"Spade sign" and inflammation/fibrosis limited to the upper and mid-dermis as the pathognomonic features of acne keloidalis
"Spade sign" and inflammation/fibrosis limited to the upper and mid-dermis as the pathognomonic features of acne keloidalis
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DOI：
10.1111/1346-8138.15127
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发表时间：
2019-10-23
影响因子：
3.1
通讯作者：
Yang, Chao-Chun
中科院分区：
文献类型：
--
作者：
Cheng, An-Yu;Lee, Chaw-Ning;Yang, Chao-Chun
瘢痕疙瘩(AK)是一种主要的瘢痕性脱发，主要影响非洲裔男性。亚洲人的报道很少。本研究旨在回顾台湾南部地区AK患者的临床及组织病理学特征，并找出AK的病因学特征。1988年至2018年，国立成功大学医院收治了15例经组织病理证实的AK患者。中位发病年龄为24岁(14-71岁)。AK急性期可见淋巴细胞性和中性粒细胞炎性渗入，伴有微小脓肿和水肿，与临床表现为孤立丘疹或脓疱者一致。随后，炎性渗入累及真皮中部和毛囊峡部。在5例患者的8例活检标本中发现的“黑桃征”，在峡部下部水平呈气球或扑克牌的黑桃状扩张，可能是AK亚急性期的一种病理征象。慢性期，毛干节段残留在真皮上部至中层，引起慢性炎症和广泛的纤维化，出现临床瘢痕疙瘩样外观。真皮上至中层炎症和纤维化的限制是AK的另一个独特的病因学特征。
Acne keloidalis (AK) is one of the primary cicatricial alopecias and predominantly affects men of African descent. Reports in Asians are scant. This study aimed to retrospectively review the clinical and histopathological features of AK patients in southern Taiwan and identify the pathognomonic features of AK. There were 15 patients with histopathologically confirmed AK in National Cheng Kung University Hospital between 1988 and 2018. The median onset age was 24 years (range, 14-71). The male : female ratio was 14:1. In the acute stage of AK, the lymphocytic and neutrophilic peri-infundibular inflammatory infiltrates with microabscess formation and edema corresponded to the clinical finding of isolated papules or pustules. Subsequently, the inflammatory infiltrates involved the mid-dermis and the isthmus of hair follicles. The "spade sign", a thin and dilated space resembling the shape of a balloon or spade symbol of playing cards at the level of lower isthmus, was identified in eight biopsies from five patients and may be a pathognomonic sign in the subacute stage of AK. At the chronic stage, the segments of hair shafts remained in the upper to mid-dermis and induced chronic inflammation and extensive fibrosis, resulting in the clinical keloid-like appearance. The restriction of inflammation and fibrosis in the upper to mid-dermis was another unique and pathognomonic feature of AK.