光动力联合点阵激光治疗鲍恩病1例  

Bowen′s Disease Treated by Photodynamic Therapy Combing with Carbon Dioxide Fractional Laser:A Case Report

作　　者：房黎亚 史冬梅[2] 高敏虹 王宝林[1] 宫模杰 王抗 FANG Liya;SHI Dongmei;GAO Minhong;Wang Baolin;GONG Mojie;WANG Kang(Department of Dermatology,Zaozhuang Municipal Hospital,Zaozhuang 277100,China;Department of Dermatology,Jining First People′s Hospital,Jining 272000,China;Department of Dermatology,Shandong Provincial Qianfoshan Hospital,the First Hospital Affiliated with Shandong First Medical University,Jinan 250000,China)

机构地区：[1]枣庄市立医院皮肤科,山东枣庄277100 [2]济宁市第一人民医院皮肤科,山东济宁272000 [3]山东第一医科大学第一附属医院(千佛山医院)皮肤科,山东济南250000

出　　处：《皮肤科学通报》2024年第6期666-670,共5页Dermatology Bulletin

基　　金：山东省中医药科技项目(2021M080);济宁市重点研发计划项目(2023YXNS001)。

摘　　要：患者男,78岁,左胫前暗红斑10年余,疼痛3个月。皮肤科查体:左胫前形状不规则暗红色斑块,约8 cm×10 cm大小,境界清楚,表面有黄褐色鳞屑、痂皮。皮肤镜检查示暗红斑上鳞屑、黄痂,褐色色素沉着,多发灶性小球状血管。皮肤病理:皮损部位表皮明显增生,棘层肥厚,可见角化亢进和角化不全。全层表皮细胞具有异型性,主要表现为核大小不一、染色深、有丝分裂像多见;见角化不良细胞。真皮浅层有中等密度的淋巴细胞浸润。诊断:鲍恩病。通过光动力荧光诊断(photodynamic fluorescence diagnosis,PDD)显示区域癌化,给予5-氨基酮戊酸光动力疗法(5-aminolevulinic acid photodynamic therapy,ALA-PDT)联合二氧化碳点阵激光治疗,间隔10天治疗1次,共4次。4次PDT治疗后疼痛完全缓解,皮肤恢复正常,再次行皮肤病理,结果正常。光动力荧光诊断、皮肤镜检查进行长期随访,18个月随访期皮损无复发。A 78-year-old male patient presented with a 10-years of dark erythema on his left anterior tibial region,accompanied by recent pain persisting for the past 3 months.Dermatological examination revealed an irregular dark red plaque with well-defined borders,measuring 8cm×10cm on the left anterior tibia.The surface of the plaque was covered with yellow-brown scales and scabs.Histopathological analysis showed significant epidermal hyperplasia with thickening of spinous layer,exhibiting features of hyperkeratosis and incomplete keratinization.The epidermal cells exhibited cellular atypia across all layers,characterized by variations in nuclear size,intense staining,and frequent mitotic figures,along with the presence of dyskeratotic cells.The epidermis remained intact,with a clear boundary and intact basement membrane.Additionally,there was a moderate-density infiltration of lymphocytes in the superficial layer of the dermis.The boundary between the true epidermis remained clear,with an intact basement membrane.There was a pronounced infiltration of inflammatory cells,predominantly composed of lymphoid tissue cells,in the superficial layer of the dermis.The patient was diagnosed with Bowen′s disease and underwent treatment with a combination of 5-aminolevulinic acid photodynamic therapy(ALA-PDT)and carbon dioxide lattice laser therapy.Prior to treatment with ALA-PDT,photodynamic fluorescence diagnosis(PDD)was utilized to visualize the cancerous region and indirectly assess the degree of lesion.5-aminolevulinic acid photodynamic therapy(ALA-PDT)combined with fractional carbon dioxide laser therapy was administered with 1 treatment at an interval of 10 days,for a total of 4 treatments.After 4 PDT treatments,the pain was completely relieved,the skin returned to normal,and the histopathological analysis was re-examined,and the results were normal.Photodynamic fluorescence diagnosis and dermoscopy were followed up for a long time,and there was no recurrence of skin lesions during the 18-month follow-up period.

关 键 词：鲍恩病 5-氨基酮戊酸光动力疗法 二氧化碳点阵激光 皮肤镜 光动力诊断 

分 类 号：R739[医药卫生—肿瘤]