典型表現(xiàn)為鱗屑性環(huán)狀紅斑塊,邊緣有膿皰(見圖 6),嚴(yán)重者出現(xiàn)多發(fā)的毛囊性丘疹和重度炎癥反應(yīng)。有時(shí)經(jīng)不適當(dāng)?shù)赝馔刻瞧べ|(zhì)激素治療后皮損變得不典型,稱為難辨認(rèn)癬??捎叙W感,熱時(shí)明顯,真菌學(xué)檢查陽(yáng)性。 圖 6. 面癬:可見環(huán)狀斑塊炎性斑塊和毛囊性膿皰(來(lái)源:Turra N 等 2019)
8. 紅斑狼瘡
面部蝶形紅斑是系統(tǒng)性紅斑狼瘡特征性皮損,也可累及全面部,表現(xiàn)為境界清楚的融合性紅斑,略有腫脹,表面有少許脫屑(見圖 7),有時(shí)可出現(xiàn)糜爛和結(jié)痂?;颊呤直?、指背和頸部 V 形區(qū)也可見紫紅色丘疹和斑塊,掌紅斑常見,特別是指尖。 圖 7. 系統(tǒng)性紅斑狼瘡的蝶形紅斑(來(lái)源:Wolff K 等 2013)
9. 面部肉芽腫
表現(xiàn)為單個(gè)或多發(fā)性紅褐色至紫色結(jié)節(jié)或斑塊,表面光滑,常伴毛細(xì)血管擴(kuò)張(見圖 8),無(wú)癥狀,呈慢性病程,病理特征為真皮內(nèi)以中性粒細(xì)胞和嗜酸性粒細(xì)胞為主的浸潤(rùn),有境界帶,可見白細(xì)胞碎裂性血管炎。 圖 8. 面部肉芽腫:右頰紅色浸潤(rùn)性斑塊,毛囊口擴(kuò)大呈假橘皮樣外觀(來(lái)源:Teixeira DA 等 2013)
10. 嗜酸性膿皰性毛囊炎
嗜酸性膿皰性毛囊炎也稱為 Ofuji 病,表現(xiàn)為反復(fù)發(fā)作的瘙癢性毛囊性丘疹和無(wú)菌性膿皰,形成境界清楚的斑塊,斑塊中央消退、邊緣擴(kuò)展呈環(huán)狀(見圖 9),病理特征為嗜酸性粒細(xì)胞親毛囊性浸潤(rùn)。 圖 9. 嗜酸性膿皰性毛囊炎(來(lái)源:Chen JF 等 2011)參考文獻(xiàn)[1] Turra N, Navarrete J, Magliano J, et al. Follicular tinea faciei incognito: the perfect simulator. Anais Brasikeiros de Dermatologia, 2019, 94(3):372-374.[2] Gallo RL, Granstein RD, Kang S, et al. Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol, 2018, 78(1):148-155.[3] Wikramanayake TC, Broda LJ, Miteva M, et al. Seborrheic dermatitis-looking beyond malassezia. Exp Dermatol, 2019, 28(9):991-1001.[4] Goldsmith LA, Katz SI, Gilchrest BA, et al. Fitzpatrick’s dermatology in general medicine, 8th edition. McGraw-Hill Compnies, 2012:170.[5] Wolff K, Johnson RA, Saavedra AP. Fitzpatrick’s color atlas and synopsis of clinical dermatology, 7th edition. McGraw-Hill Education, 2013:335.[6] Teixeira DA, Estrozi B, Ianhez M. Granuloma faciale: a rare disease from a dermoscopy perspective. An Bras Dermatol, 2013, 88(s1):97-100.[7] Srour J, Bengel J, Linden T, et al. Efficacy of a skin care cream with TRPV1 inhibitor 4-tbutylcyclohexanol in the topical therapy of perioral dermatitis. J Cosmet Dermatol, 2019, 00:1-6.[8] Chen JF, Chen YF. Dermacase. Can you identify this condition? Eosinophilic pustular folliculitis. Can Fam Physician, 2011, 57(6):683.[9] Fabbrocini G, Izzo R, Faggiano A, et al. Low glycaemic diet and metformin therapy: a new approach in male subjects with acne resistant to common treatments. Clin Exp Dermatol, 2016, 41(1):38-42. 「文章內(nèi)容僅用于學(xué)術(shù)探討,供醫(yī)療專業(yè)人士閱讀」