Darier病にみられる灰白色斑について—その初発疹としての意義の検討

GRAYISH-WHITE FLECKS IN DARIER'S DISEASE

Ⅰ．はじめに

　本邦におけるDarier病の経験は，大正11年松本，日高の第1例以来現在に至るまでに約100例を数え，その臨床的並びに組織学的研究に関しては，日高^1），広田^2），谷村^3），山田^4），和田^5），山本・大矢^7），柏村^8），須賀^9），高石^10），橋爪^11），原田^12），小野・寺山^13）等，多数の業績をみるにもかかわらず，本症の初発疹に関しては日高^1）の論文をあげうるのみである。

　最近われわれは，頭部，顔面，頸部，上背部，下腹部等に本症の定型的病像を有する患者の体幹並びに四肢の近位端に，日高のいわゆる原発疹に相当する灰白色斑を併発した症例を観察する機会を得た。そこで，かかる灰白色斑が初発疹か，あるいはAcrokeratosis verruciformis Hopf様皮疹と同様に，本症の不全型となすべきかについて，自験例を記載すると共に，文献的考察を加えつつ検討してみたい。

A 17-year-old boy of Darier's disease with typical clinical lesions on the head, neck, axillae, supra- and infraclavieular regions, middle of the back and hypogastirium is reported. Except these lesions, there scattered grayish-white flecks on the extremities which Hidaka called "primary lesions."

In this case, these grayish-white flecks did not show any tendency to transform into typial verrucous lesions of Darier's disease in spite of the existence of the disease for 7 years, and the clinical picture of the flecks lacked seasonal changes. The histopathology showed no pathognomonic findings of Darier's disease, while miliaria-like red papules occurring in the early stage of a recurred eruption after dermabrasion therapy showed a typical histologic picture. These flecks are not common and usual in Darier's disease, but very few cases with them have been reported in the literature.

Considering all the above-mentioned facts, the authors can not agree with the opinion that these flecks is a common primary change, although Hidaka and Neuman reported that they proved in their cases the transition from the grayish-white fleckle to typics verrucous papules of Darier's disease. The flecks are considered not to be primary lesions, but to show an abortive form of the lesions in Darier's disease, as well as acrodermatitis verruciformis-like lesions.