Katayama H, Okabe N, Kano T, Yaoita H
Department of Dermatology, Jichi Medical School, Japan.
J Dermatol. 1990 Mar;17(3):187-90. doi: 10.1111/j.1346-8138.1990.tb01623.x.
Synthetic analogues of retinoic acid, isotretinoin in particular, are known to cause granulation tissue in the nail sulcus and healing cystic acne. We observed granulation tissue that developed in a psoriatic patient on long-term oral etretinate therapy (30 mg/day for 3 years), another synthetic analogue of retinoic acid. In August of 1988, the patient, a 44-year-old male, hit his lower leg against a wooden stick, resulting in a laceration. At that time he had relatively limited patches of psoriasis, but his skin was generally thin with telangiectasia, even in areas without psoriasis, probably due to the long-term use of oral etretinate and topical steroid. In spite of treatment with topical disinfectants and oral antibiotics, the wound progressed into granulation tissue surrounded by erythema and multiple punctate erosions with marked secretion of a clear exudate. The histological findings of the granulation tissue included the presence of proliferating microvessels and a relatively dense cell infiltration with a predominance of plasma cells on the sparse edematous connective tissue. Based on these findings, the rash was considered to be retinoid-induced granulation tissue. As compared with previous reports, our case had the following characteristics: development of rash after minor trauma, rash on the lower leg, eosinophil infiltration into the rash. We believe that long-term users of oral etretinate should be cautioned about the potential for delayed wound healing and the formation of granulation tissue.
维甲酸的合成类似物，尤其是异维甲酸，已知会导致甲沟肉芽组织增生并治愈囊肿性痤疮。我们观察到一名银屑病患者在长期口服依曲替酯治疗（30毫克/天，持续3年）后出现了肉芽组织增生，依曲替酯是维甲酸的另一种合成类似物。1988年8月，该患者，一名44岁男性，小腿撞到木棍上，导致一处撕裂伤。当时他的银屑病斑块相对较少，但他的皮肤普遍较薄且有毛细血管扩张，即使在没有银屑病的部位也是如此，这可能是由于长期口服依曲替酯和外用类固醇所致。尽管使用了外用消毒剂和口服抗生素进行治疗，伤口仍发展为被红斑包围的肉芽组织，并伴有多处点状糜烂，有明显的清亮渗出物分泌。肉芽组织的组织学检查结果包括增生的微血管以及在稀疏水肿结缔组织中以浆细胞为主的相对密集的细胞浸润。基于这些发现，皮疹被认为是类维生素A引起的肉芽组织增生。与之前的报告相比，我们的病例具有以下特点：轻微创伤后出现皮疹、小腿出现皮疹、皮疹中有嗜酸性粒细胞浸润。我们认为，长期口服依曲替酯的患者应注意伤口愈合延迟和肉芽组织形成的可能性。
