頭皮切割性蜂窩組織炎-8個病例之臨床病理分析及文獻回顧-

Dissecting Cellulitis of the Scalp -Clinicopathologic Analysis of Eight Cases and Literature Review-

謝富芳(Fu-Fang Hsieh) ； 許明隆(Mark Ming-Long Hsu) ； 李玉雲(J. Yu-Yun Lee)

《中華皮膚科醫學雜誌》 20卷3期 (2002/09) Pp. 200-206

https://doi.org/10.29784/DS.200209.0001

摘要

頭皮切割性蜂窩組織炎為一種罕見的頭皮慢性化膿性疾病，好發於黑人男性，東方人及白種人極為少見。我們從1988至2001年間成大醫院皮膚部門診病人中搜集8位確定為頭皮切割性蜂窩組織的病例，回溯分析其臨床及病理，病患年齡分布為17歲至26歲(平均為20.6歲)，全為男性。從發病至確定診斷的期間由半個月至5年不等(平均為1.6年)。病灶發生部位主要位於頭頂部。臨床上可見疼痛，具波動性相通的結節，均有局部掉髮的情形。在4例皮膚切片中，病理變化可見從輕微的毛囊破壞、表皮增生，類似於毛囊囊腫破裂之組織反應到很厲害大片的真皮下層及皮下脂肪化膿性和肉芽腫性發炎反應，甚至纖維化的情形。膿液細菌培養結果大部皆為陰性或其他無意義菌種。所有病患分別接受2週至28週(平均13.8週)口服isotretinoin(劑量:0.5~1.0mg/kg/day)治療。在7位有完整追蹤的病人中，3位治療時間超過16週者，只有一位再復發(其使用總劑量不足120mg/kg)，而4位接受治療不足16週者皆再復發。本系列之頭皮切割性蜂窩組織炎是至今所有文獻報告中病例數最多的。根據疾病的致病機轉、組織病理變化及isotretinoin具良好療效等方面分析，我們對本病的名稱適切性做一討論。

並列摘要

Dissecting cellulites of the scalp is an uncommon, chronic, progressive suppurative disease that
predominantly affects black men and only rarely seen in Orientals or Whites. We reported the
clinicopathologic findings of 8 cases diagnosed in the National Cheng-Kung University Hospital
(NCKUH) from 1988 to 2001, the largest series to date. The patients were all young en between 17 and
26 years of old, mean 20.6 years. All presented with painful, fluctuant nodules and abscesses with hair
loss mainly on the vertex of scalp, for durations ranging from 1/2 month to 5 years (mean 1.6 years). Skin
biopsies in 4 patients revealed from ruptured follicular cyst-like findings (mild destruction of hair
follicules and epidermal hyperplasia) in small early lesions to extensive suppurative and granulomatous
inflammation in the lower dermis and subcutis with fibrosis in large or more advanced lesions. Cultures
of drained pus were negative. These patients were treated with oral isotretinoin therapy (dose: 0.5-
1.0mg/kg/day) for 2 to 28 weeks (mean 13.8 weeks). Of 3 patients treated longer than 16 weeks, only one
recurred with total dose less than 120 mg/kg. Four patients receiving short-term therapy ( ＜ weeks )
developed recurrence in about months. Based on the pathogenesis, the histopathologic findings, and the
beneficial effect of isotretinoin, nosology of this disease was discussed.

並列關鍵字

Dissecting cellulitis of the scalp