1 month of treatment. Conclusion： Hyperkeratosis lenticularis perstans is a rare keratoid dermatosis and CD4 - positive T cell - mediated immune reaction may play an important role in the pathogenesis of this disease. Topical and oral isotretinoin is effective in the treatment of hyperkeratosis lenticularis perstans.