播散型环状肉芽肿四例临床病理特点与治疗研究及文献回顾  

Clinical and pathological study of 4 cases of generalized granuloma annulare and literature review

作　　者：狄梅[1] 褚小玲[1] 

机构地区：[1]首都医科大学附属北京安贞医院皮肤性病科,100029

出　　处：《中国医药》2014年第7期1075-1079,共5页China Medicine

摘　　要：目的探讨播散型环状肉芽肿（GGA）的临床表现、组织病理特征、治疗方法及预后。方法对4例GGA的临床表现、组织病理改变、治疗方法及预后进行回顾性研究，并对近年GGA的国内外文献进行了回顾。结果4例患者，男女各2例，年龄42～72岁，以全身丘疹为主诉就诊。病程3个月至1年不等。3例曾误诊。4例GGA表现为躯干、四肢及颈部泛发肤色或红色丘疹、斑丘疹，部分损害中央可见脐凹，边缘呈环状。3例组织病理检查均示真皮浅中层胶原黏液变性，周围淋巴细胞、组织细胞呈栅状排列。1例示真皮浅中层胶原排列紊乱，胶原轻度变性，胶原束间可见散在分布的淋巴细胞、组织细胞及少量多核巨细胞。4例患者均接受了糖皮质激素制剂局部治疗，系统治疗分别为抗组胺药物、糖皮质激素、羟氯喹、异维A酸及补骨脂素紫外线疗法治疗。患者治疗后根据用药及患者治疗反应情况，不定期随诊。根据皮损数量和瘙痒程度变化判断疗效。随访6～35个月，平均随访（26±14）个月。2例患者治愈，随访2年无复发，1例有效，1例无效。结论GGA相对少见，容易误诊，临床需要注意寻找脐凹样或环状损害改变的特征性表现。组织病理特征为栅状肉芽肿或弥漫性淋巴组织细胞浸润伴胶原变性。 糖皮质激素、羟氯喹治疗及光化学疗法治疗有一定疗效。ObjectiveTo investigate the clinical and pathological features of generalized granuloma annulare. MethodsRetrospective study on clinical manifestations, histopathological changes,treatment and prognosis of 4 cases of generalized granuloma annulare was performed. ResultsFour patients included two males and two females with the chief complaint of disseminated papules, arciform and annular appearance. The eruption was distributed to extremities, neck and trunk. Duration was from 3 months to 1 year. Histopathology of 3 cases showed degenerated collagen surrounded by lymphocytes with histocytes in middle dermis. Another case showed disorder of collagen with sparsely arranged lymphocytes, histocytes and a few multinucleated cells. The degeneration of collagen was very mild. All patients received topical cortisone treatment. Systemic treatments were as follows： antihistamine medicine, cortisone, chloroquine, isotretinoin and photochemotherapy （psoralen ＋ultraviolet A, PUVA）. The patients were followed irregularly according to treatment and the response to the treatment. Efficiency of treatment was evaluated by the change of lesions and pruritus. Followup was 635 months with average （26±14） months. 2 patients were cured without recurrence for more than 2 years. One patient was improved. The last patient was failed to treatment with eruptions developed. ConclusionsGeneralized granuloma annulare is not a common diseases and easy to be misdiagnosed. Typical clinical features are arciform and annular papules or plaques. Histopathology shows palisadic granulama or interstitial infiltrate of histocytes and lymphocyte with collagen degenerated. Some cases response to cortisone, chloroquine and PUVA.

关 键 词：肉芽肿 环状 播散型 

分 类 号：R756.2[医药卫生—皮肤病学与性病学]