Reusche Ryan, Winocour Sebastian, Degnim Amy, Lemaine Valerie
1 Division of Plastic Surgery, 2 Division of General and Gastroenterologic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Gland Surg. 2015 Dec;4(6):554-60. doi: 10.3978/j.issn.2227-684X.2015.08.02.
Diffuse dermal angiomatosis (DDA) is a rare cutaneous disorder that can affect the breast. A total of nine cases of breast involvement have been described in the literature, but there is currently no consensus in the best therapeutic approach. The objective of this study was to examine patient outcomes with such therapies in women diagnosed with DDA of the breast.
Consecutive cases of DDA of the breast were retrospectively reviewed including patient demographic variables, diagnostic criteria and type of therapies. A successful outcome was defined as complete healing of chronic open breast wounds and absence of disease recurrence after cessation of therapy.
Twenty-two women (mean age, 48.4 years) diagnosed with DDA of the breast were identified between 2004 and 2012. The diagnosis was confirmed with skin biopsy in 12 patients and clinical diagnosis in the remaining ten patients. The majority of patients were obese [68.2% (15/22), average body mass index (BMI), 36.9 kg/m(2)] and at the time of diagnosis, 27.3% of patients were active smokers (6/22). Only two patients (9.1%) received isotretinoin, neither had full recovery and both patients showed recurrence when taken off of therapy. Other medical therapies showed less to no improvement. Two patients underwent successful surgical treatment. One patient had a successful outcome following breast reduction, although her postoperative course was complicated with delayed wound healing. The other patient presented with recurrence of DDA following breast reduction, and was successfully managed with bilateral simple mastectomies.
Our findings suggest that DDA of the breast is associated with macromastia, obesity and tobacco use. Isotretinoin therapy is published as having favorable outcomes to other therapies, but in this series only appears to reduce symptoms rather than eradicate DDA. Our findings indicate that other medical therapies have been attempted with limited success. Surgical management of DDA of the breast may provide definitive treatment.
弥漫性皮肤血管瘤病（DDA）是一种可累及乳房的罕见皮肤疾病。文献中总共描述了9例乳房受累病例，但目前对于最佳治疗方法尚无共识。本研究的目的是探讨诊断为乳房DDA的女性接受此类治疗后的患者结局。
对乳房DDA的连续病例进行回顾性分析，包括患者人口统计学变量、诊断标准和治疗类型。成功的结局定义为慢性开放性乳房伤口完全愈合且治疗停止后无疾病复发。
2004年至2012年间共确定了22例诊断为乳房DDA的女性（平均年龄48.4岁）。12例患者经皮肤活检确诊，其余10例为临床诊断。大多数患者肥胖[68.2%（15/22），平均体重指数（BMI）为36.9kg/m²]，诊断时27.3%的患者为现吸烟者（6/22）。仅2例患者（9.1%）接受了异维A酸治疗，均未完全康复，且停药后均复发。其他药物治疗效果不佳或无改善。2例患者接受了成功的手术治疗。1例患者乳房缩小术后结局良好，尽管术后病程并发伤口愈合延迟。另1例患者乳房缩小术后DDA复发，双侧单纯乳房切除术成功治愈。
我们的研究结果表明，乳房DDA与巨乳症、肥胖和吸烟有关。异维A酸治疗虽被报道比其他治疗效果更好，但在本系列研究中似乎仅能减轻症状而非根除DDA。我们的研究结果表明，尝试的其他药物治疗效果有限。乳房DDA的手术治疗可能提供确定性治疗。
