Brown Plaques Research Articles

Simultaneous distinct cutaneous fungal infections with chromoblastomycosis due to Exophiala xenobiotica and hyalohyphomycosis due to Scedosporium apiospermum in a patient with severe cellular immunodeficiency.

Deep-seated dermatomycosis is a rare disease that is often caused by trauma and/or systemic immunodeficiency. We describe a case of chromoblastomycosis complicated by hyalohyphomycosis that occurred simultaneously at different sites. A 92-year-old Japanese man who had been taking oral prednisolone for an IgG4-related respiratory disease visited our clinic. He developed brownish plaques with grayish-white scales with pseudo-carcinomatous hyperplasia and numerous brownish muriform cells developing in the dermis of his right hand, and multiple painful abscesses with pustules and papules and numerous hyphae within and around the histiocytes in the dermis of his right lower leg. Upon skin tissue culture and DNA sequencing, Exophiala xenobiotica and Scedosporium apiospermum were detected separately. He had severe cellular immunodeficiency indicated by low levels in the phytohemagglutinin (PHA)-stimulated lymphocyte transformation test (LTT) and serum interferon-gamma (IFN-γ), although his humoral immunity was normal. The patient died of bacterial pneumonia, despite antifungal drug treatment for 2 months. IFN-γ producing type 1 T helper (Th1) cells play an important role in the defense against fungal infections, however, corticosteroids specifically suppress Th1 cell responses and promote the induction of fungal infection. Measurement of PHA-stimulated LTT and serum IFN-γ may be useful in determining the severity and prognosis of deep-seated dermatomycosis in patients undergoing corticosteroid treatment.

Ring and flower in the eye – An incidental finding of Wilson disease in a case of diabetic retinopathy: A case report

This is to report a rare case of Wilson disease (WD) with Kayser–Fleischer (KF) ring with sunflower cataract along with diabetic retinopathy. A 43-year-old male patient presented to the comprehensive clinic with a chief complaint of diminution of vision of both eyes since 8 months. On ocular examination, the cornea showed golden brown color pigment deposition in the Descemet membrane, indicative of KF ring, which is a pathognomonic feature of WD. There was brown plaque or spoke-like radial opacities on the anterior lens capsule in both eyes, which gives sunflower appearance, which is also a feature of WD. The posterior segment revealed diabetic retinopathy in both eyes. Serum ceruloplasmin was reduced, and the bilirubin level was mildly raised. Liver function test was mildly altered. Urine excretory copper levels were raised. Ultrasonography of the abdomen and pelvis revealed liver cirrhosis with portal hypertension, splenomegaly, gross ascites, and gall bladder calculi. This is a rare case of WD with KF ring with sunflower cataract with diabetic retinopathy in both eyes. Slit lamp examination is mandatory to diagnose it as WD in the presence of KF ring.

Comparative study on the age-related incidence of seborrheic keratosis and verruca plana in patients with verruca plana-like lesions

Seborrheic keratosis (SK) is a common skin disease in the elderly. However, in cases where SK presenting as multiple skin-colored or clustered lesions can be easily misdiagnosed as verruca plana (VP), especially in the young population. This retrospective study investigated the prevalence of SK and VP in the lesions that appear clinically similar to VP according to age. We examined the pathology slides of the skin tissue and photographs of patients who were clinically suspected to have VP. A total of 503 patients were included in the study, out of which 174 patients were finally diagnosed with SK (34.6%) and 132 with VP (26.2%). The mean ages of the SK- and VP-diagnosed group were 39.3 and 35.4 years, respectively. SK had a higher prevalence among individuals older than 30 years, and relative frequency of SK should not be ignored in patients with a grouped distribution in their 20 s and 30 s. Therefore, our study suggests that multiple verrucous skin-colored to brownish plaques are also commonly diagnosed as SK in young people as well as VP, and the prevalence of SK and VP may not always depend solely on chronological aging, and the prevalence of SK among young people may be higher than commonly believed stereotypes suggest.

Clinical Characteristics of Basal Cell Carcinomas of the Scrotum: An Institutional Retrospective Review

Objective. To analyse the clinical and pathologic features, discuss therapeutic strategies, and possibly cause and identify prognostic factors of scrotal basal cell carcinoma (BCC) in Chinese patients. Materials and Methods. Between January 2012 and December 2022, 12 patients with scrotal BCC were diagnosed and treated at our institution. A review was conducted based on the clinical characteristics, pathology slides, and tissues of these patients. Results. The median patient age was 69.26 ± 11.23 years. The skin lesions presented as red papules, blue-grey polypoid nodules, erythematous patches, brownish plaques, and so on. All patients were treated using wide excision, but the margins varied from 0.5 cm to 2 cm. HPV infection was checked in all lesions, with 4 out of 12 testing positive for P16 and 1 for HPV16 DNA. We found mottled positive expression of P16 in the cytoplasm and membrane. One patient developed left inguinal lymph node metastasis and was successfully treated using bilateral inguinal lymphadenectomy. The rest recovered well without relapse. Conclusions. BCC of the scrotum is rare, but long-term surveillance is recommended for BCC patients, and whether genital HPV infection is a noteworthy feature for these patients remains under investigation.

First report of Fusarium concentricum as a causal agent of Fusarium leaf blotch on pecan (Carya illinoinensis) in Southeast China.

The economically important nut crop pecan (Carya illinoinensis (Wangenh.) K. Koch) is seriously affected by increasing incidence of fungal disease worldwide (Xiao et al 2021). The top leaves of the pecan variety 'Pawnee' in the orchard of Zhejiang A&F University, Zhejiang, China were damaged by massive dark brown plaques in summer to autumn 2021. The causal agent was isolated from leaves with target plaques following the steps: sterilized with 70% alcohol (30 s × 2), rinsed with sterilized water (3 ×) before and after 5% sodium hypochlorite (30 s), excised the plaques, and placed on PDA medium at 28℃ in a dark incubator for 3-d. The mycelium on the edge of each colony was transferred to fresh SNA medium in dark for 2 weeks to induce conidia formation. A few conidia-germinated mycelia were transferredand inoculated on new plates containing fresh PDA medium to obtain the purified cultures. Koch's postulates were applied to validate the pathogenicity of the purified isolates. Non-woundedly healthy leaves (disinfected with 5% sodium hypochlorite) of 'Pawnee' seedlings were inoculated with 5 mm 7-d old purified cultures. Dark-brown spots appeared on the leaves 2 days post inoculation at 25℃. The spots became larger accompanied by partially cracking and slight deformation of inoculated leaves from day 2 to day 4, while the control leaves remained asymptomatic. A re-isolated strain ZJ-6 from these infected leaves was identified as the pathogenic isolate with the same symptom as the previous one. Morphologically, aerial mycelia of the pathogenic isolate ZJ-6 cashmere and white. The reverse of colony orange. The edge of the colony appeared gradually thinner, the aerial mycelia loose and flocky, and the matrix mycelium whitened. Hyphae were septate, translucent with smooth wall and 1.47-7.14 µm in width. Microconidia (n = 20) obovoid to fusoid, mainly with 0-septate, 4.45-7.78×4.79-16.25 µm. Macroconidia (n = 20) sickle, mainly with 3-5 septa, 5.56-10.28×56.67-114.54 µm. Simultaneous of monophialidic and polyphialidic conidiophores. Conidiophore width 1.47-3.68 µm, slightly smaller than vegetative hyphae. The morphological characteristics matched with previous descriptions of Fusarium species (Nirenberg and O'Donnell 1998; Wang et al 2013). The identity of ZJ-6 was confirmed by phylogenetic reconstruction using the concatenated sequences of the ATP citrate lyase (ACL1), Calmodulin (CaM), the internal transcribed spacer (ITS) rDNA region, ribosomal RNA gene (LSU), the largest subunit of DNA-dependent RNA polymerase II (RPB1), partial translation elongation factor-1 alpha (TEF) and β-Tubulin (TUB). To this end, the genomic DNA of ZJ-6 was extracted by the M5 hipermix-MF859 (Mei5 Biotechnology) and submitted to GenBank under the accession numbers OP933646, OP933647, OP925890, OP925889, OP933396, OP933648, and OP933397, respectively. The obtained sequences of ZJ-6 were used for nucleotide BLAST against thetandard databases, respectively, and the strains with sequence identification values above 98% were selected to construct multiple alignment for building a phylogenetic tree. This analyses allowed the identification of ZJ-6 as Fusarium concentricum Nirenberg & O'Donnell, a species with few reports that can cause serious damage to the fruits and branches of other hosts (Hasan et al 2020; Huda-Shakirah et al 2020; Wang et al 2013). This is the first report of pathogenic F. concentricum on pecan in Southeast China that caused no harvest of infected plants.

P06 Porokeratosis ptychotropica: a rare and recalcitrant genitogluteal eruption

Abstract A 45-year-old man with a history of psoriasis presented to our male genital dermatology clinic with a several-year history of pruritic, painful, hyperkeratotic red–brown plaques on both buttocks. He had previously been treated unsuccessfully with cryotherapy and topical imiquimod and podophyllotoxin for suspected condyloma acuminata. A 4-mm punch biopsy from the left buttock showed hyperkeratosis, hypergranulosis, papillomatosis and multiple columns of parakeratin with underlying agranulosis and dyskeratosis, consistent with cornoid lamella formation. A diagnosis of porokeratosis ptychotropica was made. He was treated with Dovobet® ointment and Trimovate® cream, with little improvement. He underwent four cycles of topical photodynamic therapy to his right buttock and two cycles to his left buttock, with minimal improvement. Oral isotretinoin was also trialled, but this led to lipid derangement prior to any observed benefit, so it was stopped. Porokeratosis ptychotropica is a rare and under-recognized variant of porokeratosis, characterized by epidermal keratinization that manifests as keratotic papules in the genitogluteal region. It is often misdiagnosed as psoriasis, tinea cruris or condyloma acuminata, as in our case. Typically, multiple cornoid lamellae are seen on histology (Lucker GP, Happle R, Steijlen PM. An unusual case of porokeratosis involving the natal cleft: porokeratosis ptychotropica? Br J Dermatol 1995; 132:150–1). The aetiology of porokeratosis ptychotropica is unknown, but there is potential for malignant transformation (Mazori DR, Shvartsbeyn M, Meehan SA et al. Transformation of porokeratosis ptychotropica into invasive squamous cell carcinoma. Int J Dermatol 2017; 56:679–80). It is commonly recalcitrant to treatment, with varying reports of success with topical retinoids, keratolytics, tacrolimus, calcipotriol, topical 5-fluorouracil, imiquimod, systemic retinoids, psoralen ultraviolet A, intralesional bleomycin, cryotherapy, photodynamic therapy, excision, dermabrasion and CO2 laser.

Clinical, dermoscopic, and histopathologic findings of hidroacanthoma simplex: a case report and literature review.

Hidroacanthoma simplex (HS) is a rare benign intraepidermal tumor that originates in the acrosyringial portion of the eccrine duct. Clinically, they are well-defined lesions, flat or verrucous brownish plaque, and can be misdiagnosed with other types of benign or malignant tumors. Dermoscopy reveals small black globules and fine scales. The histopathology of HS is characterized by typical intraepidermal nests, well-circumscribed, composed of uniform basaloid and poroid cells within the acanthotic epidermis with cystic or ductal structures in the nests. We report a case of HS that changes its clinical appearance, dermoscopy, and histopathologic findings over time. Differential diagnoses included seborrheic keratosis, Bowen disease, melanoma, and malignant HS.

Human papillomavirus–related condyloma on keratinized skin

Human papillomavirus–related condyloma on keratinized skin

Xerostomia as a potential condition in patients Covid-19 with tetanus: A Case report

Introduction: Xerostomia is a dry mouth condition caused by many factors, including the potential of neuroinvasiveness and neurotropism from severe acute respiratory syndrome-coronavirus-2 (SARS-Cov-2). Tetanus causes muscle spasm, rigidity, and also as a risk factor for xerostomia. Objective: To discuss the pathogenesis of xerostomia in patients with coronavirus di-sease-2019 (Covid-19) and tetanus. Case: A 66-year-old male was referred to Oral Medicine Department from Neurology De-partment. Extraoral showed dry and exfoliative lips. Intraoral showed one finger mouth opening, a brownish plaque in dorsum of tongue, no saliva pooling in floor of mouth. Polymerase chain reaction SARS-Cov-2 was positive. Patient was diagnosed with xerostomia. Management: Cleaning the oral cavity with gauze moistened of 0.9% NaCl and 0.12% chlorhexidine diglu-conate, and applying the vaseline album on lips. Conclusion: The pathogenesis of xerostomia is an important factor as po-tential consequence of patients with Covid-19 and tetanus due to damage the angiotensin converting enzyme-2.
 Keywords: xerostomia, Covid-19, tetanus, angiotensin converting enzyme-2

Eruptive superficial porokeratosis in a patient with nephrotic syndrome

A 34-year-old female was referred to our department, complaining of multiple asymptomatic lesions that appeared two weeks previously. The patient had active nephritis with nephrotic syndrome and was treated with immunosuppressive therapies. Physical examination revealed multiple well-circumscribed rounds of flat brownish plaques with slightly elevated borders, some of which were covered by scales. The number of lesions was nine in total. Skin biopsy specimens showed dyskeratotic cells in the thinned epidermis with cornoid lamella, and the absence of a granular cell layer. The development of porokeratosis was considered to be related to immunosuppressive therapy or the activity of nephritis.

Erythematous brownish plaques with an annular configuration.

Granuloma annulare (GA) and cutaneous sarcoidosis show clinicopathological overlap and they are also aetiopathogenically related. Given the similarities of sarcoidal GA and sarcoidosis, and the reports of association of sarcoidal GA with systemic sarcoidosis, this diagnosis should prompt further investigation to exclude systemic involvement. Being aware of the subtle histopathological clues is of the utmost importance for an accurate diagnosis of this rare variant, but correlation with the clinical setting and use of ancillary investigations are also warranted to confidently exclude sarcoidosis.

Lichen planus disseminatus partim vesiculosus nakon COVID-19 vakcine

Introduction: Lichen planus is an autoimmune inflammatory disease that can be associated with infections, drugs and vaccines. As concerning the potential triggering effect of vaccine, there is evidence a few cases of new-onset lichen planus that appeared after COVID vaccine, particularly the Pfizer/BioNTech vaccine. Case report: This report is a case of a newonset lichen planus triggered by the Pfizer/BioNTech vaccine administration in a healthy young female. Dermatological examination revealed polygonal, itchy, erythematous papules on trunk, upper and lower limbs, that coalesced into brownish plaques in the ankles, flexural wrist and knee. No mucosal involvement was noted. In view of the clinical picture, the timing of the skin eruption with respect to the vaccine and the histopathologic findings, a vaccine-induced lichen planus triggered by the COVID-19 vaccine has been diagnosed. Conclusion: Lichen planus or lichenoid-like eruption as a cutaneous manifestation following COVID-19 vaccines are rare, and the pathogenesis for its development is still unclear. Clinical trials showed that the leading vaccines upregulate Tcell response (Th1) and incrementing inflammatory cytokines involved in the pathogenesis of autoimmune diseases, such as lichen planus. Although we still do not completely understand its pathogenesis, dermatologists should be aware of the possibility and keep an eye out for worsening or debut of this disease after the COVID-19 vaccine. Vaccinated patients should be monitored for skin manifestations, and dermatological evaluation should be offered, when needed.

What Are These Brown Plaques on This 16-Year-Old Girl’s Back?

What Are These Brown Plaques on This 16-Year-Old Girl’s Back?

A lesion on the abdomen in an infant

A 4-month-old girl presented to the pediatric dermatology clinic due to an enlarging growth on the abdomen. The child was born to a 32-year-old G8P6 woman via spontaneous vaginal delivery at 39 weeks and 5 days. Her mother identifies as South Sudanese. She received all recommended prenatal care. Pregnancy was complicated by low weight gain and cerclage placement. Delivery was complicated by meconium-stained amniotic fluid but otherwise uneventful and APGARS was 8,9. Newborn skin examination was completely normal, and her 2-week-old well check was also unremarkable. At her next appointment (5 weeks of age), a new skin growth was noted on the right abdomen. There was no ulceration or bleeding, and the growth did not appear to be bothersome to the infant. The plaque continued to enlarge, and she was referred to the pediatric dermatology clinic. On examination, there was a solitary 0.8 × 1.0 cm dark brown plaque with slight pink hue at the edges (Figure 1). Dermoscopy was performed (Figure 2). Dermoscopy showed mainly red lacunae with white septa consistent with an infantile hemangioma. This case underscores the utility of dermoscopy in diagnosing vascular growths such as infantile hemangioma (IH) in more deeply pigmented skin. In darker skin types, diagnosis of vascular lesions on general examination is made more challenging by the presence of melanin in the epidermis. Dermoscopy allows for enhanced visualization of structures below the stratum corneum to the level of the superficial dermis and allows for more accurate diagnosis of both melanocytic and non-melanocytic lesions.1 To date, the utility of dermoscopy in diagnosing vascular lesions in skin of color has not been well described. In both lighter and darker phototypes, the primary dermoscopic feature of the hemangioma is the red lacuna (lake of blood), usually separated by pale septae.2 In darker phototypes, dermoscopy may be particularly useful in distinguishing these red lacunae from brown globules (which are seen in melanocytic lesions), and from red structureless areas with white collarettes (which are seen in pyogenic granulomas).1 Dermoscopy of superficial port wine stain can show a uniform “lawn” of dotted and occasionally tortuous vessels, sometimes with an overlying gray-white veil if there is a deeper component.3 In some cases, the color of lacunae on dermoscopy may help clarify the depth of the lesion (superficial IHs tend to have bright red lacunae, while the lacunae of deeper IHs may have a more blue or violaceous hue). However, melanin can impart a blue hue; thus, one must take into consideration the patient's phototype and other clinical clues (ie, nodularity and height) when assessing depth.1 Serial dermoscopic examination can also help to identify subtle changes in hemangiomas; a superficial white cast portending ulceration can often be more easily appreciated with a dermatoscope.4 Infantile hemangioma is more commonly diagnosed in Caucasians compared with other ethnicities, and girls are more commonly affected than boys.5 Prematurity also appears to be a significant contributing risk factor.5 In one retrospective analysis of the National Hospital Discharge Survey, a doubling of IH incidence rate was observed in White infants between 1976 and 2006, thought to be explained at least partly by increasing rates of low birth weight births in White people in that time period.6 Infantile hemangioma is an uncommon diagnosis in neonates of African descent, for reasons that have not been fully clarified. One hypothesis for this variation by ethnic background is the protein fibromodulin, which is secreted by melanocytes. Though individuals with darker skin do not have increased melanocyte number per unit skin area, they may produce more fibromodulin, which has been identified as a key regulator of angiogenesis.7 Speculatively, the activity of fibromodulin could partly account for the decreased incidence of diseases of vascular proliferation in individuals of African descent, which include both IH and age-related macular degeneration.8 One report identified three African American infants with segmental IHs requiring systemic therapy with propranolol. All three cases were associated with hypertension (an association that has not otherwise been reported with IHs), and two of the three infants experienced improvement in blood pressure with propranolol therapy. All three infants otherwise responded well to propranolol therapy with regards to their hemangiomas. The full significance of these findings is unknown due to the rarity of segmental hemangiomas in infants of African descent. In conclusion, IHs are less common in phototype IV, V, and VI skin, but do occur. Dermoscopy can facilitate rapid and accurate diagnosis and ensure timely intervention when indicated.

Kaposi Sarcoma of the Lower Extremity with HIV and Kaposi's Sarcoma

Kaposi's sarcoma is the most common malignancy seen with HIV infection. It is a lymphoangioproliferous tumor first described by Moritz Kaposi in 1872. It is characterized by bluish red or dark brown plaques and nodules, especially in the distal of the lower extremities, often the heels and feet. Organ involvement without skin findings is observed in approximately 15% of the cases. There are four clinical variants, the classical, endemic, iatrogenic and the epidemic associated with AIDS. Kaposi's sarcoma in AIDS cases apart from the skin, it can also be seen in the oral cavity, gastro-intestinal system and respiratory system. Antiretroviral therapy (ART) should be started immediately in newly diagnosed HIV infected patients. In this research, a 65 year old male patient, who was diagnosed AIDS and Kaposi's sarcoma at the same time, is described.

Brown plaque on the arm

Brown plaque on the arm

Giant Congenital Melanocytic Nevi (GCMN): Sebuah Laporan Kasus Langka

Giant Congenital Melanocytic Nevi (GCMN) is a nevus which present at birth or arise within the first few weeks of life. Incidence of GCMN is estimated at below 1:20.000 newborns. Lesion of GCMN usually appears with a black or brownish plaque and may have abnormal borders, flat or protruding surface and hypertrichosis. Giant Congenital Melanocytic Nevi (GCMN) is associated with malignant melanoma and neurocutaneous melanocytosis. A male newborn baby is reported to have a giant black hairy plaque, with irregular shape in his head since born. Patient was born naturally, full term, and normal birth weight. The mother has no medication consumption and disease history during pregnancy. In our three years follow up, there are multiple black patches with smaller size in front right and left leg, and the back of the body. The GCMN treatment consists of surgical and non-surgical procedures, psychological support, and lifelong monitoring. In this case, further examination and observation are needed.

Adult-onset eccrineangiomatous hamartoma treated with excision and skin grafting: a case report

<p>Eccrine angiomatous hamartoma is a rare benign tumour like malformation characterized by intradermal proliferation of eccrine and vascular components. It usually arises before puberty but can occur at any age. It typically presents as a solitary or multiple reddish or brownish plaque or nodule that progressively enlarges in size. Symptoms such as pain and hyperhidrosis may be associated. Lesions are commonly located over distal extremities. We report a case of a 45-year-old lady who presented with a gradually enlarging solitary reddish plaque over the left retro-auricular region of the scalp since the last 12 years and associated with occasional pain. Histopathology revealed pproliferation of eccrine sweat glands and thin-walled blood vessels in the dermis. Additional ultrasound and MRI contrast studies were done to assess the vascular component and involvement of underlying structures. The patient was treated successfully with complete excision of the lesion followed by split thickness skin grafting.</p><p><strong> </strong></p>

Growing brown and pink plaque

Growing brown and pink plaque

A case report and discussion of Lichen myxedematosus

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。