Beutler Bryce David, Cohen Philip R
University of Nevada, Las Vegas.
Dermatol Online J. 2014 Dec 12;21(2):13030/qt4dw7k4nk.
Cryotherapy-induced milia is a rarely described cutaneous reaction that may occur in patients who have received cryotherapy with liquid nitrogen. Cryotherapy-induced milia is characterized by 1-2 millimeter white dermal cysts that develop at the healed cryotherapy site. Milia en plaque, an erythematous plaque containing numerous milia, has not previously been described following treatment of a skin lesion with liquid nitrogen cryotherapy.
We describe a man who developed cryotherapy-induced milia en plaque after receiving cryotherapy to his dorsal hand for the treatment of an actinic keratosis. We also summarize the potential complications of cryotherapy, the differential diagnosis of milia en plaque, and therapeutic interventions for this lesion.
The features of a man with cryotherapy-induced milia en plaque are presented. Using PubMed, the following terms were searched and relevant citations assessed: cryosurgery, cryotherapy, hypothermia, milia, milia en plaque, and Wolf's isotopic response. In addition, the literature on cryotherapy-induced milia and cryotherapy-induced milia en plaque is reviewed.
Our patient developed cryotherapy-induced milia en plaque shortly after his cryotherapy site had healed. Some of the asymptomatic cystic dermal lesions had spontaneously resolved when a lesional biopsy was performed to confirm the diagnosis. The diagnosis, natural course, and potential treatments were discussed with the patient. Subsequent management was to observe the area; at follow-up examination, the remainder of the milia had also spontaneously resolved.
Cryotherapy-induced milia is a benign condition characterized by the development of small white dermal cystic lesions that develop at a healed liquid nitrogen cryotherapy site. The lesions may appear individually or as milia en plaque. While the mechanism of pathogenesis is unknown, we postulate that the condition is an example of Wolf's isotopic response, in which a new, unrelated skin disease develops at the site of a previously healed dermatosis - in this circumstance, following cryotherapy which created an immune compromised zone. The diagnosis of milia en plaque can usually be established by clinical presentation; if necessary, a biopsy can be performed to provide pathologic confirmation of the suspected diagnosis. Treatment options include manual extraction, topical retinoids, or observation. Similar to our patient, the milia may resolve spontaneously.
冷冻疗法诱发的粟丘疹是一种鲜有描述的皮肤反应，可能发生于接受液氮冷冻疗法的患者。冷冻疗法诱发的粟丘疹的特征为在冷冻疗法愈合部位出现1至2毫米的白色真皮囊肿。此前，在用液氮冷冻疗法治疗皮肤病变后，尚未有关于斑状粟丘疹（一种含有大量粟丘疹的红斑性斑块）的描述。
我们描述了一名男性，他在手背部接受冷冻疗法治疗光化性角化病后出现了冷冻疗法诱发的斑状粟丘疹。我们还总结了冷冻疗法的潜在并发症、斑状粟丘疹的鉴别诊断以及针对该病变的治疗干预措施。
介绍了一名患有冷冻疗法诱发的斑状粟丘疹的男性的特征。使用PubMed搜索了以下术语并评估了相关引文：冷冻手术、冷冻疗法、体温过低、粟丘疹、斑状粟丘疹和沃尔夫氏同形反应。此外，还回顾了关于冷冻疗法诱发的粟丘疹和冷冻疗法诱发的斑状粟丘疹的文献。
我们的患者在冷冻疗法部位愈合后不久就出现了冷冻疗法诱发的斑状粟丘疹。在进行皮损活检以确诊时，一些无症状的囊性真皮病变已自行消退。与患者讨论了诊断、自然病程和潜在治疗方法。后续处理是观察该区域；在随访检查时，其余的粟丘疹也已自行消退。
冷冻疗法诱发的粟丘疹是一种良性疾病，其特征是在液氮冷冻疗法愈合部位出现小的白色真皮囊性病变。这些病变可能单独出现或表现为斑状粟丘疹。虽然发病机制尚不清楚，但我们推测这种情况是沃尔夫氏同形反应的一个例子，即在先前愈合的皮肤病部位出现一种新的、不相关的皮肤病——在这种情况下，是在冷冻疗法造成免疫受损区之后。斑状粟丘疹的诊断通常可通过临床表现确立；如有必要，可进行活检以提供对疑似诊断的病理证实。治疗选择包括手工摘除、外用维甲酸或观察。与我们的患者类似，粟丘疹可能会自行消退。
