Trichostasis spinulosa: possible association with prolonged topical application of clobetasol propionate 0.05% cream
Trichostasis spinulosa: possible association with prolonged topical application of clobetasol propionate 0.05% cream
复制标题
DOI：
10.1111/j.1365-4632.2007.03271.x
复制
发表时间：
2007-09-01
影响因子：
3.6
通讯作者：
Iftikhar, Nadia
中科院分区：
文献类型：
--
作者：
Janjua, Shahbaz A.;Mckoy, Karen C.;Iftikhar, Nadia
一名20岁的南亚裔女性担心她的黑肤色，主要影响她身体的暴露区域，包括面部、颈部、上胸部和四肢。她尝试了多种非处方产品，包括局部氢醌，曲酸和各种草药配方，但都没有成功。在她就诊前三年，她的朋友给予她0.05%丙酸氯倍他索乳膏，她将其涂抹在面部、颈部、上胸部和手臂上。每天两次应用6周后，她注意到她的肤色明显改善;因此，此后她继续使用丙酸氯倍他索乳膏。她每天涂抹大约10 g乳膏。一年前，她的介绍，她注意到一个无症状的爆发微小的深棕色丘疹和“开放毛孔”的脸，颈部，上胸部和手臂。她认为她的黑肤色正在恢复，并继续使用局部皮质类固醇一年没有改善。医生建议她去皮肤科就诊，体检发现面部、颈部、上胸部、手臂和肘前部位有多发的深棕色毛囊性丘疹（图1-3）。触诊时有一种粗糙的感觉。用手用透镜检查时，可见一簇毛发从每个小丘疹中突出。手动尝试从病变中取出材料未成功。用无菌针头取出了一些角质栓。在光镜下可见多根毫毛嵌在角蛋白中。病人拒绝接受皮肤切片检查，除了深色毛囊丘疹外，颧骨部位有多发性开放性粉刺，下巴和下脸颊有明显的增生。在颧骨区域和手臂上也可以看到毛细血管扩张。患者既往病史、其余体格检查、血、尿常规（包括血清游离睾酮、血尿素氮和血清肌酐水平）均无异常。根据临床和光镜检查结果，诊断为棘状肉芽肿（TS）。建议患者停用皮质类固醇乳膏。她的治疗包括每天睡前在患处涂抹0.05%维甲酸乳膏。在3个月随访访视时，观察到TS病变和粉刺性痤疮明显改善（图5-7）。充血和毛细血管扩张没有改善。
A 20-year-old woman of south Asian descent was concerned about her dark complexion, predominantly affecting the exposed areas of her body, including the face, neck, upper chest, and extremities. She tried multiple over-the-counter products, including topical hydroquinone, kojic acid, and various herbal formulations, without success. Three years previous to her presentation, she was given clobetasol propionate 0.05% cream by a friend, which she applied to the face, neck, upper chest, and arms.After 6 weeks of twice-daily application, she noted marked improvement of her complexion; thus, she continued to use clobetasol propionate cream thereafter. She applied approximately 10 g of cream daily. One year previous to her presentation, she noticed an asymptomatic eruption of tiny dark-brown papules and "open pores" on the face, neck, upper chest, and arms. She thought her dark complexion was returning, and continued to use topical corticosteroid for another year without improvement. She was advised to see a dermatologist.Physical examination revealed multiple, dark-brown, follicular papules involving the face, neck, upper chest, arms, and antecubital areas (Figs 1-3). There was a rough sensation on palpation. On examination with a hand lens, tufts of hairs were visible projecting through each of the tiny papules. Manual attempts to express material from the lesions were unsuccessful. A few of the horny plugs were removed with a sterile needle. Multiple vellus hairs were seen embedded in keratinous material on light microscopy of the extracted plugs (Fig. 4). The patient refused a skin biopsy.In addition to the dark follicular papules, multiple open comedones were present on the malar areas, and hypertrichosis was evident on the chin and lower cheeks. Telangiectasias were also visible over the malar areas and the arms. Her past medical history, the rest of the physical examination, and routine blood and urinalyses, including serum free testosterone, blood urea nitrogen, and serum creatinine levels, were unremarkable.On the basis of the clinical and light microscopic findings, a diagnosis of trichostasis spinulosa (TS) was made.She was advised to discontinue the use of corticosteroid cream. Her treatment consisted of daily tretinoin 0.05% cream over the affected areas at bedtime. A marked improvement of the TS lesions and comedonal acne was noted at the 3-month follow-up visit (Figs 5-7). There was no improvement of the hypertrichosis and telangiectasias.