Gan Emily Yiping, Ng See Ket, Goh Chee Leok, Lee Siong See Joyce
National Skin Centre, Singapore.
J Cutan Pathol. 2018 Jul;45(7):491-497. doi: 10.1111/cup.13148. Epub 2018 Apr 23.
There are patients with recalcitrant psoriasiform plaques that do not fit into conventional categories of facial dermatoses. Our study aims to describe the clinicopathological characteristics of several patients with a unique presentation of persistent psoriasiform facial rashes.
This retrospective cross-sectional study analyzed clinical and histological data of known cases of recalcitrant psoriasiform dermatosis of the face diagnosed at National Skin Centre, Singapore, over 10 years.
There were 8 Chinese patients with mean age at onset of 29 years. Majority had pink to pink-orange well-defined plaques with dry scale (n = 6, 75%), distributed mostly on the cheeks (100%) and chin (n = 7, 88%). Hyperkeratosis, parakeratosis, preserved granular layer and psoriasiform hyperplasia were showed in all biopsies. Other common findings included subtle subcorneal acantholysis, "checkerboard" alternating ortho-/parakeratosis, vacuolated keratinocytes and follicular plugging. All patients showed little treatment response. One patient eventually developed features of type II pityriasis rubra pilaris (PRP). Our study was limited by its small sample size and lack of a pre-existing diagnostic code.
This recalcitrant psoriasiform facial dermatosis seems to be a distinct entity, with consistent and reproducible clinical features and a PRP-like histology, bearing some resemblance to the recently described condition-facial discoid dermatosis.
有些患者患有顽固性银屑病样斑块，不符合面部皮肤病的传统分类。我们的研究旨在描述几例持续性银屑病样面部皮疹独特表现患者的临床病理特征。
这项回顾性横断面研究分析了新加坡国家皮肤中心10多年来诊断的顽固性面部银屑病样皮肤病已知病例的临床和组织学数据。
有8名中国患者，平均发病年龄为29岁。大多数患者有粉红色至粉橙色边界清晰的斑块，伴有干性鳞屑（n = 6，75%），主要分布在脸颊（100%）和下巴（n = 7，88%）。所有活检均显示角化过度、不全角化、颗粒层保留和银屑病样增生。其他常见表现包括细微的角层下棘层松解、“棋盘状”交替的正角化/不全角化、空泡化角质形成细胞和毛囊堵塞。所有患者治疗反应不佳。1例患者最终出现了II型毛发红糠疹（PRP）的特征。我们的研究受样本量小和缺乏预先存在的诊断编码的限制。
这种顽固性银屑病样面部皮肤病似乎是一种独特的疾病实体，具有一致且可重复的临床特征和类似PRP 的组织学表现，与最近描述的面部盘状皮肤病有一些相似之处。
