每日一题_2024.09.19

A 42-year-old woman with a 20-pack-year smoking history presented to the dermatology clinic with a 2-year history of a facial rash. One year before presentation, the patient’s rash had been evaluated without a request for removal of her makeup, and treatment for possible acne had been recommended. At the current presentation, a skin examination was performed after removal of her makeup. An indurated plaque with central hypopigmentation, dilated follicular ostia, and alopecia over the right eyebrow were observed, along with a plaque with scattered areas of hyperpigmentation and hypopigmentation on the right cheek. On the left cheek, there were scattered nodules, open comedones, and areas of hyperpigmentation and hypopigmentation. What is the most likely diagnosis?

一位42岁女性，有20年吸烟史，因面部皮疹2年病史来到皮肤科诊所。在就诊前一年，患者的皮疹被评估过，但没有要求她卸妆，推荐了可能的痤疮治疗。在目前的就诊中，进行了卸妆后的皮肤科检查。观察到右眉上方有一个硬化斑块，中央有色素减退，毛囊口扩张，以及眉毛脱落，右侧脸颊上有一个斑块，散在的色素沉着和色素减退区域。在左脸颊上，有散在的结节，开放性粉刺，以及色素沉着和色素减退区域。最可能的诊断是什么？

A. Cutaneous sarcoidosis皮肤结节病

B. Discoid lupus erythematosus盘状红斑狼疮

C. Granuloma faciale面部肉芽肿

D. Lupus vulgaris寻常狼疮

E. Rosacea玫瑰痤疮

答案解析：

对右眉上方皮肤活检标本的检查显示，有苔藓样浸润，涉及真皮-表皮交界处和毛囊上皮，同时毛囊口扩张，伴有浅层和深层真皮的毛囊周围和血管周围淋巴细胞浸润。基底膜增厚和粘液沉积也存在。直接免疫荧光检测在真皮-表皮交界处发现了IgM和IgG的颗粒状沉积。为了评估系统性红斑狼疮的实验室研究，唯一值得注意的是抗核抗体滴度为1:160。诊断为盘状红斑狼疮——一种慢性皮肤红斑狼疮。

正确答案：B