Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_141_библиотеки_им_акад_М_И_Перельмана
.pdf
70 Scabies, Scabies Mites, Scabies Mite Burrows
https://t.me/med1917
Fig. 70.107 Charcoal
drawing by Jules Meresz—
The Renucci demonstration
(La demostración de Renucci,
1834)
303
Dilated Pore ofWiner
∗∗∗
https://t.me/med1917
71
I have a hole in my facial skin. It’s much bigger than acne
blackheads and there’s not much coming out even if I
squeeze it (Fig.71.1).
Mr. A, a 40-year-old man, has been worried about a wide
hole that appeared on the skin above his forehead recently.
“It’s much bigger than acne blackheads and there’s not much
coming out even if I squeeze it. What is this? How should I
get treated?” he asked. I quickly put the loupe on my
forehead.
Dilated pore of Winer, rst described by Winer in 1954,
is a benign tumor showing follicular differentiation. It is a
relatively common disease, often occurring in adults aged
30–50, and more common in men. It is observed as a single,
large, non-protruding comedo-like lesion on the face,
Fig. 71.1 Dilated pore of Winer
mainly on the cheeks, above the lips, nasolabial folds,
bridge of the nose, and temporal area. The color of the
lesion appears in brown, black, esh color, red, etc. Winer
reported that this disease is a type of trichoepithelioma in
which the follicular epithelium proliferates secondary to
infection or obstruction of the hair follicle opening caused
by cystic acne or other cystic diseases. However, since
there has been no literature report to support this, the evidence is believed to be weak. Therefore, dilated pore of
Winer is currently classied as an adenoma with better differentiation than trichoepithelioma among tumors showing
hair follicular differentiation in appendage tumors. Rarely,
squamous cell carcinoma and basal cell carcinoma have
been reported in dilated pore of Winer (Figs. 71.2, 71.3,
71.4, 71.5, 71.6 and 71.7).
Histologically, the dilated pore of Winer is characterized
by an expanded cyst, the wall of which is squamous epithelial cells with nger-like proliferations. That is, a cyst with
the same wall as the epidermis shows a shape deeply embedded into the dermis, and the cyst wall proliferates thicker as
it goes down, and the cyst wall of the opening is characterized by atrophy. Diseases that require differential diagnosis
include epidermal cysts, comedones, nevus comedonicus,
trichofolliculoma, pilar sheath acanthoma, etc. The treatment
of dilated pore of Winer is surgical excision of the lesion, as
the lesion exists relatively deep, and the effects of electrocautery, chemical peeling, and laser treatment are small. It is
necessary to excise at least 2mm around the dilated pore, but
often, a 2–4mm punch excision is performed for cosmetic
reasons. For Mr. A, smaller dilated pores are directly punched
out, but in this case, it is a rather large dilated pore of Winer,
so I recommended a plastic surgery consultation and referred
him (Figs. 71.8–71.13).
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
J. Y. Jeong, Dermatology Diaries, https://doi.org/10.1007/978-981-97-1578-7_71
305
306
https://t.me/med1917
Figs. 71.2 and 71.3 Dilated pore of Winer—60× magnication
71 Dilated Pore ofWiner
Fig. 71.4 Dilated pore of Winer in the temple area
Fig. 71.6 Dilated pore of Winer observed above the eyebrow
Fig. 71.5 Dilated pore of Winer in the cheekbone area
71 Dilated Pore ofWiner
https://t.me/med1917
307
Fig. 71.7 Dilated pore of Winer in the cheek area
308
https://t.me/med1917
71 Dilated Pore ofWiner
Figs. 71.8–71.13 Punch excision for dilated pore of Winer
Traumatic Anserine Folliculosis
https://t.me/med1917
72
My child has a lot of bumpy things on the skin under his
chin that won’t go away (Fig.72.1).
The mother of a 12-year-old boy, B, asks, “What on earth
is this? This morning, I felt my child’s chin and found a lot
of bumpy things on the skin under his chin. I brought him
here because it didn’t seem right to just leave it!” After a
brief look at his chin, I asked, “What did you use to support
your chin?” He replied, “Huh? Yes. Like this!” and demonstrated his posture (Fig.72.2).
Traumatic anserine folliculosis is a skin condition that
causes goosebump-like lesions on the chin due to continuous
pressure and friction from habits such as propping the chin
on the hand or knee while reading, watching TV, or drawing,
especially in children who are engrossed in something. The
age of onset varies from 7 to 23years, but it mainly appears
in children under 11years old. Small follicular papules with
a rough surface appear in clusters without any conscious
symptoms, and most patients have a habit of postures where
the chin rubs and presses against other skin of the body. This
disease is more common in the pediatric age group because
such habits are common in children, and the skin of children
is more susceptible to friction and pressure. The lesions are
mainly located in the central part of the chin, where small
follicular papules (1–2 mm) with a rough surface of skin
color cluster to form a plaque with unclear boundaries, showing a goosebump-like skin nding, with larger and clearer
papules in the central part and smaller and fainter ones
toward the periphery. Histological ndings can observe an
expanded follicular entrance lled with keratinized material,
and inammatory cell inltration around the follicle is
reported to be rare (Figs.72.3, 72.4, 72.5, 72.6, 72.7, 72.8,
72.9 and 72.10).
If the habit of propping or rubbing the chin with the knee
or hand is eliminated, the lesions are known to completely
disappear, but there are also observed cases where the lesions
continue to persist in a 19-year-old male who had such a
habit in childhood but no longer has it. If the lesion persists,
adjunctive treatments such as keratolytics, topical steroids,
topical retinoids, and topical vitamin D3 derivatives can be
tried. Although a prescription for a treatment cream was
given and explained thoroughly, will B be able to kick that
habit?
Fig. 72.1 Traumatic anserine folliculosis observed under the chin
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
J. Y. Jeong, Dermatology Diaries, https://doi.org/10.1007/978-981-97-1578-7_72
Fig. 72.2 Mr. B has a habit of propping his chin with his st
309
310
https://t.me/med1917
Figs. 72.3 and 72.4 Traumatic anserine folliculosis caused by the habit of propping the chin on a pillow and using a mobile phone
72 Traumatic Anserine Folliculosis
Figs. 72.5 and 72.6 Traumatic anserine folliculosis in children
Figs. 72.7 and 72.8 Traumatic anserine folliculosis in children
72 Traumatic Anserine Folliculosis
https://t.me/med1917
Figs. 72.9 and 72.10 Traumatic anserine folliculosis in 18-and 19-year-old males
311
Woronoff Ring: Psoriasis
https://t.me/med1917
73
One day, the area around my coin-shaped psoriasis
lesions suddenly turned white. Why does this happen?
(Fig.73.1).
Mr. U, a 35-year-old man who had been suffering from
psoriasis for the past 3years, came to see a doctor because he
became concerned after noticing that the area around the
psoriasis lesions on his torso was turning white. He asks,
“Why is the area around the psoriasis suddenly turning so
white?” After all, doctors must study endlessly. In this case,
it would be really embarrassing if I couldn’t answer
(Fig.73.2).
In psoriasis patients, there can be a pale ring of reduced
pigmentation around the plaque-like psoriasis lesion, known
as a Woronoff ring. It was rst described by Woronoff in
1926. The mechanism behind this phenomenon is not yet
fully understood, but it can appear in the natural course of
untreated psoriasis, or after ultraviolet treatment, or after
treatment with steroids, coal tar, anthralin, fumaric acid
esters, methotrexate, or adalimumab. Recently, attention has
been paid to the autoimmune response of CD8+ T cells
against epidermal melanocytes, one of the mechanisms of
psoriasis onset. It has been reported that interleukin-17 and
tumor necrosis factor-α produced by CD8+ T cells inhibit the
production of melanin in melanocytes, leading to reduced
pigmentation. Histopathological ndings of the pale ring
area show mild acanthosis and reduced amount of epidermal
melanin pigment. Although I explained in detail to Mr. U
about the various causes that can lead to this hypopigmentation, my heart is always heavy when dealing with psoriasis
patients who have to silently endure the deterioration of their
quality of life (Fig.73.3 and 73.4).
Fig. 73.1 Woronoff ring around psoriasis lesions
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
J. Y. Jeong, Dermatology Diaries, https://doi.org/10.1007/978-981-97-1578-7_73
Fig. 73.2 Woronoff ring
313
314
https://t.me/med1917
Fig. 73.3 and 73.4 Woronoff ring
73 Worono Ring: Psoriasis
Соседние файлы в папке Библиотека им академика М.И. Перельмана