A case report and discussion of Lichen myxedematosus

Abstract

A case of myxedematous lichen is reported. A 60 years old male presented with pigmentation and pruritus for 2 years, and aggravated for 1 month. He was admitted to Hainan Fifth People's Hospital on March 6, 2019. Two years ago, there was no obvious inducement for the patient to have plaque on his face, which gradually increased, hardened and appeared dark brown pigmentation. With the gradual development of the disease, trunk skin appeared rough, hypertrophy, hardening and pigmentation, hand joints appeared stiff and affected activity. Special examination showed diffuse yellowish brown patches and plaques on the forehead, which were distributed in a grid shape, and scattered with atrophic hypopigmentation spots. Black and brown patches were scattered on the back, partially fused into pieces. Sclerotic and atrophic white plaques can be seen in the neck. The skin of the front chest and back is slightly thickened, and obviously hardened. It can still be pinched up. The skin lesions have no tenderness. The joints of the fingers are stiff and the movement is limited. Skin biopsy: The trochanterellus of epidermis disappeared, fibroblasts were arranged in the whole dermis, and some of them were disordered. Ashen blue staining showed that there were clumps of positive material deposition between collagen fibers and around hair follicles in the whole dermis, which was consistent with lichen myxedematosus (LM). The patient was treated with thalidomide 50 mg 3 times a day, prednisone 30 mg orally and acitretin 10 mg twice a day orally, combined with twice a week photochemical therapy (PUVA), external application of allantoin ointment, desonide cream, Halometasone Cream. On June 10, 2019, the patient's condition gradually became stable when he came to the follow-up visit, so the drug dosage was reduced to prednisone 15 mg once a day and acitretin 10 mg twice a day, once a week for photochemical therapy, and topical plaster continued. On September 8, 2019, the patient's condition was further improved when he came to the follow-up visit, so the patient's oral medication was reduced to acitretin 10 mg/d, and allantoin ointment was applied externally. On December 1, 2019, the patient's condition had improved significantly (the patient refused to take photos). Continued treatment was given to the case. 摘要： 报道1例黏液水肿性苔藓案例。患者男,60岁,因全身皮肤变硬伴色素沉着、瘙痒2年,加重1月,于2019年3 月6日就诊于海南省第五人民医院。患者2年前无明显诱因面部皮肤出现斑块,并逐渐增大、变硬及出现黑褐色色素 沉着。随病情逐渐发展,躯干皮肤出现粗糙,肥厚,变硬及色素沉着,手关节出现僵硬且影响活动。专科检査额部见弥 漫性黄褐色斑片、斑块,呈网格状分布,其上散在萎缩性色素减退斑。背部散在黑褐色斑片,部分融合成片。颈部可见 硬化萎缩性白色斑块。前胸后背皮肤轻度增厚,明显变硬,仍可捏起,皮损无触痛。指关节较僵硬,活动受限。皮肤病 理活检:表皮突变平消失,真皮全层见较多的成纤维细胞排列,部分混乱,阿申蓝染色:真皮全层的胶原纤维间、毛囊周 围见团块状阳性物质沉积,结合临床符合黏液水肿性苔藓（Lichen myxedematosus,LM)。予以沙利度胺50 mg 3次/d,强 的松30 mg顿服及阿维A 10mg2次/d 口服治疗,并结合每周两次的光化学疗法(PUVA),外擦尿囊素软膏、地奈德乳 膏,卤米松乳膏。2019年6月10日患者前来复诊时病情逐渐稳定,遂将药物用量减至强的松15 mg顿服及阿维A 10 mg 2次/d,每周一次光化学疗法,外用膏药继续。2019年9月8日患者前来复诊,病情进一步好转,遂将患者口服药 物减为阿维A 10 mg/d,外擦尿囊素软膏。2019年12月1日患者再次前来复诊,病情已明显好转(患者拒绝拍照）。遂对 该病例临床症状及治疗进行讨论。