Aberer E, Klade H, Hobisch G
Department of Dermatology II, University of Vienna, Austria.
Am J Dermatopathol. 1991 Aug;13(4):334-41. doi: 10.1097/00000372-199108000-00003.
We compared 19 patients with acrodermatitis chronica atrophicans (ACA), a dermatosis caused by Borrelia burgdorferi infection, and 40 patients with morphea, a disease of heterogeneous origin where a borrelia etiology has been suggested in some cases, both clinically and histologically to define the differences between these two dermatoses. Clinically, ACA involves acral body sites with lower temperatures, is seen mostly in elderly persons, and presents as a livid discoloration that is not sharply demarcated. Morphea can be localized in embryonal structures, affects any age and body site, and exhibits extension at the periphery of the lesions. Histologically, ACA shows atrophy of collagen and elastic tissue as well as hypertrophic basophilic elastic tissue; whereas in morphea, sclerosis and polarizing elastic tissue are prominent. Graft-versus-host-like reactions may be present in both dermatoses. Immunohistochemical testing with different lymphocyte markers showed differences only in the expression of HLA-DR antigens. These conditions can be distinguished from each other on a clinical and histological basis in most cases. In 17% of morphea biopsy specimens, however, histological differentiation from ACA was not possible. Moreover, the histological pattern of morphea was not associated with a positive borrelia serology.
我们比较了19例慢性萎缩性肢端皮炎（ACA）患者和40例硬斑病患者，前者是一种由伯氏疏螺旋体感染引起的皮肤病，后者病因多样，部分病例临床及组织学检查提示有伯氏疏螺旋体病因，旨在从临床和组织学方面明确这两种皮肤病的差异。临床上，ACA累及体温较低的肢体部位，多见于老年人，表现为无明显边界的青紫色变色。硬斑病可局限于胚胎结构，可累及任何年龄和身体部位，病变周边可见扩展。组织学上，ACA表现为胶原和弹性组织萎缩以及嗜碱性弹性组织肥厚；而硬斑病中，硬化和偏振弹性组织较为突出。两种皮肤病均可能出现移植物抗宿主样反应。用不同淋巴细胞标志物进行免疫组化检测仅显示HLA - DR抗原表达存在差异。多数情况下，这两种疾病可通过临床和组织学进行区分。然而，在17%的硬斑病活检标本中，无法从组织学上与ACA进行区分。此外，硬斑病的组织学模式与伯氏疏螺旋体血清学阳性无关。
