临床诊断湿疹患者400例的病理诊断分析

Pathological diagnosis of 400 cases of clinically diagnosed eczema： a retrospective analysis

目的 根据临床诊断为湿疹的患者的病理诊断,分析误诊情况.探讨临床容易误诊为湿疹的皮肤病及容易导致误诊的相关因素.方法 回顾性分析我院皮肤科门诊2006年8月到2013年4月间临床以湿疹为诊断并做组织病理检查的所有病例,收集临床数据,重新阅片确定病理诊断,对获得的资料进行分析.结果 400例临床诊断为湿疹的患者中,110例病理诊断为非湿疹皮炎,占27.5％.误诊病种包括银屑病16例,大疱性类天疱疮13例,扁平苔藓11例,皮肤淀粉样变9例,蕈样肉芽肿8例,恶性肿瘤14例等,其他39例.60 ～ 79岁年龄段及生殖器部位误诊率最高,分别为33.9％和46.2％.结论 湿疹临床上容易误诊,易误诊疾病包括银屑病、大疱性类天疱疮、扁平苔藓、皮肤淀粉样变、蕈样肉芽肿以及皮肤恶性肿瘤等.老年人及生殖器部位误诊率最高,对于此类患者应积极采取皮肤病理检查.

Objective To analyze the pathological diagnosis of patients with clinically diagnosed eczema,to describe the spectrum of skin diseases tending to be misdiagnosed as eczema,and to investigate factors associated with their misdiagnosis.Methods A retrospective study was performed on 400 patients who were clinically diagnosed as eczema and received pathological examination at the dermatology clinic of Peking University Third Hospital from August 2006 to April 2013.Skin biopsy specimens were re-reviewed for these patients,and pathological diagnosis was made in combination with clinical presentations.Results Of the 400 outpatients with clinically diagnosed eczema,110 （27.5％） were finally diagnosed as non-eczema skin diseases pathologically,including 16 cases of psoriasis,13 bullous pemphigoid （BP）,11 lichen planus （LP）,9 cutaneous amyloidosis,8 mycosis fungoides （MF）,14 skin malignancies,and 39 other skin diseases.The highest misdiagnosis rate was observed in people aged 60 to 79 years （33.9％） and lesions at the genital sites （46.2％）.Conclusions Many conditions tend to be misdiagnosed as eczema in clinic,including psoriasis,BP,LP,cutaneous amyloidosis,MF and skin malignancies.Misdiagnosis is rather frequent in elderly people and eczematous lesions in genital areas,and pathological examination should be taken actively for uncertain cases.