以掌跖角化性丘疹为首发表现的毛囊角化病1例

A Case of Follicular Keratosis Initially Featured by Keratosis Papules on Palmoplantar

患者男,19岁。掌跖白色丘疹6年,头皮、颞部毛囊性丘疹1年余,颈部毛囊性丘疹2个月。家族中无类似疾病患者。皮肤科情况:掌跖点状角化过度,色白,质硬,头皮、颞部、颈部对称性黑褐色油腻性毛囊性坚硬丘疹,均针尖至米粒大小。皮损组织病理:表皮角化过度,灶性角化不全,部分区域可见圆体和谷粒形成,棘层肥厚,呈乳头瘤样增生,棘层松解,基底层上方裂隙形成,裂隙内可见棘突松解细胞,绒毛结构形成,真皮浅层血管周围单一核细胞浸润。诊断:毛囊角化病。

A 19-year-old male presented with a 6-year history of white papulas on palmoplantar, follicular-like papules on scalp and tempus for more than one year, and a 2-month history of follicular-like papules on neck. There were no similar patients in his family. Dermatological examination revealed whitish and hard palmoplantar hyperkeratosis. The dark brown and greasy follicular papules of sizes between needlepoint and rice distributed symmetrically on scalp, tempus and neck. Histopathological examination of lesions showed hyperkeratosis of epidermis and focal parakeratosis. The formation of rounds and grains-like horus could be seen in some sections. Acanthosis, papillomatosis and acantholysis were also observed. There was lacunae formation at the top of the basal lamina with spines release cells and villi structures. Mononuclear cells infiltrated around blood vessels in the superficial dermis. Based on clinical and histopathological manifestation, a diagnosis of follicular keratosis was made.