Combemale P, Courtois D, Chouvet B
Clinique Dermatologique, Hôpital d'Instruction des Armées Desgenettes, Lyon.
Ann Dermatol Venereol. 1990;117(8):515-20.
We report the case of a 20-year old male patient without significant familial or personal history who presented with a disseminated papular eruption on the abdomen, flanks and buttocks. The eruption was continual and proceeded by outbreaks, but it was not influenced by seasons. Physical examination of the skin, mucosae and skin appendages was otherwise normal. Histological examination showed all the criteria of perforating folliculitis as described by Mehregan and Coskey. On the basis of our case we would put perforating folliculitis back among the perforating dermatoses. The concept of this curious phenomenon is briefly reviewed; perforating folliculitis is part of the third group of the so-called primary forms. The clinical features are suggestive of the disease, with its small pigmented papules centred around a keratotic plug, forming a permanent disseminated eruption. Histology shows a granuloma facing a lateral perforation of the hair follicle, a pseudo-epitheliomatous epithelial hyperplasia and the presence of hair and keratin debris in the perforation. Various keratolytic treatments have been applied without success; retinoids have not been tried. The main diagnostic and nosological problem is Kyrle's disease. In view of clinical and histological data, many authors regard Kyrle's disease as a major form of perforating folliculitis. Pruritus, ascribed to an underlying illness in Kyrle's disease, is thought to increase the importance of the lesions. The specificity of perforating folliculitis is discussed, but it seems that side by side with secondary forms occurring in recognized diseases, there may be primary forms of perforating folliculitis. Dyskeratosis might be a cause of the perforation.
我们报告了一例20岁男性患者，其无明显家族史或个人史，腹部、侧腹和臀部出现播散性丘疹性皮疹。皮疹持续存在且呈暴发性发作，但不受季节影响。皮肤、黏膜及皮肤附属器的体格检查未见其他异常。组织学检查显示符合Mehregan和Coskey所描述的穿通性毛囊炎的所有标准。基于我们的病例，我们认为穿通性毛囊炎应重新归入穿通性皮肤病范畴。本文简要回顾了这一奇特现象的概念；穿通性毛囊炎是所谓原发性类型第三组的一部分。临床特征提示该病，其小的色素沉着丘疹围绕角质栓形成，构成持续性播散性皮疹。组织学显示肉芽肿面向毛囊的侧方穿通、假上皮瘤样上皮增生以及穿通处有毛发和角质碎屑。已应用多种角质松解治疗但均未成功；尚未试用维甲酸类药物。主要的诊断和分类学问题是 Kyrle病。鉴于临床和组织学资料，许多作者将Kyrle病视为穿通性毛囊炎的一种主要类型。Kyrle病中归因于潜在疾病的瘙痒被认为增加了皮损的严重性。本文讨论了穿通性毛囊炎的特异性，但似乎在已确认疾病中出现的继发性类型之外，可能还存在原发性穿通性毛囊炎。角化不良可能是穿通的一个原因。
