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NEJM：光化性肉芽肿-案例报道

2017-02-12 xing.T MedSci原创

光化性肉芽肿肉芽肿反应
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光化性肉芽肿是一种无症状性肉芽肿反应，并可以影响到受太阳暴露的皮肤，通常是在面部、颈部和头皮。它的特点是环状或多环的病变，并且可以慢慢地呈现离心性扩大，有红色增高的边缘和色素减退伴萎缩的中心。

患者为一名50岁的女性，因其额头（如图A所示）和双手手背（如图B和C所示）上出现无症状皮肤病变18个月而就诊。


这些皮损病灶边界清楚，为红色环形斑块，边界稍高并且中心略有萎缩。随着时间的推移，该患者病灶的数量逐渐增加，并且慢慢呈现离心性扩张。

皮肤活检显示淋巴组织多核巨细胞浸润，周围存在日光性弹性组织变性，并且没有明显的栅栏状排列、坏死或粘蛋白沉积。肉芽肿部位可以明显观察到弹性纤维碎片和偶尔被巨细胞吞噬弹性蛋白，这些发现支持光化性肉芽肿的诊断。

光化性肉芽肿是一种无症状性肉芽肿反应，并可以影响到受太阳暴露的皮肤，通常是在面部、颈部和头皮。它的特点是环状或多环的病变，并且可以慢慢地呈现离心性扩大，有红色增高的边缘和色素减退伴萎缩的中心。

该患者被建议减少暴露在阳光下，并使用防晒霜。用卤米松乳膏治疗双手手背，以及用吡美莫司乳膏开始治疗额头；治疗2个月后，出现了部分疗效。

原始出处：

Dong-Lai Ma,,et al. Actinic Granuloma. N Engl J Med 2017; 376:475February 2, 2017.DOI: 10.1056/NEJMicm1600384

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  1. [GetPortalCommentsPageByObjectIdResponse(id=177520, encodeId=98001e7520f3, content=很典型又有特点的病例！, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLC1BMzZWdMSPQWuib6BtQGicK8ygGBM6YakpfkRc67soFSuKbZr86enL1KggQZEZbgWSeicJibafmYfQ3AibicIHMwwicmDShfRFvvI38/0, createdBy=272a110164, createdName=laoli, createdTime=Thu Feb 23 04:49:34 CST 2017, time=2017-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176046, encodeId=b0171e6046dc, content=非常好的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Tue Feb 14 08:29:17 CST 2017, time=2017-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344744, encodeId=04ff1344e44f8, content=<a href='/topic/show?id=0e98808e9f9' target=_blank style='color:#2F92EE;'>#肉芽肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80879, encryptionId=0e98808e9f9, topicName=肉芽肿)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=09a12500213, createdName=12498f1em08(暂无昵称), createdTime=Tue Feb 14 02:47:00 CST 2017, time=2017-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175791, encodeId=069f1e5791e3, content=没有治疗后的照片么, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRhMvhh5icA01VlaGzCZQ0VOzgHK4JVfic4aufJ9ic3NibwHq6QCpLFptGLWLOyZms63YicPa1vgcuVlT2/0, createdBy=b3172018021, createdName=Dr.赵, createdTime=Sun Feb 12 20:16:34 CST 2017, time=2017-02-12, status=1, ipAttribution=)]
    2017-02-23 laoli

    很典型又有特点的病例！

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=177520, encodeId=98001e7520f3, content=很典型又有特点的病例！, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLC1BMzZWdMSPQWuib6BtQGicK8ygGBM6YakpfkRc67soFSuKbZr86enL1KggQZEZbgWSeicJibafmYfQ3AibicIHMwwicmDShfRFvvI38/0, createdBy=272a110164, createdName=laoli, createdTime=Thu Feb 23 04:49:34 CST 2017, time=2017-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176046, encodeId=b0171e6046dc, content=非常好的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Tue Feb 14 08:29:17 CST 2017, time=2017-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344744, encodeId=04ff1344e44f8, content=<a href='/topic/show?id=0e98808e9f9' target=_blank style='color:#2F92EE;'>#肉芽肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80879, encryptionId=0e98808e9f9, topicName=肉芽肿)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=09a12500213, createdName=12498f1em08(暂无昵称), createdTime=Tue Feb 14 02:47:00 CST 2017, time=2017-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175791, encodeId=069f1e5791e3, content=没有治疗后的照片么, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRhMvhh5icA01VlaGzCZQ0VOzgHK4JVfic4aufJ9ic3NibwHq6QCpLFptGLWLOyZms63YicPa1vgcuVlT2/0, createdBy=b3172018021, createdName=Dr.赵, createdTime=Sun Feb 12 20:16:34 CST 2017, time=2017-02-12, status=1, ipAttribution=)]
    2017-02-14 天涯183

    非常好的文章

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=177520, encodeId=98001e7520f3, content=很典型又有特点的病例！, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLC1BMzZWdMSPQWuib6BtQGicK8ygGBM6YakpfkRc67soFSuKbZr86enL1KggQZEZbgWSeicJibafmYfQ3AibicIHMwwicmDShfRFvvI38/0, createdBy=272a110164, createdName=laoli, createdTime=Thu Feb 23 04:49:34 CST 2017, time=2017-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176046, encodeId=b0171e6046dc, content=非常好的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Tue Feb 14 08:29:17 CST 2017, time=2017-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344744, encodeId=04ff1344e44f8, content=<a href='/topic/show?id=0e98808e9f9' target=_blank style='color:#2F92EE;'>#肉芽肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80879, encryptionId=0e98808e9f9, topicName=肉芽肿)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=09a12500213, createdName=12498f1em08(暂无昵称), createdTime=Tue Feb 14 02:47:00 CST 2017, time=2017-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175791, encodeId=069f1e5791e3, content=没有治疗后的照片么, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRhMvhh5icA01VlaGzCZQ0VOzgHK4JVfic4aufJ9ic3NibwHq6QCpLFptGLWLOyZms63YicPa1vgcuVlT2/0, createdBy=b3172018021, createdName=Dr.赵, createdTime=Sun Feb 12 20:16:34 CST 2017, time=2017-02-12, status=1, ipAttribution=)]
    2017-02-14 12498f1em08(暂无昵称)

    #肉芽肿#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=177520, encodeId=98001e7520f3, content=很典型又有特点的病例！, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLC1BMzZWdMSPQWuib6BtQGicK8ygGBM6YakpfkRc67soFSuKbZr86enL1KggQZEZbgWSeicJibafmYfQ3AibicIHMwwicmDShfRFvvI38/0, createdBy=272a110164, createdName=laoli, createdTime=Thu Feb 23 04:49:34 CST 2017, time=2017-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176046, encodeId=b0171e6046dc, content=非常好的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Tue Feb 14 08:29:17 CST 2017, time=2017-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344744, encodeId=04ff1344e44f8, content=<a href='/topic/show?id=0e98808e9f9' target=_blank style='color:#2F92EE;'>#肉芽肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80879, encryptionId=0e98808e9f9, topicName=肉芽肿)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=09a12500213, createdName=12498f1em08(暂无昵称), createdTime=Tue Feb 14 02:47:00 CST 2017, time=2017-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175791, encodeId=069f1e5791e3, content=没有治疗后的照片么, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRhMvhh5icA01VlaGzCZQ0VOzgHK4JVfic4aufJ9ic3NibwHq6QCpLFptGLWLOyZms63YicPa1vgcuVlT2/0, createdBy=b3172018021, createdName=Dr.赵, createdTime=Sun Feb 12 20:16:34 CST 2017, time=2017-02-12, status=1, ipAttribution=)]
    2017-02-12 Dr.赵

    没有治疗后的照片么

    0