Bansal I, Kerr H, Janiga J J, Qureshi H S, Chaffins M, Lim H W, Ormsby A
Department of Pathology, Henry Ford Hospital, Detroit, MI 48202, USA.
J Eur Acad Dermatol Venereol. 2006 Apr;20(4):406-10. doi: 10.1111/j.1468-3083.2006.01482.x.
Polymorphous light eruption (PMLE) is the most common chronic idiopathic photodermatosis usually manifesting as a papular eruption along with several other morphological variants including a pinpoint papular variant.
Between June 1998 and August 2003, 10 PMLE patients presented to the Department of Dermatology at Henry Ford Hospital with complaints of a pruritic pinpoint papular eruption associated with sun exposure. In six patients skin biopsies were performed along with a detailed history and complete skin examination. We correlated the histology with the clinical course of disease corresponding to acute and subacute disease presentation. We also performed immunohistochemistry on three cases to study the immunophenotype in PMLE.
The clinical, histologic and immunostain findings are summarized. Acute: Clinically pinpoint papules and vesicles, some with erythematous base, were seen. Histology showed focal vesicle formation, spongiosis, oedema, red blood cells extravasation, and superficial and deep perivascular and interstitial lymphocytic infiltrate with occasional eosinophils. Subacute: Clinically pinpoint papules with or without erythema were seen. Histology of the pinpoint lesion showed a nodular collection of lymphocytes and histiocytes with claw-like extension of epidermal rete ridges at the lateral boundaries of the lesion. Overlying epidermal atrophy with adjacent spongiosis, exocytosis, oedema and a superficial perivascular lymphocytic infiltrate and parakeratosis was also observed. The histologic differential diagnosis included lichen nitidus. Immunohistochemical stains revealed the following results: CD8, CD68 positive, CD4 variable (strongly positive to negative) and S-100 negative.
(i) Pinpoint papular variant of PMLE is a distinct entity, which shows characteristic histology corresponding to the clinical course of the disease (acute and subacute). (ii) The histologic and immunophenotypic differential diagnosis of this variant during the subacute phase includes lichen nitidus.
多形性日光疹（PMLE）是最常见的慢性特发性光皮肤病，通常表现为丘疹性皮疹，以及包括针尖样丘疹变体在内的其他几种形态学变体。
1998年6月至2003年8月期间，10例多形性日光疹患者到亨利·福特医院皮肤科就诊，主诉有与日晒相关的瘙痒性针尖样丘疹皮疹。对6例患者进行了皮肤活检，并详细询问了病史并进行了全面的皮肤检查。我们将组织学与对应急性和亚急性疾病表现的疾病临床过程相关联。我们还对3例病例进行了免疫组织化学检查，以研究多形性日光疹的免疫表型。
总结了临床、组织学和免疫染色结果。急性：临床上可见针尖样丘疹和水疱，部分有红斑基底。组织学显示局灶性水疱形成、海绵形成、水肿、红细胞外渗，以及浅层和深层血管周围及间质淋巴细胞浸润，偶见嗜酸性粒细胞。亚急性：临床上可见有或无红斑的针尖样丘疹。针尖样病变的组织学显示淋巴细胞和组织细胞的结节状聚集，在病变的侧边界处表皮 rete 嵴呈爪样延伸。还观察到上方表皮萎缩伴相邻的海绵形成、细胞外渗、水肿、浅层血管周围淋巴细胞浸润和角化不全。组织学鉴别诊断包括光泽苔藓。免疫组织化学染色显示以下结果：CD8、CD68 阳性，CD4 可变（从强阳性到阴性），S - 100 阴性。
（i）多形性日光疹的针尖样丘疹变体是一个独特的实体，其显示出与疾病临床过程（急性和亚急性）相对应的特征性组织学。（ii）该变体在亚急性期的组织学和免疫表型鉴别诊断包括光泽苔藓。
