儿童孪生兄弟同患颜面播散性粟粒性狼疮并文献回顾

Lupus Miliaris Disseminatus Faciei in Twin Brothers: a Case Report and Literature Review

患儿男,9岁。面部多发丘疹半年,其同卵双生哥哥面部出现相同皮疹3个月。皮肤科情况:面部、腋部多发红色圆顶小丘疹,密集分布。皮损组织病理示:真皮中下层毛囊皮脂腺周围有大量的淋巴细胞、组织细胞形成肉芽肿样损害,可见干酪样坏死形成,切片中可见到大量中性粒细胞聚集形成的脓肿。诊断为颜面播散性粟粒性狼疮。给予甲泼尼龙片和米诺环素口服,2周后,明显好转。回顾文献分析本病可能发病机制为毛囊皮脂腺单位破坏形成肉芽肿性反应,治疗可采用抗生素如米诺环素或者甲硝唑联合他克莫司外用治疗。

Two 9-year-old twin brothers presented with a 3 to 6- month history of asymptomatic papules. These skin eruptions initially appeared on eyelids and subsequently spread over faces and axillae. Histopathological examination revealed a granulomatous inflammation surrounding hair follicles and sebaceous glands in the deep dermis. Neutrophilic abscess was observed in the center of the biopsy. There were several patches of caseous necrosis in the center of the granuloma. They were diagnosed as lupus miliaris disseminatus faciei（LMDF）. After treated with methylprednisolone and minocycline for two weeks,the papules diminished significantly. In the literatures,the pathogenesis of granuloma was associated with the inflammation and destruction of pilosebaceous units. Combination regimen of oral antibiotics and topical tacrolimus was effective in some cases.