Wilson-Jones E, Winkelmann R K
Institute of Dermatology, St. John's Hospital for Diseases of the Skin, London, England.
J Am Acad Dermatol. 1988 Mar;18(3):511-21. doi: 10.1016/s0190-9622(88)70074-2.
Twenty-five patients had superficial ulcerative and vegetative pyoderma with granulomatous histologic findings. Healing occurred without systemic corticosteroid therapy in all but three patients. All patients had clinical pyoderma gangrenosum. In five patients the lesion occurred after surgery of the skin. Histopathologic study of 40 biopsy specimens showed focal neutrophilic abscesses of the papillary dermis, often with peripheral palisading histiocytes and foreign-body giant cells. Pseudoepitheliomatous, vegetative hyperplasia and sinus tract formation were observed frequently. All patient had massive areas of plasmacytosis, and 13 had eosinophils. Granulation tissue, hemorrhage, and fibrosis were additional features in some areas. Foreign material in the lesions was considered unimportant, except in one patient with a starch granuloma. Therapy with local corticosteroids, minocycline, tetracycline, or sulfa drugs resulted in healing in 15 patients. We believe that we have identified a localized, limited form of chronic superficial pyoderma gangrenosum with verrucous and ulcerative lesions and a granulomatous histologic appearance that represents a unique pattern of this disease in some patients.
25例患者患有浅表溃疡性和增殖性脓皮病，组织学表现为肉芽肿性。除3例患者外，其余患者均未接受全身糖皮质激素治疗而痊愈。所有患者均患有临床坏疽性脓皮病。5例患者的皮损发生于皮肤手术后。对40份活检标本的组织病理学研究显示，乳头真皮层有局灶性中性粒细胞脓肿，常伴有外周栅栏状组织细胞和异物巨细胞。常可见假上皮瘤样、增殖性增生和窦道形成。所有患者均有大片浆细胞增多，13例有嗜酸性粒细胞。在一些区域还可见肉芽组织、出血和纤维化。除1例有淀粉样肉芽肿的患者外，皮损中的异物被认为并不重要。局部使用糖皮质激素、米诺环素、四环素或磺胺类药物治疗使15例患者痊愈。我们认为，我们已经识别出一种局限性、有限形式的慢性浅表性坏疽性脓皮病，其具有疣状和溃疡性皮损以及肉芽肿性组织学表现，代表了部分患者中该疾病的一种独特模式。
