顔面播種状粟粒性狼瘡の13例

STATISTIC STUDIES ON THIRTEEN CASES OF LUPUS MILIARIS DISSEMINATUS FACIEI

I．はじめに

　顔面播種状粟粒性狼瘡は1878年のT．Foxの報告にはじまり，本邦では大正4年，土肥の報告を嚆矢とする^1）。以後，本症に関する発表，報告は枚挙に遑なく，現在，本邦では結核疹の中の一代表疾患とされている^1）2）。周知の如く，本邦における本症の問題点としては，統計的に第2次大戦後，特に昭和30年代以後増加をみること，さらに病理組織学的には定型的結核結節の形成を主体とし，そのほか類肉腫様構造，上皮嚢腫形成，毛嚢表皮腫様構造を呈する場合もあること，皮膚結核中，ツ反応陽性率が最も低いこと，治療学的には抗結核剤による化学療法に対し反応し難いことなどであり，これらに関連して，類肉腫症との関係が本態論として問題とされている。

　当教室では昭和37年から42年までの6年間に30例の皮膚結核症例を経験したが，うち真正皮膚結核は僅かに2例であり，第1位は本症の13例であつた。これらの症例について報告する。

Statistic studies on 13 cases of lupus miliaris disseminatus faciei for 6 years-from 1962 to 1967-were performed. During that period, number of patients of skin tuberculosis was 30 (about 0.15 % of total outpatients ), which was composed of 2 cases (6.7 %) of true cutaneous tuberculosis and 28 (93.3 %) of tuberculids. The latter included 13 cases (43.3 %) of lupus miliaris disseminatus faciei as a main group and then 12 cases (40 %) of erythema induratum Bazin.

The results of statistics on lupus miliaris disseminatus faciei were as follows :

1) No sex difference in the frequency of occurrence. 2) Age of onset was from 21 to 51. The lesions started mainly in the second and third decades in male, while in rather higher age in female. Number of cases over 40 years of age were 1 in male and 5 in female respectively. 3) The lesions were distributed on the upper and lower eyelids in all cases, on the glabella and cheek in 85%, and in the order of the nasal back and tip, nasolabial folds and chin. 4) One case complained of itching. 5) Sixty percent of cases showed positive tuberculin test, and the results of e.s.r. in 64% of cases were within normal limits. 6) Tuberculous diseases were found in past history of 3 cases and in family history of one case. 7) Histologic specimens from 10 cases showed typical tubercle in 6 cases, sarcoid-like granuloma in two, epidermal cyst formation in one, and trichoepitheliomatous structure in one respectively. No transitional form between the tubercle and sarcoid-like granuloma could be confirmed. There was no relationship between histologic type and tuberculin reaction. 8) Two cases showed satisfactory results with antitu-berculous therapy and 2 cured completely by antituberculous agents accompanied by corticoste-roids.