Gunasti S, Marakli S S, Tuncer I, Ozpoyraz N, Aksungur V L
Cukurova University, Dermatology, Adana, Turkey.
J Eur Acad Dermatol Venereol. 2007 Jul;21(6):811-7. doi: 10.1111/j.1468-3083.2006.02055.x.
We have seen several patients with itchy lichenified plaques located bilaterally on the elbows and/or knees and have named this condition 'psoriatic neurodermatitis' (PN).
The purpose of this study was to compare clinical and histopathological characteristics of these patients to those of patients with typical lichen simplex chronicus (LSC).
Nineteen patients with PN and 34 patients with typical LSC were included. Besides clinical dermatological evaluation, the prick test was carried out on 49 patients; the Phadiatop test on 40 patients; the patch test with European standard series on 47 patients; histopathological evaluation on 39 patients; and clinical psychiatric examination on 38 patients.
Almost exclusively, PN was seen in females and was located on the extremities. It caused more plaques than typical LSC did. In PN, the plaques were smaller, sharper, more keratotic and less excoriated, and had fewer lichenoid papules around them. Itching was usually more severe in the evening, while resting and in a hot environment in typical LSC, but not in PN. In plaques of PN, microabscesses in the horny layer, hypogranulosis, regular acanthosis and thinning of the suprapapillary plates were more frequent, and hyperpigmentation in the basal layer was less. In patients with PN, depressive disorder was found more frequently; and generalized anxiety disorder or psychosomatic characteristics, less. There were no significant differences in the results of prick, Phadiatop and patch tests between patients with PN and those with typical LSC.
In our opinion, it is most likely that the so-called PN is itchy psoriasis superimposed by LSC.
我们见过数位患者双侧肘部和/或膝部出现瘙痒性苔藓化斑块，我们将这种病症命名为“银屑病性神经性皮炎”（PN）。
本研究旨在比较这些患者与典型慢性单纯性苔藓（LSC）患者的临床和组织病理学特征。
纳入19例PN患者和34例典型LSC患者。除临床皮肤科评估外，对49例患者进行了点刺试验；对40例患者进行了变态反应原筛查试验；对47例患者进行了欧洲标准系列斑贴试验；对39例患者进行了组织病理学评估；对38例患者进行了临床精神检查。
PN几乎仅见于女性，且位于四肢。与典型LSC相比，PN导致的斑块更多。在PN中，斑块更小、边界更清晰、角化更明显且抓痕更少，周围的苔藓样丘疹也更少。典型LSC患者通常在晚上、休息时以及炎热环境中瘙痒更严重，而PN患者并非如此。在PN的斑块中，角质层微脓肿、颗粒层减少、棘层规则增厚和乳头上方板变薄更为常见，基底层色素沉着较少。PN患者中抑郁症更为常见；广泛性焦虑障碍或心身特征则较少。PN患者与典型LSC患者在点刺试验、变态反应原筛查试验和斑贴试验结果方面无显著差异。
我们认为，所谓的PN很可能是叠加了LSC的瘙痒性银屑病。
