Nishioka S
Department of Dermatology, Kurume University School of Medicine, Japan.
Kurume Med J. 1997;44(2):83-90. doi: 10.2739/kurumemedj.44.83.
Although lichen sclerosus et atrophicus at an early stage and morphea can be differentiated clinically and histologically, both diseases at a late stage present diagnostic difficulties. In this study, collagen and acid glycosaminoglycans in the skin of both morphea and lichen sclerosus et atrophicus were examined by polarization microscopy. Picrosirius red and Toluidine blue (pH 5.8) were used as stains. Under polarized light, the picrosirius red-stained collagen fibers appeared green in the papillary and reticular dermis of morphea, except the fibers immediately below the epidermis, which appeared orange yellow. In lichen sclerosus et atrophicus, the collagen fibers appeared green in the reticular dermis at both early and late stage. In the papillary dermis the fibers appeared orange at an early stage and greenish orange at a late stage. Toluidine blue-stained birefringence in morphea diminished in the presence of MgCl2 at 0.2 M, in lichen sclerosus et atrophicus in the presence of MgCl2 at 0.3 M. Histologically, there were some differences in epidermal changes between the two diseases; the epidermis was thick in morphea and thin in lichen sclerosus et atrophicus. This difference seems to relate to that in the fibers beneath the epidermis.
尽管早期的硬化萎缩性苔藓和硬斑病在临床和组织学上可以鉴别，但这两种疾病在晚期都存在诊断困难。在本研究中，通过偏振显微镜检查了硬斑病和硬化萎缩性苔藓皮肤中的胶原蛋白和酸性糖胺聚糖。使用丽春红和甲苯胺蓝（pH 5.8）作为染色剂。在偏振光下，丽春红染色的胶原纤维在硬斑病的乳头层和网状真皮中呈绿色，但紧挨着表皮下方的纤维呈橙黄色。在硬化萎缩性苔藓中，胶原纤维在早期和晚期的网状真皮中均呈绿色。在乳头层，纤维在早期呈橙色，在晚期呈绿橙色。在0.2M的MgCl2存在下，硬斑病中甲苯胺蓝染色的双折射减弱，在0.3M的MgCl2存在下，硬化萎缩性苔藓中甲苯胺蓝染色的双折射减弱。组织学上，这两种疾病在表皮变化方面存在一些差异；硬斑病的表皮增厚，而硬化萎缩性苔藓的表皮变薄。这种差异似乎与表皮下方纤维的差异有关。
