每日一题_2024.08.02

A 70-year-old woman with a history of hypothyroidism presented to the dermatology clinic with a 1-year history of progressive indentation and darkening of the skin of her forehead. The skin changes had occurred along a wrinkle that had been present for 10 years. On physical examination, a paramedian, linear, atrophic depression with a violaceous border was observed on the right side of the forehead. The depression extended from the orbital rim to the frontal scalp and was associated with cicatricial alopecia. Examination of a skin-biopsy specimen of the depression revealed a perivascular infiltrate of lymphocytes, eosinophils, and plasma cells, along with vacuolar interface dermatitis and dermal scarring. What is the diagnosis?一个70岁的女性，有甲状腺功能减退症的病史，她来到皮肤科诊所，主诉额头皮肤出现逐渐加深的凹陷和色素沉着已经持续了1年。这些皮肤变化发生在已经存在10年的皱纹上。在体格检查中，观察到右侧额头有一个副中线的、线性的、萎缩性凹陷，边缘呈现紫罗兰色。凹陷从眼眶边缘延伸到额部头皮，并伴有瘢痕性脱发。对凹陷处的皮肤活检标本检查显示，血管周围有淋巴细胞、嗜酸性粒细胞和浆细胞的浸润，以及空泡性界面性皮炎和真皮瘢痕。诊断是什么？

A. Alopecia areata斑秃

B. Carcinoma en cuirasse硬皮病

C. En Coup de Sabre剑击痕

D. Lupus panniculitis盘状红斑狼疮

E. hemifacial atrophy (Parry-Romberg syndrome)半侧面部萎缩症（Parry-Romberg综合征）

答案解析：

由于皮肤活检结果显示与早期和晚期混合性硬皮病一致，因此诊断为剑击痕——局限性硬皮病的一种线性亚型。局限性硬皮病，也称为硬斑病，是一种特发性、炎症性硬化性皮肤病，与系统性硬化病不同。剑击痕这个名字来源于其特征性疤痕，类似于剑击的痕迹。病变可能进展到涉及眼眶和大脑，因此需要进行头部影像学检查。在本例中，头部磁共振成像的结果是正常的。经过8个月的阿巴西普治疗，病变的活动性和大小有所减少。

正确答案：C