追踪获得性反应性穿通性胶原病的临床皮肤镜和组织病理学演变：一例病例报告
Tracing the clinicodermoscopic and histopathological evolution of acquired reactive perforating collagenosis: a case report.
摘要(中文译文)
获得性反应性穿通性胶原病（ARPC）是一种罕见的穿通性皮肤病，常被误诊，尤其是在明显的经表皮排出形成之前。尽管既往报道中曾零星提及早期皮损，但支持可识别的穿通前阶段的直接临床病理学证据仍然有限。我们报告一例64岁女性患者，有3年进行性泛发性瘙痒性丘疹和结节病史，最初被误诊为湿疹，常规治疗难治。患者有长期2型糖尿病及其他代谢性共病。早期红斑性丘疹的皮肤镜检查显示出细微但可重复的特征，与充分发展的皮损不同。值得注意的是，即使在显示局灶性表皮破坏的早期皮损中，也缺乏典型的穿通性皮肤镜征象。对这些早期皮损的靶向活检显示，真皮浅层胶原异常聚集和排列紊乱，紧贴表皮但无经表皮排出。相比之下，成熟脐凹状斑块的活检显示典型的胶原挤出，其上覆盖角化性栓。连续性Masson三色染色和弹性纤维染色进一步支持从浅层胶原重塑到明显穿通的逐步演变过程。通过将同一患者的皮肤镜表现与连续组织病理学变化相关联，本病例报告提供了直接证据，表明ARPC经历一个可定义的穿通前阶段，在该阶段中单纯表皮破坏不足以诱导胶原排出。识别这一早期阶段对于及时诊断、合理选择活检部位以及避免长期误诊具有重要意义。
Abstract
Acquired reactive perforating collagenosis (ARPC) is a rare perforating dermatosis that is frequently misdiagnosed, particularly before the development of overt transepidermal elimination. Although early lesions have been sporadically mentioned in previous reports, direct clinicopathological evidence supporting a recognizable pre-perforating stage remains limited. We report the case of a 64-year-old woman with a 3-year history of progressive, generalized pruritic papules and nodules, initially misdiagnosed as eczema and refractory to conventional treatments. The patient had long-standing type 2 diabetes mellitus and other metabolic comorbidities. Dermoscopy of early erythematous papules revealed subtle but reproducible features distinct from those of fully developed lesions. Notably, even in early lesions showing focal epidermal disruption, classic dermoscopic signs of perforation were absent. Targeted biopsy of these early lesions exhibited abnormal aggregation and disorganization of dermal collagen in the superficial dermis, closely apposed to the epidermis but without transepidermal elimination. In contrast, biopsies of mature umbilicated plaques revealed typical collagen extrusion with overlying keratotic plugs. Sequential Masson's trichrome and elastic fiber staining further supported a stepwise evolution from superficial collagen remodeling to overt perforation. By correlating dermoscopic findings with sequential histopathological changes in the same patient, this case report provides direct evidence that ARPC progresses through a definable pre-perforating stage, in which epidermal disruption alone is insufficient to induce collagen elimination. Recognition of this early stage has important implications for timely diagnosis, appropriate biopsy selection, and avoidance of prolonged misdiagnosis.
如何引用
AMA
Jue Wang, Lizhu Chen, Xinlong Chen, Nuoyan Li, Mingling Chen, Zhifei Wen. Tracing the clinicodermoscopic and histopathological evolution of acquired reactive perforating collagenosis: a case report.. Frontiers in medicine. 2026; doi:10.3389/fmed.2026.1812713.
APA
Jue Wang, Lizhu Chen, Xinlong Chen, Nuoyan Li, Mingling Chen, Zhifei Wen (2026). Tracing the clinicodermoscopic and histopathological evolution of acquired reactive perforating collagenosis: a case report.. Frontiers in medicine. https://doi.org/10.3389/fmed.2026.1812713
GB/T 7714
Jue Wang, Lizhu Chen, Xinlong Chen, Nuoyan Li, Mingling Chen, Zhifei Wen. Tracing the clinicodermoscopic and histopathological evolution of acquired reactive perforating collagenosis: a case report.[J]. Frontiers in medicine, 2026 doi:10.3389/fmed.2026.1812713.
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