案例
一名 20 岁皮肤白皙的女性,因颈部 V 形区和前臂背侧出现严重瘙痒的小丘疹前来就诊。这种状况出现在她在海边度春季假期的第 3 天;但她大部分时间是在海滩阴凉处度过的。她记得去年出现了同样的问题。
其他表现
虽然这种皮肤疾病最常表现为丘疹型,[1]Holzle E, Plewig G, von Kries R, et al. Polymorphous light eruption. J Invest Dermatol. 1987;88(3 Suppl):32s-38s.http://www.ncbi.nlm.nih.gov/pubmed/3819473?tool=bestpractice.com 但也可能表现为其他亚型。[1]Holzle E, Plewig G, von Kries R, et al. Polymorphous light eruption. J Invest Dermatol. 1987;88(3 Suppl):32s-38s.http://www.ncbi.nlm.nih.gov/pubmed/3819473?tool=bestpractice.com[2]Kontos AP, Cusack CA, Chaffins M, et al. Polymorphous light eruption in African Americans: pinpoint papular variant. Photodermatol Photoimmunol Photomed. 2002;18:303-306.http://www.ncbi.nlm.nih.gov/pubmed/12535026?tool=bestpractice.com[3]Bansal I, Kerr H, Janiga JJ, et al. Pinpoint papular variant of polymorphous light eruption: clinical and pathological. Eur Acad Dermatol Venereol. 2006;20:406-410.http://www.ncbi.nlm.nih.gov/pubmed/16643137?tool=bestpractice.com 尽管针尖大小的小丘疹变异(直径为 1-3 mm)也很常见,[2]Kontos AP, Cusack CA, Chaffins M, et al. Polymorphous light eruption in African Americans: pinpoint papular variant. Photodermatol Photoimmunol Photomed. 2002;18:303-306.http://www.ncbi.nlm.nih.gov/pubmed/12535026?tool=bestpractice.com[3]Bansal I, Kerr H, Janiga JJ, et al. Pinpoint papular variant of polymorphous light eruption: clinical and pathological. Eur Acad Dermatol Venereol. 2006;20:406-410.http://www.ncbi.nlm.nih.gov/pubmed/16643137?tool=bestpractice.com 但较少表现为出血型。[1]Holzle E, Plewig G, von Kries R, et al. Polymorphous light eruption. J Invest Dermatol. 1987;88(3 Suppl):32s-38s.http://www.ncbi.nlm.nih.gov/pubmed/3819473?tool=bestpractice.com斑块型 PLE (第二常见的 PLE) 的亚型为非常罕见的渗出性多形性红斑型,其可形成花纹状帽章样病变。[4]Calzavara Pinton PG, Venturini M, Capezzera R, et al. Photosensitive erythema multiforme and erythema multiforme-like polymorphous light eruption. Photodermatol Photoimmunol Photomed. 2003;19:157-159.http://www.ncbi.nlm.nih.gov/pubmed/12914602?tool=bestpractice.com猝发或似昆虫叮咬的变异型属于 PLE 的丘疹水疱型。[5]Elpern DJ, Morison WL, Hood AF. Papulovesicular light eruption. A defined subset of polymorphous light eruption. Arch Dermatol. 1985;121:1286-1288.http://www.ncbi.nlm.nih.gov/pubmed/4037822?tool=bestpractice.com[6]Diepgen TL, Haberle M, Fartasch M, et al. Characteristics of polymorphous light dermatosis - results of a prospective survey and study of 302 affected patients. Z Hautkr. 1989:15;64:279-280, 283-285.http://www.ncbi.nlm.nih.gov/pubmed/2735085?tool=bestpractice.com其特征是多个荨麻疹性丘疹包围中央水疱。水疱大疱型也是一种罕见的变异型,表现为丘疹和大疱性病变的混合。[7]Neumann NJ, Holzle E, Lehmann P. Polymorphous light dermatoses. J Dtsch Dermatol Ges. 2004;2:220-224, 226.http://www.ncbi.nlm.nih.gov/pubmed/16281641?tool=bestpractice.com尽管 PLE 表现出不同(多形态)的变异型,而且人与人之间的表现各不相同,但每一例患者的临床表现是单一形态的:即仅限于一种变异型。[1]Holzle E, Plewig G, von Kries R, et al. Polymorphous light eruption. J Invest Dermatol. 1987;88(3 Suppl):32s-38s.http://www.ncbi.nlm.nih.gov/pubmed/3819473?tool=bestpractice.com[6]Diepgen TL, Haberle M, Fartasch M, et al. Characteristics of polymorphous light dermatosis - results of a prospective survey and study of 302 affected patients. Z Hautkr. 1989:15;64:279-280, 283-285.http://www.ncbi.nlm.nih.gov/pubmed/2735085?tool=bestpractice.com PLE 仅累及日晒部位;蔓延非常罕见。[8]Guarrera M, Micalizzi C, Rebora A. Heterogeneity of polymorphous light eruption: a study of 105 patients. Arch Dermatol. 1993;129:1060-1061.http://www.ncbi.nlm.nih.gov/pubmed/8352615?tool=bestpractice.com好发部位(按发生率递减)为喉咙、颈部 V 形区、胳膊和手部伸肌表面、腿部和面部。[9]Berg M. Epidemiological studies of the influence of sunlight on the skin. Photodermatology. 1989;6:80-84.http://www.ncbi.nlm.nih.gov/pubmed/2748434?tool=bestpractice.com[10]Dummer R, Ivanova K, Scheidegger EP, et al. Clinical and therapeutic aspects of polymorphous light eruption. Dermatology. 2003;207:93-95.http://www.ncbi.nlm.nih.gov/pubmed/12835565?tool=bestpractice.com[11]Jansen CT. The natural history of polymorphous light eruptions. Arch Dermatol. 1979;115:165-169.http://www.ncbi.nlm.nih.gov/pubmed/426521?tool=bestpractice.com 儿童面部受累更频繁。[1]Holzle E, Plewig G, von Kries R, et al. Polymorphous light eruption. J Invest Dermatol. 1987;88(3 Suppl):32s-38s.http://www.ncbi.nlm.nih.gov/pubmed/3819473?tool=bestpractice.com青少年春季疹 (juvenile spring eruption, JSE) 表现为累及年轻男性的丘疹水疱疹,已表明是 PLE 的一个亚型。[12]Stratigos AJ, Antoniou C, Papadakis P, et al. Juvenile spring eruption: clinicopathologic features and phototesting results in 4 cases. J Am Acad Dermatol. 2004;50(suppl 2):S57-S60.http://www.ncbi.nlm.nih.gov/pubmed/14726868?tool=bestpractice.com[13]Lava SA, Simonetti GD, Ragazzi M,et al. Juvenile spring eruption: an outbreak report and systematic review of the literature. Br J Dermatol. 2013;168:1066-1072.http://www.ncbi.nlm.nih.gov/pubmed/23374016?tool=bestpractice.com在印度,开展了一项针对疤痕组织中发生 PLE 的病例研究。[14]Balasubramanian P, Jagadeesan S, Sekar L, et al. An interesting observation of polymorphous light eruption occurring on hypopigmented scars. Indian Dermatol Online J. 2015;6:294-296.http://www.idoj.in/article.asp?issn=2229-5178;year=2015;volume=6;issue=4;spage=294;epage=296;aulast=Balasubramanianhttp://www.ncbi.nlm.nih.gov/pubmed/26225343?tool=bestpractice.com