인문학
사회과학
자연과학
공학
의약학
농수해양학
예술체육학
복합학
DBpia AI
AI 에이전트
AI 아이디어
AI 리더
AI 뷰어
Citeasy
크롬 서지관리 다운로드
지원사업
학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
커뮤니티
연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
초록·키워드
A healthy 24-year-old man presented with a discrete erythematous scaly plaque on the right mid-back associated with pruritus for 4 weeks. On physical examination, in addition to the plaque, there were several smaller papules scattered on the right mid-back and left mid-back. His family medical history was significant for pemphigus vulgaris and myasthenia gravis. Based on his clinical presentation and associated signs/symptoms, there was a clinical suspicion of psoriasis. A 2-cm punch biopsy was performed. A well-defined, annular, scaly, pink plaque with a raised border and a depressed center (Fig 1) is located on the right mid-back. A confocal microscopy assessment was obtained using line-field confocal optical coherence tomography (LC-OCT). In the two-dimensional vertical (histologic) view (Fig 2) and “en face” views (Fig 3), hyperkeratosis was seen in the form of thickened bright structures in addition to dark polygonal structures corresponding to parakeratosis. Acanthosis was seen as islands of keratinocytes with broadened outlines and dark rounded areas corresponding to spongiosis. There were focal areas of dark globular structures at the tips of the dermal papillae, possibly corresponding to erythrocyte extravasates or dilated capillaries with infiltrate.Fig 3Line-field confocal optical coherence tomography (LC-OCT) (en face) view. A, Hyperkeratosis with focal parakeratosis (yellow arrows) in stratum corneum at 5-μm depth. B, Darker epidermal areas (green bracket) with presence of a few small bright inflammatory cells within the epidermis at 35-μm depth. C, Dermoepidermal junction at 75-μm depth. D, Tips of the dermal papillae with dark globular aggregates likely representing erythrocytes (red box) at 117-μm depth.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The punch biopsy showed a subacute spongiotic process (Fig 4). Epidermal hyperkeratosis, acanthosis, and mild spongiosis were present. There were foci of parakeratosis with mild infiltration of mononuclear cells and extravasation of erythrocytes within the papillary dermis. These features of spongiotic dermatitis are consistent with pityriasis rosea (PR) based on the clinical presentation. LC-OCT is a noninvasive, in vivo, high-resolution imaging technique that provides information regarding the epidermal and superficial- to mid-dermal architecture. It captures vertical and horizontal two-dimensional images to create a three-dimensional image block. It has been used to evaluate histopathologic features of skin cancer, pustular dermatoses, and some eczematous conditions.1Tognetti L. Cinotti E. Falcinelli F. et al.Line-field confocal optical coherence tomography: a new tool for non-invasive differential diagnosis of pustular skin disorders.J Eur Acad Dermatol Venereol. 2022; 36: 1873-1883https://doi.org/10.1111/jdv.18324Crossref PubMed Scopus (7) Google Scholar Although PR may clinically mimic other eczematous dermatoses, which present as erythematous papules and plaques, rapid histopathologic visualization with LC-OCT can help determine the diagnosis. Key differentials that appear histologically as spongiotic dermatitis include psoriasis, contact dermatitis, and nummular eczema. A lack of visualization by LC-OCT of psoriasiform dermatitis, papillomatosis, and Munro microabscesses (usually visible in the epidermis as dark roundish areas with bright particles corresponding to neutrophils) makes the diagnosis of psoriasis less likely. In acute spongiotic processes, like allergic or irritant contact dermatitis, the widening of intercellular spaces between the keratinocytes forms epidermal vesicles.2Leung A.K.C. Lam J.M. Leong K.F. Hon K.L. Pityriasis rosea: an updated review.Curr Pediatr Rev. 2021; 17: 201-211https://doi.org/10.2174/1573396316666200923161330Crossref PubMed Scopus (10) Google Scholar Parakeratosis is usually present, and lymphocytic/leukocytic infiltration can also occur. The absence of vesicles makes an acute spongiotic process less likely. While spongiosis and parakeratosis are present in nummular eczema, the presence of focal parakeratosis with hemorrhage supports the diagnosis of PR. In summary, we found good histopathologic correlation of LC-OCT visualization with key findings of focal parakeratosis, spongiosis, and erythrocyte extravasation in both “en face” and vertical views. This case report supports the utility of LC-OCT imaging as a clinical diagnostic aid for diagnosing PR. Future studies should evaluate LC-OCT imaging in other spongiotic dermatoses and in larger cohorts of patients with PR. Dr Rao is a speaker for Incyte. All other authors have no disclosures.
인공지능 문자 인식 모델을 통해 추출된 텍스트로, 일부 오타나 오류가 포함될 수 있으나 지속적으로 개선 중입니다.
오류를 발견하셨다면 해당 부분을 드래그한 후 ' 를 통해 신고해주세요.
오류를 발견하셨다면 해당 부분을 드래그한 후 ' 를 통해 신고해주세요.
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