爆发性鳞状异型（也称为爆发性角化棘皮瘤）：疾病实体的定义和通过病灶内 5-氟尿嘧啶成功治疗。

Eruptive squamous atypia (also known as eruptive keratoacanthoma): Definition of the disease entity and successful management via intralesional 5-fluorouracil.

机构信息

Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana.

Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri; Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri.

出版信息

J Am Acad Dermatol. 2019 Jul;81(1):111-122. doi: 10.1016/j.jaad.2018.10.014. Epub 2019 May 15.

DOI:10.1016/j.jaad.2018.10.014

PMID:31103317

Abstract

BACKGROUND

Eruptive squamous atypia (ESA), which is an idiopathic, sometimes koebnerizing, proliferation of atypical but well-differentiated keratinocytes (also termed eruptive keratoacanthoma), is often misdiagnosed as cancer and managed by excisional surgery, provoking further koebnerization. A clear definition of this phenomenon and treatment outcome data are lacking.

OBJECTIVE

To define ESA and evaluate efficacy of intralesional (IL) 5-fluorouracil (5-FU) treatment.

METHODS

A retrospective cohort study examined patients with ESA that arose spontaneously or within a recent surgical scar and was treated with IL 5-FU at a tertiary academic center between January 2008 and December 2016. Complete clearance, partial clearance, and number of surgical excisions performed were tabulated.

RESULTS

Of 30 patients with 136 ESA lesions, 20 (67%) had resolution of ESA with IL 5-FU monotherapy. In all, 10 patients (33%) required additional therapy (topical 5-FU, steroids, cryotherapy, or acitretin). No IL 5-FU-treated ESA lesions required surgical excision. The number of excisional procedures decreased significantly (P = .006), with 27 patients (90%) needing fewer excisions 12 months after versus 12 months before initiation of IL 5-FU therapy. Dyspigmentation was the only adverse event.

LIMITATIONS

Limitations include retrospective analysis and use of data from a single institution.

CONCLUSION

With close clinical monitoring, IL 5-FU can be used to successfully treat ESA.

摘要

背景

爆发性鳞状异型（ESA）是一种特发性、有时可出现 Koebner 现象的、不典型但分化良好的角化细胞的增生（也称为爆发性角化棘皮瘤），常被误诊为癌症并通过手术切除进行治疗，从而导致进一步的 Koebner 现象。目前，对于这种现象缺乏明确的定义和治疗结果数据。

目的

定义 ESA，并评估病灶内（IL）5-氟尿嘧啶（5-FU）治疗的疗效。

方法

回顾性队列研究，分析了 2008 年 1 月至 2016 年 12 月期间在一家三级学术中心接受 IL 5-FU 治疗的自发性或近期手术瘢痕内出现的 ESA 患者。记录完全清除、部分清除和进行的手术切除次数。

结果

30 例患者共 136 个 ESA 病变中，20 例（67%）患者接受 IL 5-FU 单一疗法治疗后 ESA 消退。共有 10 例患者（33%）需要额外的治疗（外用 5-FU、类固醇、冷冻疗法或阿维 A）。没有接受 IL 5-FU 治疗的 ESA 病变需要手术切除。接受 IL 5-FU 治疗的患者需要手术切除的次数显著减少（P =.006），与 IL 5-FU 治疗前相比，治疗后 12 个月有 27 例（90%）患者需要的手术切除次数更少。色素沉着异常是唯一的不良反应。