患儿男,5岁,全身多部位皮肤黄色结节2年.其母亲、舅舅均患高胆固醇血症,父亲血脂正常.辅助检查:血清总胆固醇、低密度脂蛋白胆固醇均明显升高.组织病理:真皮及筋膜内大量泡沫状细胞呈群或结节状排列在胶原束间,可见Touton多核巨细胞.诊断:Ⅱa型家族性高胆固醇血症性结节性黄瘤病杂合子型.

患者女,25岁,因全身泛发灰褐色斑疹3个月就诊.3个月前无明显诱因躯干及四肢出现散在红斑,无明显痒痛,未予特殊处理.红斑范围逐渐扩大,且颜色转变为灰褐色.否认食物、药物等过敏史及家族类似疾病史.体检:各系统无明显异常.皮肤科检查:躯干及四肢散在分布大小不等的圆形或不规则形灰褐色斑疹,部分融合成片,边界尚清,部分灰褐色斑边缘可见隆起性淡红斑(图1).皮损组织病理检查:表皮网篮状角化过度,棘层萎缩变薄,局灶性基底细胞液化变性,真皮浅层可见淋巴细胞浸润,以血管周围显著,真皮可见大量噬色素细胞(图2).

报告1例罕见头皮小汗腺痣合并乳头状汗管囊腺瘤.患者男,78岁,出生时即发现头皮黄豆大小肿物.皮肤科检查:头皮顶部可见一肤色及玫瑰红色斑块.皮损组织病理检查示:部分表皮呈疣状增生,真皮深层可见大量结构正常的小汗腺腺体及导管;另一部分表皮向真皮凹陷形成囊状腔,囊状腔下部可见乳头状突起,乳头状突起由两排细胞组成,乳头状突起基质内可见较多浆细胞.诊断:头皮小汗腺痣合并乳头状汗管囊腺瘤.予手术切除皮损及皮瓣修复术.术后18个月电话随访无复发.

患者,男,29岁.颈部咖啡斑、斑块2年.皮损组织病理示:表皮大致正常,真皮内可见境界清楚的无包膜团块,其内可见胞浆淡染的梭形细胞,细胞核扭曲变长,瘤体内散在肥大细胞.免疫组化:S-100阳性,CD34阳性.诊断为节段型神经纤维瘤病.

报告皮肤孤立性神经纤维瘤1例.患者女,39岁,背部褐色结节1年.皮肤科情况:背部可见一0.8cm×1.0cm大小褐色结节,明显高于皮面.皮损组织病理示:表皮大致正常,真皮浅层可见境界清楚的无包膜团块,其内可见胞浆淡染的梭形细胞,细胞核扭曲变长,瘤体内散在肥大细胞.免疫组化:S-100阳性,EMA、Melan-A、HMB-45均阴性.诊断为孤立性神经纤维瘤.行手术完整切除,随访3年无复发.

目的 对比分析复方倍他米松联合5-氟尿嘧啶与单纯复方倍他米松注射治疗小面积增生性瘢痕的临床效果.方法 选取2018年1月至2019年7月毕节市第一人民医院收治的36例小面积增生性瘢痕患者作为研究对象,按照随机数表法将其随机分为观察组与对照组,每组18例.观察组患者采用复方倍他米松联合5-氟尿嘧啶注射治疗,对照组患者单纯采用复方倍他米松注射治疗,对比观察两组患者温哥华瘢痕量表(VSS)评分及临床疗效.结果 治疗结束后1个月,观察组患者VSS评分为(2.00±0.77)分,明显低于对照组患者的VSS评分(6.22±1.93)分(t=8.616,P<0.001);随访1年后,观察组患者中治愈8例、显效10例,明显优于对照组患者的治愈3例、显效11例、无效4例(Z=-2.340,P=0.019).结论 与单纯应用复方倍他米松相比,应用复方倍他米松联合5-氟尿嘧啶治疗小面积增生性瘢痕可有效促进瘢痕组织消退,改善瘢痕症状,疗效更显著.

Objective To evaluate the clinical value of dermoscopy in the diagnosis of seborrheic keratosis (SK), actinic keratosis (AK) and basal cell carcinoma (BCC). Methods A total of 50 patients with SK, 25 patients with AK and 30 patients with BCC in the First People''s Hospital of Bijie from September 2017 to December 2019 were collected. According to the current diagnostic criteria of dermoscopy, two doctors were arranged to carry out blind independent diagnosis of three kinds of skin tumors. Taking histopathological results as the gold standard, the value of dermoscopy in the diagnosis of three diseases and its consistency with pathological diagnosis were analyzed. Results Compared with pathological diagnosis: ①the diagnostic accuracy of SK by doctors A and B was 95.92％ and 95.74％, the sensitivity was 97.78％ and 97.67％, the specificity was 75.00％ and 75.00％, the misdiagnosis rate was 25.00％ and 25.00％, the missed diagnosis rate was 2.22％ and 2.33％, the Youden index was 72.78％ and 72.67％, respectively, the Kappa value was 0.85 and 0.84; ②the diagnostic accuracy of AK by doctors A and B was 90.91％ and 91.30％, the sensitivity was 94.44％ and 94.74％, the specificity was 75.00％ and 75.00％, the misdiagnosis rate was 25.00％ and 25.00％, the missed diagnosis rate was 5.56％ and 5.26％, the Youden index was 69.44％ and 69.74％, respectively, the Kappa values were 0.70 and 0.71; ③the diagnostic accuracy of BCC by doctors A and B was 92.86％ and 92.86％, the sensitivity was 96.00％ and 96.00％, the specificity was 66.67％ and 67.00％, the misdiagnosis rate was 33.33％ and 33.33％, the missed diagnosis rate was 4.00％ and 4.00％, the Youden index was 62.67％ and 62.67％, the Kappa values were 0.81 and 0.81. Conclusion The diagnostic accuracy of dermoscopy for SK, AK and BCC is close to that of pathological diagnosis, and the diagnostic results of different doctors are consistent, indicating that dermoscopy is of high diagnostic value.

Objective To investigate the diagnostic value of dermoscopy in the screening of common facial skin tumors in the elderly. Methods A total of 238 elderly patients who were clinically diagnosed as common facial skin tumors in Bijie First People '' s Hospital from September 2017 to December 2019 were selected as the research objects. Based on clinical naked eye observation, the diagnosis was carried out according to the indications of dermoscopy. Taking histopathological examination as the gold standard, the value of dermoscopy in the diagnosis of common facial skin tumors in the elderly was observed. Results Of the 238 patients, 49 patients were seborrheic keratosis, 27 patients were basal cell carcinoma, 25 patients were squamous cell carcinoma, 23 patients were solar keratosis, 12 patients were Bowen''s disease, 12 patients were keratoma, 35 patients were sebaceous hyperplasia, 32 patients were soft fibroma, and 23 patients were other. The accuracy of dermoscopy in the diagnosis of head and face skin tumors was 90.34％, which was higher than 70.59％ of naked eye diagnosis, and the difference was statistically significant (P ＜0.05). Conclusion Dermoscopy has good application value in the diagnosis of common facial skin tumors in the elderly, which can be used for clinical auxiliary diagnosis.

报告1例巨大寻常疣继发原位鳞状细胞癌.患者男,54岁,右膝关节斑块10年,破溃结痂2年.皮肤科检查:右膝关节内侧见一范围约5 cm×6 cm角化性斑块,表面乳头状突起,可见厚层痂壳,边界清楚,无破溃、渗出,有臭味,局部轻压痛.皮损组织病理示:表皮角化过度伴角化不全,棘层肥厚,表皮突向下延长,真皮乳头瘤样增生,乳头状突起之间的凹陷处可见明显的颗粒细胞,表皮上部可见挖空细胞;部分表皮全层细胞排列紊乱,大小形态不一,可见异形细胞和角化不良细胞,基底细胞层完整.真皮浅层可见混合炎性细胞浸润.诊断:巨大寻常疣继发原位鳞状细胞癌.予手术完整切除联合植皮治疗,术后半年电话随访,术区恢复良好,无新发皮损.

患儿男,10岁,阴囊多发性丘疹1年.皮肤科情况:右侧阴囊及阴茎根部多发性皮色小丘疹,部分呈丝状突起,触之柔软.皮损组织病理示:表皮轻度角化过度,包绕真皮形成外生性损害,真皮可见疏松排列的胶原纤维、扩张的淋巴管和毛细血管.诊断为儿童阴囊多发性软纤维瘤.

目的 观察CO2点阵激光联合重组人表皮生长因子凝胶(Recombinant human epidermal growth factor,rhEGF)治疗面部凹陷性痤疮瘢痕的疗效及不良反应.方法 收集凹陷性痤疮瘢痕患者34例,试验组采用CO2点阵激光治疗后外用rhEGF均匀涂抹于创面,术后严格防晒.对照组外用生理盐水涂抹,其余治疗、护理等均与实验组相同.治疗3次后观察治疗效果.结果 试验组总有效率(91.2％)略高于对照组(85.3％),差异无统计学意义(P>0.05).试验组ECCA评分明显高于对照组,差异有统计学意义(P<0.05).试验组疼痛评分与对照组相当,差异无统计学意义(P>0.05).结痂持续时间、红斑持续时间、皮肤角质层含水量及不良反应发生率,试验组均优于对照组,差异有统计学意义(P<0.05).结论 CO2点阵激光联合rhEGF治疗面部凹陷性痤疮瘢痕可减少术后不良反应的发生,增加治疗效果,提高患者满意度.

1 临床资料 患者女,68岁,因头皮肿物20年就诊.患者20年前发现头顶处出现一肤色质软的黄豆大小丘疹,无痛痒,未予特殊处理.丘疹渐增大形成隆起性包块,无明显不适.近2年来头部包块迅速增大,感局部胀痛不适,遂就诊本科室.患者否认有类似疾病家族史、外伤史. 体格检查:生命体征正常,神志清楚,浅表淋巴结未触及肿大,神经系统体征阴性.皮肤科检查:头顶部头皮有一约6.5cm×5.5cm×2.5cm包块,质地中等偏软,无压痛及波动感,头皮变薄,发稀疏(见图1).彩超检查:提示未见明显血流信号,考虑头顶部低回声团块.辅助检查:血常规、凝血功能、肝肾功均无明显异常.治疗:予手术完整分离囊肿后皮瓣修复创面缝合(见图2).皮损组织病理示:囊肿位于真皮内,囊壁由上皮细胞组成,基底细胞呈栅栏样排列,棘层细胞淡染,未见颗粒层,囊内容物为均一性嗜酸性物质,部分呈板层状排列,局部可见钙化(见图3).

患儿男,出生3d.患者出生时左手拇指桡侧即有肤色囊性赘生物.皮损组织病理示:角化过度,真表皮分离,真皮乳头层触觉小体,真皮网状层内见增多的神经纤维束.诊断为新生儿漂浮指.

目的:探讨中重度痤疮运用红蓝光联合果酸治疗的临床效果.方法:选择2018年2月-2019年3月期间我院收治的中重度痤疮患者90例为研究对象,随机分为三组,其中A组采用单一红蓝光照射治疗,B组给予果酸治疗,而C组则采用果酸和红蓝光联合治疗,比较两组治疗效果.结果:与A组和B组相比,C组的治疗有效率高,组间比较差异明显(P＜0.05);但是三组的不良反应发生率对比无差异(P＞0.05).结论:果酸联合红蓝光可有效治疗痤疮,尤其对中重度痤疮临床疗效显著,而且安全性高,值得临床推广应用.

1 病例资料 患儿女,9岁,因右侧下腹部、腰部皮肤萎缩6年,于2018年2月9日于本科门诊就诊.6年前不明原因于右下腹部出现片状萎缩斑,呈淡红色,约2cm×3cm大小,边界清楚,无痒痛,未予以治疗.此后萎缩斑逐渐扩大,向右侧腰部扩展,相应皮肤随之凹陷,颜色由淡红逐渐转变为淡褐色,皮肤表面血管明显显露,就诊于外院,诊断为"局限性硬皮病""湿疹"等,外用糖皮质激素软膏(具体不详)治疗,病情无好转.家族中无遗传病史,无类似疾病史,其兄弟姐妹均无类似病史.

1 病例资料 患者男,24岁,自由职业.左肩部外生性肿物渐进性增大6个月,6个月前无诱因于左肩出现米粒大小暗红色结节,稍突起于皮面,呈半球形,触之稍韧,无明显自觉症状,未予以治疗,随时间延长,结节不断增大,明显突出皮面,表面增大,基地较宽,呈蒂状,触之软,无红肿、疼痛,于2017年08月28日入院,入院查体:患者一般情况可,系统检查未见明显异常.专科检查:左肩部皮肤见1个为4 cm×3cm×3 cm大小半球形暗红色肿物,表面可见树枝状血管分布,基底较宽,呈蒂状,质软、活动性好,见图1.入院后积极完善术前相关辅查,明确无手术禁忌后于2017年08月29日在手术室局麻下行左肩部肿物切除术,皮瓣形成修复创面.

1临床资料 患者男,49岁.右小腿皮肤肿物42年,增大伴疼痛4年.42年前无明显诱因患者右小腿内侧出现一肤色丘疹,约蚕豆大小,后逐渐增大,表面欠光滑,无疼痛,偶有瘙痒.自行外用药膏(具体不详)治疗无效,皮损继续增大.4年前皮损已增大至鸡蛋大小,并出现疼痛及渗血渗液,多次于外院行敷药、理疗等治疗(具体诊治不详),皮损未见好转.1周前,患者自制草药外敷,皮损周围出现红斑、水疱,院外未行任何诊治.门诊以“右小腿皮肤鳞状细胞癌伴感染”收入院.患者既往体健,家族中无类似疾病史,无有毒物质及放射物局部接触史.

患者女,14岁,全身泛发黑褐色斑疹11年,其余系统无异常.皮损组织病理示:表皮轻度角化过度,部分表皮突延长,基底层色素明显增多,真皮浅层可见噬色素细胞.诊断为泛发性黑子病.

1临床资料 患者,52岁,女,因“外阴皮肤红斑糜烂伴瘙痒、疼痛10年”入院.患者自述约10年前开始不明诱因双侧外阴皮肤出现红斑,伴有明显瘙痒,初发病时皮损面积小,瘙痒能忍,未作任何治疗.病情渐进性加重后,即反复在当地医院就诊,考虑为湿疹,但疗效差.病来无尿频、尿急、尿痛等症状.曾就诊于我院妇科,行分泌物涂片检查未见杆菌及球菌等感染.既往史:既往体健,家庭成员中无类似病史.查体:一般情况好,心肺腹无明显异常.双大腿内侧、会阴部、大小阴唇及肛周等处皮肤红肿创面,边界清楚,表面糜烂,伴有渗液,可见白色分泌物,无明显溃疡形成,阴毛无脱落,无渗血,无疣状增生性肿物.