亚急性皮肤型红斑狼疮误诊为寻常型银屑病1例  

Subacute cutaneous lupus erythematosus misdiagnosed as psoriasis vulgaris:a case report

作　　者：刘承灵 邓涵杰 温海宇 汪俊芳 叶竞辉 杨扬 王丹 张海鹏 杨卫兵 李欣 LIU Chenging;DENG Hanjie;WEN Haiyu;WANG Junfang;YE Jinghui;YANG Yang;WANG Dan;ZHANG Haipeng;YANG Weibing;LI Xin(Department of Dermatology,924th Hospital of the PLA Joint Logistic Support Force(924th Hospital),Guilin 541000,China)

机构地区：[1]中国人民解放军联勤保障部队第九二四医院皮肤科,桂林541000 [2]中国人民解放军联勤保障部队第九二四医院病理科

出　　处：《实用皮肤病学杂志》2024年第6期382-385,共4页Journal of Practical Dermatology

基　　金：广西壮族自治区卫生健康委自筹经费科研课题(ZC20231103);广西壮族自治区临床重点专科建设项目。

摘　　要：报道1例亚急性皮肤型红斑狼疮误诊为寻常型银屑病。患者女,75岁。躯干、四肢出现鳞屑性红斑和丘疹,伴片状脱发1年余。体格检查:头面部、躯干、四肢可见广泛散在分布甲片大小的红斑、红斑内可见毛囊性丘疹,红斑表面覆有轻薄鳞屑,头皮局部红斑轻度浸润,部分皮损表面可见抓破后的渗血、结痴,表面少量脱屑,无明显渗液、触痛。曾误诊为寻常型银屑病,予以外用糖皮质激素软膏,以及窄谱中波紫外线照射等治疗,效果不佳,持续脱发。经皮肤镜检查和组织病理检查,最终诊断为亚急性皮肤型红斑狼疮。予以硫酸羟氯喹0.2 g每日2次口服,白芍总苷胶囊0.6 g每日3次口服,醋酸泼尼松龙片30 mg每日1次口服(疗程1个月),外用卤米松乳膏每日2次。3个月后随访,躯干鳞屑性红斑大部分消退,遗留少部分色素沉着,原有脱发部位已长出新发。A case of subacute cutaneous lupus erythematosus was reported.A 75-year-old femalepatient presented withscaly erythematous plaques and papules on her trunk and limbs,accompanied by flaky alopecia for over a year.Physical examination revealed widely scattered,erythematous plaques,approximately the size of a fingernail,on the head,face,trunk,and limbs.These plaques contained follicular papules and were covered with thin,light scales.Mild erythematous infiltration was noted on the scalp,with some lesions showing post-scratching blood oozing,crusting,and minimal scale shedding,without obvious exudation or tenderness.The patient was misdiagnosed as psoriasis vulgaris.Limited affection was observed with topical glucocorticoids and NB-UVB therapy.Dermatoscopic examination and histopathological analysis led to a final diagnosis of subacute cutaneous lupus erythematosus.The patient was treated with hydroxychloroquine sulfate 0.2 g twice daily,total glucosides of paeony 0.6 g three times daily,and prednisone acetate 30 mg once daily for 1 month.Topical halometasone cream was applied twice daily.Three months later,follow-up examination showed significant resolution of the scaly erythematous plaques on the trunk,with a small amount of pigmentation remaining,and new hair had grown in the areas of hair loss.

关 键 词：皮肤型红斑狼疮 亚急性 银屑病 寻常性 误诊 

分 类 号：R593.24[医药卫生—内科学]