異所性に発生したBlack heelの1例

ABERRANT BLACK HEEL

　踵に黒褐色点状皮疹が集簇性に生じる疾患がBazex^1）によつてPseudochromidrose plantaireとして1962年にはじめて報告され，DegosとCivatte^2）は同じ症状を1963年にPseudochromidrose eccrine intra-corneeという病名で報告している．また1965年には，KirtonとPrice^3）により同一疾患と考えられるものが，black heelという病名で報告され，Rookら^4）の編集したTextbook of Dermatologyにはblack heelという病名が採用され，同書では本症が踵にのみ生じることと，運動競技種目，靴，靴下等の種類に関係なく運動後に発生し，あたかも伝染性疾患のように集団発生がみられることに疑問が提出されている．

　最近，われわれは，black heelと臨床的にも，組織学的にも同一と考えられる症例で，皮疹を手掌にのみ生じた例を経験したので，ここに報告し，本症の発生機序について考察を加えた．

A case of this disease in a 15-year-old girl with small black points on the palms, confirmed histologically was reported.

Histologic specimen showed the eosinophilic, PAS-positive, homogeneous substances containing hemoglobin studded almost at the same distance in the horny layer. No hyperkeratosis and no other abnormal finding in the epidermis and cutis could be revealed.

Almost all the homogeneous substances did not have any connection with the sweat duct in the horny layer, although some did. This finding indicates that this substance does not have an essential relationship with the sweat duct.

Although all reported cases had the disease on the sole, this disease on the palm is not unaccountable considering the anatomical similarity of the both sites.

Because all patients in the reported cases and the author's one were healthy and the eruption was temporary, it seemed that it was caused by the similar mechanism as the hemorrhagic friction blister. It may be formed by the movement of the tiny bleeding.