<link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/css/video-js.min.css?v=1"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/base.css?v=5"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/index.css?v=35"><link rel="stylesheet" href="https://ysz-web.yxj.org.cn/live/dist/static/base/index.css?ysz_v=2.0"><script src="https://studioyszimg.yxj.org.cn/js/dsbridge.js?v=13" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/dsBridge/main.js?v=26" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/base/fun.js?ysz_v=3" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/js/nativeToWeb.js?v=1" type="text/javascript"></script><div id="ysz-header" style="margin:0;overflow:hidden;"><h1 style="font-size:24px;line-height:1.8;color:#333333;word-wrap:break-word;">​暴发性色素性丘疹,会是什么病?| 看图诊断</h1><h2 style="font-size:16px;color:#999999;word-wrap:break-word;"><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">2022-05-14</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">何娟</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">原创:医学界皮肤频道</em></h2></div><p class="brief">看图诊断,快来自测!</p><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">诊断难度:⭐⭐⭐</span></section><section><br/></section><section><section><p style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">病例简介</span></p><p style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;"><br/></span></p></section></section><section><section><section><section><section><section><section><section><section><section><section><section><section></section><section></section><p></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">患者,男,25岁,因臀部及大腿近端多发色素性丘疹3月就诊,无自觉症状。患者有哮喘和特应性皮炎病史,发病前6月因发病部位经常性瘙痒和湿疹而一直外用他克莫司。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">体格检查:全大腿和臀部散在分布粉红色和棕色的圆顶状丘疹和斑点,直径为1~7mm,可达数百个,其余部位未受累(图1)。</span></p><p><br/></p><p style="text-align: center;"><img class="rich_pages wxw-img" data-src="https://mmbiz.qpic.cn/mmbiz_png/YvFeD6T0icibKkNu2j8lrlYDx2fPibXvyv9suOh5kK3VIBAW3jwwEyJdkkXHH6xMPVaCxicp9hAg5Hlg0G5Fk3nvlA/640?wx_fmt=png" src="https://studioyszimg.yxj.org.cn/AC14B1620180BDD1FA5F9B66679A14B6.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; visibility: visible ; width: 262px ;"/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">图1. 临床表现(引自参考文献)</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">实验室检查:风湿免疫相关检查未见异常、淋巴结相关检查正常。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">皮肤镜检查:大多数皮损呈网状,中心颜色较深,周边有一些小球状结构(图2)。</span></p><p><br/></p><p style="text-align: center;"><img class="rich_pages wxw-img" data-src="https://mmbiz.qpic.cn/mmbiz_png/YvFeD6T0icibKkNu2j8lrlYDx2fPibXvyv9G3GKP4xo0hQuuB8ufIibMhegTicmLicX7DmicVCfiaKBxnEW4K09Pa8aBbg/640?wx_fmt=png" src="https://studioyszimg.yxj.org.cn/AC14B1620180BDD1FBEC4DFF09875B25.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 431px ; visibility: visible ;"/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">图2. 皮肤镜表现(引自参考文献)</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">对红色及棕色两种皮疹都进行了组织活检,图3a可见对称且边界清楚的复合型黑素细胞增殖,排列在上皮样细胞巢中;图3b可见表皮内上皮样和梭形的痣细胞巢。</span></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></p><p style="text-align: center;"><img class="rich_pages wxw-img" data-src="https://mmbiz.qpic.cn/mmbiz_png/YvFeD6T0icibKkNu2j8lrlYDx2fPibXvyv9ByKykOAEiaS1VGbST4W24xVED8Rd5at9zbtOgENjOFdjiapV6WHkyvuA/640?wx_fmt=png" src="https://studioyszimg.yxj.org.cn/AC14B1620180BDD1FD140E6F39441C75.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 633px ; visibility: visible ;"/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">图3. 组织病理(HE染色,a.低倍镜,b.高倍镜)(引自参考文献)</span></p></section></section></section></section></section></section></section></section></section></section></section></section><section><br/></section><section><section><section><section><section><section><section><section><section style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">Q:最可能的诊断是什么?</span></section></section></section><section><section><br/></section></section><section><section><section style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">A:</span></section></section><section><p></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">A.&nbsp;发疹黑素细胞痣</span></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">B. 多发性幼年黄色肉芽肿</span></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">C. 播散性Spitz痣</span></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">D. 色素性荨麻疹</span></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">E. 发育不良痣综合征</span></p></section></section></section></section></section></section><section><section><br/></section></section></section></section><section><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; white-space: normal; color: rgb(0, 0, 0); font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; text-align: justify; box-sizing: border-box; -webkit-font-smoothing: antialiased; word-spacing: 1px; background-color: rgb(255, 255, 255);"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; box-sizing: border-box; font-family: PingFangSC, PingFangSC-Regular, &quot;Noto Sans SC&quot;; -webkit-font-smoothing: antialiased;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; box-sizing: border-box; font-family: 微软雅黑; -webkit-font-smoothing: antialiased; background-color: rgb(230, 0, 18); color: rgb(255, 255, 255);">站友们,你们Pick哪一项?欢迎下方留言</span></p></section></section></section></section></section></section><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; white-space: normal; color: rgb(0, 0, 0); font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; text-align: justify; box-sizing: border-box; -webkit-font-smoothing: antialiased; word-spacing: 1px; background-color: rgb(255, 255, 255);"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; box-sizing: border-box; font-family: PingFangSC, PingFangSC-Regular, &quot;Noto Sans SC&quot;; -webkit-font-smoothing: antialiased;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><br/></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><span class="ysz-ueditor-content" style="padding: 0px; margin: 0px; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased; line-height: 28px;">PS:留言“选项+选择理由”,版主将挑选出优质评论三名,奖励医米10-20~</span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><span class="ysz-ueditor-content" style="padding: 0px; margin: 0px; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased; line-height: 28px;">&nbsp;</span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><span class="ysz-ueditor-content" style="padding: 0px; margin: 0px; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased; line-height: 28px;">明晚九点整,我们在下期文末公布正确答案。</span></p></section></section></section></section><section><br/></section></section><section><section><section><section><section><p style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">上期答案</span></p></section><section><p><br/></p><p style="text-align: justify;"><strong><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">诊断:D. 盘状红斑狼疮</span></strong></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">患者青年女性,临床慢性病程,无自觉症状,结合皮肤病理的改变及真皮内大量黏蛋白沉积、基底膜带免疫荧光的特征,可诊断为盘状红斑狼疮(DLE)。予口服羟氯喹和外用0.03%他克莫司治疗3个月后,患者右下眼睑红斑性肿胀明显消退,仅有轻度色素沉着。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">组织学上最重要的鉴别诊断是红斑狼疮或浆细胞浸润症。红斑狼疮通常没有或仅有轻微的局限性表皮改变,如毛囊角栓、角化过度、基底细胞层空泡样变性和表皮基底膜显著增厚。此外,与DLE相比,红斑狼疮或浆细胞浸润症患者的直接免疫荧光检查(DIF)通常为阴性。同时,浆细胞浸润症的浸润主要由T细胞尤其是CD4+细胞形成,而DLE则是B细胞和T细胞的混合,因此免疫组织化学CD20染色阳性支持DLE的诊断。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">当持续性眼睑皮肤病患者对常规治疗无效时,必须考虑将DLE作为鉴别诊断,并建议对DLE进行常规组织病理学检查和DIF检查。</span></p><p><br/></p><section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">上期参考文献:<span class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:18,&quot;id&quot;:0,&quot;title&quot;:&quot;&quot;,&quot;url&quot;:&quot;https://onlinelibrary.wiley.com/doi/10.1111/ijd.15397&quot;}">Wang X, Wang P, Wang M, et al. Discoid lupus erythematosus solely involving the eyelids: case report and literature review. Int J Dermatol. 2021; 60(10): 1190-1198.</span></span></section><section><br/></section><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">上期文章链接:《<span class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:1,&quot;id&quot;:316259,&quot;title&quot;:&quot;右眶周红斑、鳞屑,会是什么病?|看图诊断&quot;}">右眶周红斑、鳞屑,会是什么病?| 看图诊断</span>》</span></p></section></section></section></section></section></section><p><br/></p><p style="padding: 0px; text-align: justify; overflow-wrap: break-word; white-space: normal; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; box-sizing: border-box; -webkit-font-smoothing: antialiased; word-spacing: 1px; background-color: rgb(255, 255, 255);"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; box-sizing: border-box; font-family: PingFangSC, PingFangSC-Regular, &quot;Noto Sans SC&quot;; -webkit-font-smoothing: antialiased;">点击图片即可进入《看图诊断》专栏,查看更多精彩内容~</span></p><p style="padding: 0px; text-align: justify; overflow-wrap: break-word; white-space: normal; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; box-sizing: border-box; -webkit-font-smoothing: antialiased; word-spacing: 1px; background-color: rgb(255, 255, 255);"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; box-sizing: border-box; font-family: PingFangSC, PingFangSC-Regular, &quot;Noto Sans SC&quot;; -webkit-font-smoothing: antialiased;"><br/></span></p><p style="padding: 0px; text-align: center; overflow-wrap: break-word; white-space: normal; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; box-sizing: border-box; -webkit-font-smoothing: antialiased; word-spacing: 1px; background-color: rgb(255, 255, 255);"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; box-sizing: border-box; font-family: PingFangSC, PingFangSC-Regular, &quot;Noto Sans SC&quot;; -webkit-font-smoothing: antialiased;"></span></p><div class="appskip-wrap"><img class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:4,&quot;id&quot;:571,&quot;title&quot;:&quot;皮科看图诊断&quot;}" data-yxjysz="1" src="https://studioyszimg.yxj.org.cn/jbdab94wpcw.png"/><em class="appskip-icon"></em></div><p style="padding: 0px; text-align: center; overflow-wrap: break-word; white-space: normal; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; box-sizing: border-box; -webkit-font-smoothing: antialiased; word-spacing: 1px; background-color: rgb(255, 255, 255);"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; box-sizing: border-box; font-family: PingFangSC, PingFangSC-Regular, &quot;Noto Sans SC&quot;; -webkit-font-smoothing: antialiased;"></span><br/></p><p style="padding: 0px; text-align: center; overflow-wrap: break-word; white-space: normal; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; box-sizing: border-box; -webkit-font-smoothing: antialiased; word-spacing: 1px; background-color: rgb(255, 255, 255);"><img src="https://studioyszimg.yxj.org.cn/mkbefa9o5t.png" data-src="https://studioyszimg.yxj.org.cn/mkbefa9o5t.png" title="" alt="" style="padding: 0px; margin: 0px auto; border: none; width: auto; box-sizing: border-box; font-family: PingFangSC, PingFangSC-Regular, &quot;Noto Sans SC&quot;; -webkit-font-smoothing: antialiased; display: inline;"/></p><!--auditorInfo-->

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