间质性肉芽肿性皮炎

Interstitial granulomatous dermatitis: report of two cases

报告2例间质性肉芽肿性皮炎。例1.男,62岁。因背部暗红斑块5个月,加重2个月就诊。皮肤科检查:躯干、四肢散在大小不等的暗红褐色斑块,部分融合成片,境界清楚,边缘鲜红色,其上覆少许细薄鳞屑,局部皮温高,无压痛,后背最大斑块40 cm×30 cm。例2.男,68岁。因鼻部红斑1年,全身暗红色结节、斑块5个月就诊。皮肤科检查:躯干、四肢散在绿豆至黄豆大丘疹及结节,部分融合成斑块,表面呈肤色、黄红色或暗红色,无压痛。2例患者皮损组织病理检查均示:表皮大致正常,真皮胶原间组织细胞浸润,部分形成多核巨细胞,伴淋巴细胞浸润,免疫组化提示组织细胞CD68呈强阳性,均诊断为间质性肉芽肿性皮炎。例1经中小剂量的甲泼尼龙联合窄谱中波紫外线(UVB)照射,例2经窄谱UVB照射,均取得显著疗效。

Two cases of interstitial granulomatous dermatitis(IGD) are reported. Case 1 was a 62-year-old male who presented with asymptomatic, multiple, irregularly shaped, and erythematous to brown plaques on the back for five months. The lesions had increased in size in the past two months. Dermatological examination showed a large, irregular shaped plaque,measuring in 40 cm×30 cm, with well defined margins, located in the middle of his back. Similar rashes were scattered throughout the abdomen and extremities, especially on the extensor surface of the lower limbs and the back of his hands.Case 2 was a 68-year-old male who presented with a pruritic, sun-exacerbated patch on his nose for 1 year and widespread dark-red nodules/plaques on his chest, back and upper limbs for 5 months. Dermatological examination showed multiple papules and nodules, skin-colored to yellow red or dark red, on his trunk and extremities. Histological examination of both cases showed an unremarkable epidermis and a histiocytic infiltrate mixed with lymphocytes and multinucleated giant cells distributed between collagen bundles in the dermis. Immunohistochemical study revealed the dermal infiltrates were predominantly CD68-positive histiocytes. The clinical and histologic findings confirmed the diagnosis of IGD. The first patient received methylprednisolone combined with narrow-band ultraviolet B phototherapy, and the case 2 patient was treated with narrowband ultraviolet B phototherapy. The treatment for both patients had been shown effective.