获得性反应性穿通性胶原病

A case of acquired reactive perforating collagenosis

报告1例获得性反应性穿通性胶原病。患者女,44岁。全身红斑、斑丘疹及溃疡半年,进行性加重3个月,伴痒痛感。皮肤科检查:胸部、背部及双小腿散在黄豆至蚕豆大红斑和结节,中等硬度,部分皮损破溃,中央出现脐凹伴溃疡,并可见白色角质样物质排出;外阴中度水肿,表面可见糜烂。背部皮损组织病理检查:局部表皮缺失形成浅层溃疡,溃疡基底内可见大量胶原纤维,有外排现象,溃疡内大量中性粒细胞及坏死组织;真皮浅层炎性细胞浸润,以淋巴细胞及组织细胞为主,血管增生较明显,溃疡下方胶原破坏,排列不规则。Masson染色示变性的胶原纤维从表皮穿出。诊断:获得性反应性穿通性胶原病。

A case of acquired reactive perforating collagenous is reported. A 44-year-old female presented with itchy and painful erythemas, macular papules and ulcers over the entire body for half years, with aggravation for 3 months. Dermatological examination showed a number of moderate firm erythemas and nodules sized from soybean to broad bean on the chest, back and lower limbs. Lesions appeared central umbilication with keratotie plug. Some lesions were ulcerated. The vulva was moderate edema with surface erosion. Histopathological examination revealed epidermal ulcers with a large number of neutrophils and necro sis, and extrusion of collagen fibers. Other histological features included lymphocytic and histiocytic infiltrates in the upper dermis, vascular hyperplasia, denaturation and irregular arrangement of collagen fibers. Masson staining revealed the transepidermal elimination of denatured collagen bundles. The diagnosis of acquired reactive perforating collagenosis was made.