环状肉芽肿81例临床及组织病理分析

Clinical and Pathological Analysis of 81 Cases of Granuloma Annulare

目的了解局限型和泛发型环状肉芽肿临床特点、组织学改变及治疗转归情况。方法回顾性分析2010年1月-2016年12月本科收治的81例皮肤环状肉芽肿患者临床资料。结果局限型环状肉芽肿41例,泛发型环状肉芽肿38例(泛发环形21例,播散丘疹型14例,非典型泛发型3例),皮下型1例,穿通型1例。组织病理改变以栅状肉芽肿多见(占69.14%),散在性组织细胞浸润仅占29.63%,上皮样结节型占1.23%。局限型以避光、局部外用糖皮质激素、冷冻等局部治疗为主,泛发型以系统性治疗为主,如糖皮质激素、复方甘草酸苷片、米诺环素、烟酰胺、雷公藤多苷片、羟氯喹、甲氨蝶呤、维甲酸类和窄谱中波紫外线(NB-UVB)照射均可取得满意疗效,但部分患者停药后皮损易复发。结论泛发型环状肉芽肿成人多发,组织病理学改变以栅状肉芽肿最为多见。局限型以局部治疗为主,泛发型以系统治疗为主。

Objective To study the clinical features,histopathological changes and treatment in patients with localized and generalized granuloma annulare（GA）.Methods We retrospectively analyzed the clinical data of 81 cases of GA who visited our department between January, 2010 and December, 2016. Results Forty-one cases were localized GA, and 38 cases were generalized GA, including 21 cases of generalized granular GA, 14 cases of disseminated popular GA and 3 cases of atypical generalized GA. Subcutaneous and perforating GA were 1 case each. The histopathological changes included palisading granuloma（69.14% ）,scattered histiocytic infiltration（ 29.63%）, and epithelioid nodules（ 1.23%）.Main therapies for localized GA were avoidance of ultraviolet light,topical steroids and cryotherapy while effective treatments for generalized GA included systemic corticosteroids, compound glycyrrhizin tablets, minocyline,nicotinamide, tripterygium glycosides, hydroxychloroquine, methotrexate, tretinoin and NB-UVB. Relapse could occur in some cases after discontinuation of treatment. Conclusion Majority of generalized GA occur in adults. The histopathological changes vary though palisading granuloma is the most common pattern.Topical therapy is effective for localized GA,and systemic therapy is mainly used for generalized GA.