Hard spots
Introduction
Hard spot introduction Localized scleroderma, also known as morphea, is a skin disease that restricts skin swelling and gradually hardens and shrinks. Occurs in the scalp, forehead, waist and abdomen and limbs. Skin lesions start from a reddish color of varying sizes, with a slightly edematous rash, single or multiple. It gradually hardens yellowish or yellowish white. The surface is smooth and shiny like wax, the central dimples, the hair loss at the skin lesions, the sweating is reduced, the surrounding capillaries are dilated, and the purple color or pigmentation is deepened. Late skin atrophy, hypopigmentation. The lesions have different shapes, and are divided into four types according to the shape: patchy, banded, drip, and generalized. Among them, patchy is the most common. The disease generally has no symptoms, some may have mild itching or tingling, gradually become dull, no obvious systemic symptoms, and limited scleroderma generally does not invade the internal organs. basic knowledge The proportion of illness: 0.0003% Susceptible population: no specific disease population Mode of infection: non-infectious Complications: Scleroderma esophagus Pregnancy with scleroderma Pediatric scleroderma Symptoms associated with scleroderma
Cause
Hard spot cause
Genetic factors (25%):
According to some patients with a clear family history, the incidence of HLA-B8 is increased in critically ill patients and there are chromosomal abnormalities in the relatives of the patients. It is believed that the characteristics of the genetic type may be on the dominant allele of the X chromosome.
Infection factor (20%):
Many patients often have acute infections before onset, including angina, tonsillitis, pneumonia, scarlet fever, measles, sinusitis, etc. Paramyxovirus-like inclusions have been found in patients' striated muscles and kidneys.
Connective tissue metabolism abnormalities (10%):
The patient showed extensive connective tissue lesions, and the collagen content in the skin increased significantly. There were more soluble collagen and unstable intermolecular side chains in the virus active skin lesions, and the activity of collagen synthesis was significantly increased in the fibroblast culture of the patients. .
Vascular abnormalities (15%):
Patients with Raynaud's phenomenon, not only limited to the extremities, but also in the visceral blood vessels; histopathology shows that the skin lesions and internal organs may have small blood vessels (arterial) contracture and intimal hyperplasia, so some people think that this disease is a primary blood vessel Disease, but because vascular disease is not seen in all patients, it is also considered that vascular disease is not the only cause of the disease.
Immune abnormality (20%):
This is the most important view in recent years. A variety of autoantibodies (such as anti-nuclear antibodies, anti-DNA antibodies, anti-ssRNA antibodies, antibodies against scleroderma skin extracts, etc.) can be detected in patients; The number of cells increased, the humoral immunity was significantly enhanced, and the positive rate of circulating immune complexes in systemic patients was as high as 50% or more. Most patients had hypergammaglobulinemia; some cases were often associated with lupus erythematosus, dermatomyositis, rheumatoid arthritis, Sjogren's syndrome or Hashimoto's thyroiditis is complicated. At present, most people think that this disease may be an autoimmune disease caused by a persistent chronic infection based on a certain genetic background.
Prevention
Hard spot prevention
1 Remove infected lesions, pay attention to hygiene, strengthen physical exercise, and improve autoimmune function.
2 life rules, work and rest, comfortable, avoid strong mental stimulation.
3 strengthen nutrition, fasting and cold, pay attention to warming.
Complication
Hard spot complication Complications Scleroderma esophageal pregnancy with scleroderma pediatric scleroderma associated with schizophrenia
Can be complicated by scleroderma esophagus, pregnancy with scleroderma, pediatric scleroderma, scleroderma associated with mental disorders.
Symptom
Hard spot symptoms common symptoms hard skin hardening nodular sclerosis
1. Spotted morphea usually occurs in the upper chest, neck, shoulders, buttocks or thighs. Damage is from the size of the soybean to the five-cent coin, white or ivory clustered or linearly arranged spots, round, sometimes slightly concave. When the lesion is active, there is a purple-red halo around it. The texture is hard in the early stage, and the texture can be soft or have a "parchment" feeling. The lesions develop very slowly, expanding to the periphery and merging or persisting. Some skin lesions can subside, and local residual mild atrophic pigmentation.
2, plaque plaque disease is more common. Most often occurs in the abdomen, back, neck, limbs, and face. Initially round or irregular reddish or purplish edematous patches, enlarged over weeks or months, with diameters of 1 to 10 cm or more, pale yellow or ivory. The surface is dry and smooth, with a waxy luster, a mild purple-red halo around it, a leather-like hardness, sometimes accompanied by telangiectasia. No sweat or hair. After a slow period of time, the hardness is reduced, gradually shrinking, and the central pigment is lost. It can invade the dermis and superficial skin, but it can still move. The number and location of lesions vary, and most patients have only one or a few lesions, sometimes symmetrical. Skin lesions can cause cirrhotic atrophic plaque alopecia in the scalp.
3, linear or banded plaque skin hardening often along the intercostal nerve or one limb in a band-like distribution, can also occur in the forehead near the middle of the scalp extension to the scalp cut, local lesions significantly depressed, often start It is atrophic, the skin is thin and not hard, and the degree is unevenly attached to the bone surface. Most of the frontal squamous plaques appear alone, and in some cases, facial atrophy can be combined. Banded lesions often involve shallow and deep subcutaneous layers such as subcutaneous fat, muscles and fascia, and eventually harden the tissue underneath, often causing severe deformities. When the joint surface of the elbow, wrist, or finger is crossed, the joint activity is limited, and the arched contracture and the claw-like hand occur.
4, generalized morphea, spotted, plaque and linear type of damage can be partially or completely combined, a lot of damage, distributed in all parts of the body, but rarely involving the face, damage often has a tendency to fusion, often Combined with joint pain, abdominal pain, neuralgia, migraine and mental disorders, can even be converted to systemic scleroderma.
5, deep morphea Su and Person (1981) reported cases, that is, deep fat film and fascia sclerosis hard spot disease, and sometimes invade the deep and shallow muscles of the dermis and dermis.
6, disabling total sclerosing plaque disease is another type of scleroderma recently reported, occurring in children, the age of onset from 1 to 14 years old, more common in girls. Inflammation and sclerosis of the dermis, subcutaneous tissue, fascia, muscles and bones occur in the limbs, especially on the extension side. The hands, feet, elbows and knees are flexed and contracted, rarely invade the internal organs, and there is no Raynaud phenomenon. The patient may have hardening. Mossy-like skin lesions, typical of other parts of the body can have typical hard spot disease.
Examine
Hard spot inspection
Test blood, urine routine, erythrocyte sedimentation rate, protein electrophoresis, anti-nuclear antibodies, rheumatoid factor, and chest X-ray, barium meal, electrocardiogram and other tests. Perform a biopsy of the skin if necessary.
Generally biochemical examination, serum high protein can be gradually reduced, blood fibrinogen content is higher, the amount of creatinine excretion can be increased in 18 hours. There are many patients with creatine phosphate and serum potassium, urea nitrogen and creatinine can appear to varying degrees of anomalies.
Second, the blood flow diagram for detailed examination, blood flow can be gradually reduced, and the elasticity of blood vessels is poor. Patients with systemic morphea have increased blood stasis, thrombocytopenia, and more eosinophils, so everyone should pay special attention when checking.
Diagnosis
Hard spot diagnosis
Differential diagnosis of hard spots:
(1) plaque plaque disease: skin lesions occur in the abdomen, back and limbs, and are round or oval red edema-like hard spots. After a few years, the skin lesions disappeared and the pigmentation remained.
(2) Drop-shaped morphea: The lesion is composed of numerous miliary round spots, which can occur in any part of the body, and is more common in the neck, chest and back. The lesion progresses slowly and the hard spot can completely resolve.
(3) generalized morphea: skin lesions are extensive, dripping or linear, often accompanied by joint pain, abdominal pain, migraine and visceral damage, some patients can develop into systemic scleroderma.
