| Objective:Based on the clinicopathological analysis of 20 cases of atrophic skin lesions in children,the similarities and differences between LCA and LEP were understood,and the relationship between them was discussed in order to have a further understanding of the two diseases.The effect of hydroxychloroquine on LCA and its safety in children were observed.Methods:20 cases of children with atrophic skin lesions and clinically suspected LCA were collected as the subjects of the study.The final diagnosis was made according to the clinical,laboratory and pathological manifestations: group A was LCA and group B was LEP.The clinical,laboratory and pathological manifestations of the two groups were analyzed and their characteristics were summarized.It was also treated with hydroxychloroquine,the efficacy and safety of hydroxychloroquine were observed through clinical follow-up.Results:1)Among 12 cases of group A,there were 4 males and 8 females,the average age of onset was 3 years old,75% of them occurred before 4 years old.the most common site was groin and its adjacent areas(76.5%).The positive rate of ANA was 8.3%.Among 8 cases of group B,there were 4 males and 4 females with an average age of 3.5.the sites were neck and shoulder,waist and buttocks,groin and face.the positive rate of ANA was 75% and the positive rate of titer more than 1:80 was 25%.2)The skin lesions of both groups were atrophic and sunken,12 cases of surface blood vessels were exposed in group A,and 5 cases of slight redness at the edge of atrophy.8 cases of obvious erythema at the edge of atrophy and 3 cases of surface blood vessels in group B.The pathology of the two groups showed that there was no atrophy of epidermis and dermis,and inflammatory infiltration of subcutaneous adipose tissue in varying degrees.In group A,1 case of subcutaneous fat deficiency,11 cases of subcutaneous adipose tissue lymphocytes mainly sparse inflammatory infiltration,including 1 case with mast cells,1 case with foam cells.In addition,1 case of fat lobule was reduced,3 cases of fat septum were widened,and 8 cases of fat cell membrane degeneration.In group B,lymphocytic lobular panniculitis was found in 8 cases,of which plasma cells were found in 7 cases.In addition,basal cell liquefaction was found in 2 cases,fatty cell membrane degeneration was found in 5 cases,adipocyte size was different in 1 case,and phagocytosis was found in 1 case.3)Of the 18 patients treated with hydroxychloroquine,17 had improved rashes to varying degrees.The area of rash was reduced in 7 cases(70%)in group A and 6 cases(75%)in group B,the surface vascular exposure and depression were improved in 9 cases in group A,and the erythema on the atrophic edge disappeared in 8 cases in group B.4)18 patients treated with hydroxychloroquine were examined by ophthalmology and related laboratory every 3 months after treatment,and no other side effects such as eyes were found.Conclusions:1)The main difference between LCA and LEP is that the surface blood vessels at the atrophy of the former are obviously exposed,and the erythema at the edge of the atrophy is obvious in the latter.The main pathological difference was that the degree of inflammatory infiltration in subcutaneous adipose tissue was different,the degree of inflammatory infiltration in LCA was lighter than that in LEP,and LEP was often accompanied by plasma cells.2)the clinicopathological features of LCA and LEP were overlap,suggesting that the two diseases may be a pedigree disease.3)17 of 18 patients treated with hydroxychloroquine were improved.To a certain extent,the efficacy of hydroxychloroquine in LEP was verified,and the role of hydroxychloroquine in LCA was confirmed.4)Hydroxychloroquine was used in the treatment of child patients with a dose of 5 mg ? kg / d,a maximum dose of 250 mg / d and a minimum age of 2 years.no obvious side effects were found in the follow-up for half a year.to a certain extent,the safety of hydroxychloroquine in children was confirmed. |
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