Associate Professor, Departments of Dermatology and Pediatrics, Section of Pediatric Dermatology, Medical College of Wisconsin, Milwaukee, WI.
Staff Dermatologist, Aurora Healthcare, Gurnee, IL.
Am J Dermatopathol. 2021 Jan 1;43(1):1-8. doi: 10.1097/DAD.0000000000001662.
Morphea is an autoimmune skin disease with protean clinical manifestations. Histologic features are similarly variable, and skin biopsies may be nondiagnostic. A single-institution retrospective cohort study was conducted. Morphea patients who had a biopsy in 2005-2015 were included, and a histopathological review was conducted by 2 pathologists. There were 51 biopsy specimens from 40 subjects. The most common histologic features were dermal sclerosis (90%), dermal thickening (78%), collagen homogenization (86%), a superficial and deep infiltrate (76%), a moderate-abundant inflammatory infiltrate (73%), and periadnexal fat loss/decreased skin appendages (71%). Twenty-four specimens were not diagnostic of morphea. In these specimens, the main clues to diagnosis included the presence of dermal sclerosis (79%), subtle collagen homogenization (75%), dermal thickening (58%), moderate-to-abundant plasma cells (50%), and perineural inflammation (50%). There were no statistically significant differences between active and inactive lesions, nor untreated and treated lesions. The histopathologic features of morphea are variable and a high proportion of biopsies are not diagnostic. Clinicians and pathologists should have a high degree of suspicion to correctly make the diagnosis of morphea.
硬斑病是一种具有多种临床表现的自身免疫性皮肤病。组织学特征同样具有变异性，皮肤活检可能无法做出明确诊断。本研究开展了一项单机构回顾性队列研究。纳入了 2005 年至 2015 年间进行活检的硬斑病患者，并由 2 位病理学家进行了组织病理学复查。共有 40 名患者的 51 份活检标本纳入研究。最常见的组织学特征是真皮硬化（90%）、真皮增厚（78%）、胶原均质化（86%）、浅层和深层浸润（76%）、中度至丰富的炎症浸润（73%）和附属器周围脂肪丧失/皮肤附属器减少（71%）。24 份标本不能明确诊断为硬斑病。这些标本中，诊断的主要线索包括真皮硬化（79%）、细微的胶原均质化（75%）、真皮增厚（58%）、中至丰富的浆细胞（50%）和神经周围炎症（50%）。活动期和非活动期病变之间、未治疗和治疗后病变之间均无统计学差异。硬斑病的组织病理学特征具有变异性，很大一部分活检无法明确诊断。临床医生和病理科医生应高度怀疑该病，以正确诊断硬斑病。
