颗粒状角化不全一例

Granular parakeratosis： a ease report

患者女，31岁，左腋窝红斑、糜烂、痒23年。体检：左腋下可见近环形红色斑片，约8cm×10cm，皮损中央淡紫红色粟粒大棘状丘疹，不完全融合形成斑块，皮损外周红斑表面轻度糜烂、渗液，散在少量米粒大脓疱，部分区域可见瘢痕；全身其他间擦部位未见任何皮损。皮损表面分泌物真菌镜检阴性。组织病理：角质层增厚，角化过度并显著角化不全，角质层大多数细胞保留细胞核，包含大量嗜碱性颗粒。角化不全下方颗粒层仍然保留，其中少部分细胞胞质呈空泡状。表皮呈银屑病样增生，真皮内血管周围以淋巴细胞为主的混合炎症浸润，并可见明显血管扩张。诊断：颗粒状角化不全。

A case of granular parakeratosis is reported. A 31-year-old woman presented with a 23-year history of pruritic erythema and erosion in the left axilla. On examination, there was a ring-like annular erythematous patch sized 8 cm×10 cm in the left axilla. Bright mauve, cone-shaped, millet-like papules were observed in the center of the lesion, some confluenced into plaques. Erythema was present in the perilesional region along with mild erosion, exudation and small numbers of grain-sized pustules. Scar formed in some perilesional areas. No lesions were noted at any other intertriginous regions. Fungal microscopy of lesion secretions was negative. Histological examination of biopsy specimens from the center of the left axilla revealed psoriasiform hyperplasia of epidermis and thickened stratum corneum with hyperk- eratosis and parakeratosis. Most cells in the stratum comeum retained nuclei and contained numerous basophilic granules. Granular layer could be noted under the parakeratotic cells with cytoplasm vacuolization of some cells. There was a perivascular, mixed inflammatory infiltration predominated by lymphocytes and hemangiectasis in the dermis. A diagnosis of granular parakeratosis was made.