大疱性出血性硬化萎缩性苔藓1例

A Case of Bullous Hemorrhagic Lichen Sclerosus et Atrophicus

患者男,33岁。右侧躯干外侧皮肤硬化、萎缩斑2年,起水疱、血疱1个月。体检:右侧躯干外侧可见约12cm×10cm大萎缩性斑片,皮肤皱缩呈"羊皮纸样",周围呈淡红色,中心呈瓷白色;皮疹下部可见约7cm×5cm大环形血疱,呈椭圆形,尼氏征阴性。皮损组织病理示:角化过度,表皮萎缩,灶性基底细胞空疱变性,表皮下大疱形成,疱内较多红细胞;真皮浅层胶原均质化改变,并见带状淋巴组织细胞浸润。诊断:大疱性出血性硬化萎缩性苔藓。

A 33-year-old male presented with the skin sclerosis and maculae atrophicae on his right lateral trunk for two years. Hemorrhagic bullae was found one month ago. Clinical examination showed a parchmentlike maculae atrophicae on his right lateral trunk, 12cm × 10cm in size, periphery of skin lesion was reddish, center was porcelain-white colored. Lower part of it presented with an annular and elliptical hemorrhagic bullae,7cm × 5cm in size, the nikolsky sign of hemorrhagic bullae was negative. The histopathologic examination showed hyperkeratosis,liquefaction of basal cells and atrophy of the epidermis. Subepidermis blister in which there were lots of erythrocytes was formed. The upper dermis showed collagen sclerosis and a band-like infiltration of lymphocytes and histocytes. Bullous hemorrhagic lichen sclerosus et atrophicus was diagnosed.