Kang Hyun Jin, Kim Hyo Jung, Han Ju Hee, Bang Chul Hwan, Kim Tae-Yoon
Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Ann Dermatol. 2022 Aug;34(4):297-300. doi: 10.5021/ad.20.072.
Inflammatory acquired Blaschko-linear dermatoses (IABLD) are a continuous concept involving diseases such as lichen striatus, blaschkitis, and atopic dermatitis. However, atopic dermatitis that showed increase in severity along Blaschko lines is rarely reported on its own. Herein, we report a rare case of atopic dermatitis with secondary prurigo nodularis along Blaschko lines, which may be valuable in broadening the concept of IABLD. A 28-year-old male presented with multiple, pruritic, brownish nodules on the left lower extremity along Blaschko lines for 3 to 4 years. The patient had atopic dermatitis since childhood. Histopathologic findings revealed compact orthohyperkeratosis, hypergranulosis, spongiosis, and irregular acanthosis in the epidermis. Fibrosis with vertically arranged collagen fibers and perivascular lymphohistiocytic infiltration were shown in the upper dermis. We diagnosed the case as secondary prurigo nodularis along Blaschko lines, accompanied by the preceding atopic dermatitis. We hypothesized that the patient's underlying atopic dermatitis increased in severity along Blaschko lines, and prurigo nodularis occurred due to frequent scratching. The lesions improved with topical methylprednisolone cream, oral antihistamines and intralesional triamcinolone injection.
炎症性获得性线状苔藓样皮肤病（IABLD）是一个连续性概念，涵盖线状苔藓、线状皮炎和特应性皮炎等疾病。然而，单独报道沿Blaschko线严重程度增加的特应性皮炎却很少见。在此，我们报告一例罕见的沿Blaschko线继发结节性痒疹的特应性皮炎病例，这可能有助于拓宽IABLD的概念。一名28岁男性，左下肢沿Blaschko线出现多个瘙痒性褐色结节3至4年。该患者自幼患有特应性皮炎。组织病理学检查发现，表皮有致密正角化过度、颗粒层增厚、海绵形成和不规则棘层肥厚。真皮上层可见垂直排列的胶原纤维纤维化及血管周围淋巴细胞和组织细胞浸润。我们将该病例诊断为沿Blaschko线继发结节性痒疹，伴有先前的特应性皮炎。我们推测，患者潜在的特应性皮炎沿Blaschko线严重程度增加，由于频繁搔抓导致结节性痒疹发生。皮损经外用甲基泼尼松龙乳膏、口服抗组胺药及皮损内注射曲安奈德后好转。
