儿童模拟血管炎样人工皮炎2例病例报告

2 cases of dermatitis artefacta mimicking cutaneous vasculitis: A case report

目的 总结2例儿童模拟血管炎样人工皮炎(DA)的临床资料,提高对该病的认识。方法 收集2例患儿门诊和住院病史资料,包括就诊过程、临床特点、相关实验室检查、病理资料等,并行文献复习。结果 男女各1例,起病年龄为9岁和10岁。2例均在不同医院多次就诊,频繁、重复检查。均表现为双侧上肢、手或颈部紫癜样皮疹,形态各异,压之不褪色,与正常皮肤分界清楚,对称性分布于双手及口可触及的范围。1例伴鼻腔出血,1例伴皮肤疼痛、头痛、头晕。皮肤损害与实验室检查结果无关联性,其中1例皮肤活检病理发现异物,对药物治疗无反应。患儿均极力否认皮肤损伤是自我造成的。结论 DA在儿童中罕见,皮肤损害表现虽无特异性,与正常皮肤分界清楚,分布于双手及口可触及的范围,皮肤活检发现异物有助于疾病诊断,DA患儿需重视其潜在的精神心理问题,多学科协作有助于DA诊断和管理。

Objective To summarize the clinical data of 2 children with simulated vasculitis like artificial dermatitis(DA) and improve the understanding of the disease.Methods The outpatient and inpatient medical history data of 2 patients were collected, including treatment process, clinical characteristics, relevant laboratory examination and pathological data, and the literature was reviewed. Results There were 2 patients, 1 male and 1 female. The onset age was 9 and 10 years old respectively. Two patients underwent frequent and repeated examinations at different hospitals. The shape of skin injury was nonspecific, the boundary with normal skin was clear, and it was distributed in the accessible range of both hands and mouth symmetrically.There was no correlation between skin damage and laboratory examination results.Foreign bodies were found in 1 case by skin biopsypathology, and there was no response to drug treatment. Patients denied that skin damage was self-caused.Conclusion Artificial dermatitis is rare in children. Although the manifestations of skin damage are nonspecific, they are clearly separated from normal skin and distributed in the accessible range of hands and mouth. The discovery of foreign bodies by skin biopsy is helpful to the diagnosis of the disease. Attention should be paid to the potential mental and psychological problems of children with DA. Multidisciplinary collaboration contributes to the diagnosis and management.