糖尿病性硬肿病并发黑棘皮病

Scleredema diabeticorum complicated with acanthosis nigricans

报告1例糖尿病性硬肿病(SD)并发黑棘皮病(AN)。患者男,33岁。褶皱部位皮肤增厚、色素沉着5年,背部皮肤变硬1年。患者有2型糖尿病病史,服用中药控制不佳。皮肤科检查:项部、腋窝、腹股沟可见深褐色色素沉着,皮肤增厚,如天鹅绒样。右背上部一约16 cm×15 cm非凹陷性肿胀、变硬,伴有褐色色素沉着,境界不清。皮损组织病理示表皮角化过度,乳头瘤样增生,基底层色素增加;乳头状突起之间棘层轻度增厚,并充满角质。真皮明显增厚,真皮浅层可见少数噬黑素细胞及轻度血管周围淋巴细胞浸润,真皮深层胶原束肿胀和分离。皮下脂肪被增厚的胶原纤维代替。阿辛蓝染色显示黏蛋白沉积在真皮深部胶原束之间。诊断:SD并发AN。未予患者特殊治疗,约2年随访中皮损无明显变化。

A case of scleredema diabeticorum （SD） complicated with acanthosis uigricans （AN） is reported. A 33-year- old man presented with skin thickening and hyperpigmentation in body folds for 5 years, and skin on his back became hard- ening for 1 year. The patient had a history of type 2 diabetes, and received traditional Chinese medicine with no response. Physical examination revealed dark-brown velvety patches on the nape of the neck, axillae and groins. There was a brown pigmented, non-pitting edematous indurated plaque sized 16cm×15cm, with undefined borders, on the right-upper back. Histopathologieal examination showed epidermal hyperkeratosis, papillomatous proliferation and hyperpigmentation in the basal layer. The valleys between the dermal papillae were mild acanthosis and filled with keratotic materials. The thickened dermis with a few melanophages and slight perivascular lymphocytic infiltrate in the upper dermis were seen. Swollen collagen bun- dles were separated in the deep dermis. The subcutaneous fat was replaced by collagen fibers. Alcian blue staining revealed mucin deposition between the collagen bundles in the deep dermis. The final diagnosis was SD complicated with AN. The patient was given no specific therapy, but skin lesions remained unchanged during about 2 years of follow-up.