Mandrell Joshua, Youker Summer, Allen Erin J, Hurley Maria Yadira, Obadiah Joseph
Division of Dermatology, Loyola University Medical Center, Maywood, IL 60153, USA.
Skinmed. 2010 Sep-Oct;8(5):298-300.
A 35-year-old African American man presented with complaints of malodorous drainage from hypertrophic lesions on his occipital scalp (Figure 1, inset). The patient had no family history of keloid formation and no other keloids on his body. The hypertrophic mass on his scalp had been present for 10 years and had not been a result of any type of mechanical, surgical, or laser treatment. It corresponded to the distribution of a large vascular malformation over the occiput (Figure 1). The vascular malformation extended from the occipital scalp to the right parietal scalp, the right side of the face, neck, upper chest, and right arm, with varicosities and hypertrophy of the right upper extremity (Figure 2). The vascular malformation over the right parietal scalp and ear was characterized by bleb formation and hypertrophy of the right ear. The patient reported that no manipulation, including laser treatment, of the vascular malformation had been previously performed. He did state that a previous dermatologist had attempted serial surgical excision of the cerebriform nodules but retired during the course of treatment. He stated that the appearance of his keloid formation and port-wine stain had not changed during the past 10 years. A previous biopsy of a hypertrophic lesion showed histologic findings consistent with folliculitis keloidalis nuchae. Cephalexin 500 mg 4 times daily for 14 days was prescribed for the purulent drainage. A Doppler ultrasound was ordered of the right upper extremity to evaluate for an arteriovenous malformation and showed no evidence of venous thrombosis or arteriovenous malformation. On a second visit 2 weeks later, the hypertrophic lesions continued to show drainage. Clindamycin gel to be applied twice daily to the scalp was added. The patient also had magnetic resonance imaging with and without gadolinium contrast (Figure 3) ordered, which showed a large hypertrophic giant scalp keloid overlying the occipital and suboccipital region measuring 12x 19 cm. There was soft tissue thickening involving the right external ear, extending inferior to the right ear, overlying an intact parotid gland. There was no evidence of muscular or skull invasion.
一名35岁的非裔美国男性因枕部头皮上的肥厚性病变出现恶臭分泌物而前来就诊（图1，插图）。患者无瘢痕疙瘩形成的家族史，身体其他部位也没有瘢痕疙瘩。他头皮上的肥厚性肿块已经存在10年，并非任何机械、手术或激光治疗所致。它与枕部一个大的血管畸形分布相对应（图1）。血管畸形从枕部头皮延伸至右顶叶头皮、面部右侧、颈部、上胸部和右臂，伴有右上肢静脉曲张和肥大（图2）。右顶叶头皮和耳部的血管畸形表现为水疱形成和右耳肥大。患者报告称，此前未对血管畸形进行过任何处理，包括激光治疗。他确实表示，之前的一位皮肤科医生曾尝试对脑回状结节进行系列手术切除，但在治疗过程中退休了。他说，在过去10年里，他的瘢痕疙瘩形成和葡萄酒色斑的外观没有改变。之前对一个肥厚性病变进行的活检显示组织学结果与项部瘢痕疙瘩性毛囊炎一致。因脓性分泌物，开具了头孢氨苄500毫克，每日4次，共14天的药方。对右上肢进行了多普勒超声检查以评估动静脉畸形，结果显示没有静脉血栓形成或动静脉畸形的迹象。两周后复诊时，肥厚性病变仍有分泌物。加用了每日两次涂抹于头皮的克林霉素凝胶。还为患者安排了有无钆对比剂的磁共振成像检查（图3），结果显示枕部和枕下区域有一个12×19厘米的巨大肥厚性头皮瘢痕疙瘩。右外耳道有软组织增厚，延伸至右耳下方，覆盖完整的腮腺。没有肌肉或颅骨侵犯的迹象。
