每日一题_2023.12.28

A 43-year-old woman presented to the dermatology clinic with an 8-year history of yellow-brown spots on her shins. The lesions had been asymptomatic, and she had not sought care for them until they had grown in size. She had no history of diabetes mellitus, hypertension, or thyroid disease. On physical examination, atrophic yellow-brown plaques with telangiectasias and irregular violaceous borders were observed on both shins. A skin biopsy of the right shin was performed. Histopathological analysis showed several layers of necrobiosis within the dermis, perivascular inflammatory-cell infiltrates, collagen degeneration, and findings consistent with granulomatous dermatitis. Which of the following is the most likely diagnosis?

患者女，43岁，小腿黄褐色斑点8年就诊于皮肤科。病变无症状，直到病变增大，她才就诊。患者无糖尿病、高血压或甲状腺疾病病史。体格检查:双侧小腿可见萎缩性黄褐色斑块伴毛细血管扩张，边缘呈不规则紫红色。对右小腿进行皮肤活检。组织病理学分析显示，真皮内有数层坏死、血管周围炎症细胞浸润、胶原变性，并且发现符合肉芽肿性皮炎。下列哪一项是最可能的诊断?

A. Cutaneous sarcoidosis 皮肤结节病

B. Granuloma annulare 环状肉芽肿

C. Necrobiosis lipoidica 类脂性坏死

D. Pigmented purpuric dermatosis 色素紫癜性皮肤病

E. Stasis purpuric dermatosis 淤滞性紫癜性皮肤病

答案解析：

类脂性坏死是一种慢性肉芽肿性皮肤病，常与糖尿病相关，可能发生在血糖控制受损之前。然而，这种情况也见于无糖尿病的人，如该患者，他们的血糖检测结果正常。目前尚无循证治疗指南，病变往往会自行消退。

正确答案：C