Gusdorf L, Cribier B
Clinique dermatologique, hôpitaux universitaires de Strasbourg, BP 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
Clinique dermatologique, hôpitaux universitaires de Strasbourg, BP 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
Ann Dermatol Venereol. 2016 Jun-Jul;143(6-7):446-52. doi: 10.1016/j.annder.2016.02.023. Epub 2016 Apr 6.
Terra firma-forme dermatosis was first described in 1987. It is characterized by the appearance in children or adolescents of dirt-like patches despite normal cleansing. The lesions are removed when the skin is rubbed with a 70°C alcohol swab. This largely unknown condition is of uncertain origin but could be due to a keratinisation disorder.
Herein we report the case of a 17-year-old male patient who, after seeking the opinions of a number of doctors, consulted in dermatology for multiple pigmented patches on the trunk and limbs that had appeared one year earlier. These lesions had persisted despite appropriate cleansing. He had no history of endocrine disorders and no familial history of pigmentation disorders. A skin biopsy revealed compact orthokeratotic hyperkeratosis resembling a second layer of stratum corneum on top of a normal layer. Very small granules were seen within this layer and PAS staining revealed spores. These skin lesions disappeared when rubbed with an alcohol swab, resulting in a diagnosis of terra firma-forme dermatosis.
Where a diagnosis of terra firma-forme dermatosis is suspected, confirmation is easy to obtain using an alcohol swab. Nevertheless, the disease is not familiar to dermatologists. The most common differential diagnoses are acanthosis nigricans, reticulate and confluent papillomatosis, and Dowling-Degos disease. Their histopathological appearances are very different and skin biopsy can be useful for diagnosis. These entities belong to a group of disorders involving abnormal keratinisation and pigmentation. Anatomoclinical correlation is essential for optimal management. The appearance of the stratum corneum may play an important role in the diagnosis of terra firma-forme dermatosis.
地衣状皮肤病变于1987年首次被描述。其特征是儿童或青少年身上出现类似污垢的斑块，尽管进行了正常清洁。用70°C酒精棉签擦拭皮肤时，病变会消失。这种在很大程度上尚不为人知的病症起源不明，但可能是由于角化异常所致。
在此，我们报告一例17岁男性患者的病例。该患者在咨询了多位医生后，因一年前躯干和四肢出现多个色素沉着斑块而到皮肤科就诊。尽管进行了适当清洁，这些病变仍持续存在。他没有内分泌紊乱病史，也没有色素沉着障碍的家族史。皮肤活检显示致密正角化性角化过度，在正常角质层之上类似第二层角质层。在这一层内可见非常小的颗粒，过碘酸雪夫染色显示有孢子。用酒精棉签擦拭后，这些皮肤病变消失，从而诊断为地衣状皮肤病变。
在怀疑地衣状皮肤病变的诊断时，使用酒精棉签很容易获得确诊。然而，皮肤科医生对这种疾病并不熟悉。最常见的鉴别诊断是黑棘皮病、网状和融合性乳头瘤病以及道林 - 迪戈斯病。它们的组织病理学表现非常不同，皮肤活检有助于诊断。这些病症属于一组涉及角化和色素沉着异常的疾病。解剖临床相关性对于最佳治疗至关重要。角质层的外观在地衣状皮肤病变的诊断中可能起重要作用。
