Psoriasiform Spongiotic Dermatitis 银屑病样海绵状皮炎

A 50-year-old male presented with generalised skin lesions for 12 months. He reported brown rashes appearing on the arms one year ago. It gradully spread with severe itching and scaling over the arms, legs and torso that coalesced into plaques. His medical history included childhood allergic rhinitis and 20 years of herps papilloma vrius HPV infection still ongoing.

An over-the-counter antifungal ointment was unhelpful. His primary care physician prescribed antihistamine and topical salicylic acid. The lesions did not improve. His dermatologist gave provisional diagnosis eczema, and betamethasone valerate cream was adminnistred topically but to no avail. Biopsy for histopathology was ordered and revealed Psoriasiform Spongiotic Dermatitis. Subsequent oral steroid predinisolone given 2 weeks was ineffective.

Psoriasiform Spongiotic Dermatitis Histology 4

Patient was concerned that potent immunosuppressive therapy may worsen his HPV infection, he sought herbal medication. Physical examination revealed multiple well-circumscribed, scaly plaques on arms, legs, trunk bilaterally. After 3 months of TCM herbal therapy, the lesions had substantially improved, the lesions had been stable in size with lesser itch and thinner. The patient continued with oral TCM herbal monotherapy twice daily. In additional 7 months follow-up, the patient’s lesions resolved completely after 9 months.

Case22 c

Discussion

Psoriasiform Spongiotic Dermatitis is a term pathologists use to describe a pattern of injury in the skin caused by inflammation. This kind of “pattern of injury” is not specific to a single medical condition. It is most commonly seen in a group of medical conditions called eczema.

Spongiosis is intercellular edema which describe widened spaces between keratinocytes, with elongation of intercellular bridges. There is often associated exocytosis of inflammatory cells, with migration from the vasculature into the epidermis.

In Chronic Spongiotic Dermatitis, the spongiosis may be more difficult to appreciate, being instead overshadowed by thickening of the epidermis. Also, a predominance of certain inflammatory cells in association with spongiosis, such as eosinophils or neutrophils, may serve as a clue to a hypersensitivity component or infectious process, respectively.

Psoriasiform Dermatitis refers to a regular pattern of epidermal hyperplasia, there is usually very little fluid or inflammatory cells in the epidermis. In contrast, the epidermis is typically thicker than normal and the epidermis may form long projections that push down into the dermis. Pathologists describe this change as “psoriasiform” because a similar change can be seen in psoriasis. It is observed not just in psoriasis, but also in a number of other, generally chronic skin conditions. In this case presentation, psoriasisform associated with Spongiotic Dermatitis.

一名50岁的男性出现全身皮肤病变12个月。他报告说12个月前手臂上出现了棕色皮疹，随后出现严重的瘙痒，并顺着手臂、腿部和躯干而逐渐蔓延，在手臂、腿部和躯干形成红褐色斑块。他的病史包括 儿童过敏性鼻炎和缠绵20 年的人乳头状瘤病毒感染至今未愈。

非处方抗真菌药膏对皮疹未产生作用，他的家庭医生开出了抗组胺药和局部水杨酸软膏，病变没有改善。他的皮肤科医生给出了湿疹的临时诊断，外用皮质激素软膏戊酸倍他米松，但无济于事。组织病理学活检揭示银屑病样海绵状皮炎。随后2周口服类固醇泼尼松龙也是无效。

病人担心大量强效的免疫抑制疗法会恶化他的HPV感染，他寻求中药的替代疗法。检查发现他的手臂、腿部、躯干上有多块不规则鳞状斑块。经过3个月的中草药治疗，病变已大为改观，病变面积稳定，瘙痒减轻，皮疹变薄。患者继续口服中药，每天两次。经过随后的7个月的治疗，患者的皮疹在9个月后完全消退。

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Reference

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