炎症性辺縁隆起性白斑について—Vitiligo with inflammatory raised Border

VITILIGO WITH ELEVATED INFLAMMATORY BORDER

I．はじめに

　通常尋常性白斑は脱色斑のみを主徴とする皮膚疾患で一般には自覚症状を欠如しており，境界明瞭で辺縁部に色素集積がみられることを特徴とするが，自覚的に瘙痒感をもち脱色斑の辺縁に炎症性隆起を伴う特殊な白斑の存在が1928年Freudenthal^1）により第3期梅毒患者の腹部に認められ"luetic leucomelanoderma"と記載したのが最初で，その後1948年Garb ＆ Wise^2）が現在の名称である"Vitiligo with raised Borders"としたもので，白斑の1臨床型として梅毒には関係のないものと考えられている。

　最近までにこの種の白斑例は文献上外国で4例本邦で1例の計5例が報告されているに過ぎず，極めて稀な症例と考えられているようであるが，私共は本学皮膚科外来において最近2年間に本症に該当すると思われるものを4例経験したのでここにまとめて報告し，いささか考察を配することにした。

　Four cases of this disease were reported, of which only 5 cases had been reported in the world.

　They were all women who were 31 to 51 years of age. The lesions existed on the neck in 3 cases, and on the abdomen in 2 cases. They were solitary in 2 cases and multiple in one.

　The lesions were all incomplete depigmented macules surrounded with annular or irregularlyshaped, erythematosquamous, itchy, elevated inflammatory areas.

　Although it had been reported that some cases were accompanied with Sutton's leukoderma or bronchial asthma etc, cases in this study lacked these symptoms, but vitiligo vulgaris or a similar lesion accompanied in 2 cases respectively. In one case possibility of contact allergic mechanism by drug or underware was suggested.

　Histologic specimen from all cases showed acanthosis, intracellular edema of the epidermal cells and liquefaction degeneration of the basal cell layer.

　Three specimens revealed residual melanin granules in depigmented area.

　DOPA whole mount specimen proved decreased DOPA-tyrosinase activity around the boundary area of the macule.