WordNet

an abnormal but benign thickening of the prickle-cell layer of the skin (as in psoriasis)
of or relating to or having acanthosis

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/07/10 07:34:41」(JST)

wiki en

Not to be confused with Acantholysis.

Acanthosis is diffuse epidermal hyperplasia (thickening of the skin).^[1] It implies increased thickness of the Malpighian layer (stratum basale and stratum spinosum).^[2]

References[edit]

^ Kumar, Vinay; Fausto, Nelso; Abbas, Abul (2004) Robbins & Cotran Pathologic Basis of Disease (7th ed.). Saunders. Page 1230. ISBN 0-7216-0187-1.
^ "Acanthosis". DermPathTutor. Department of Dermatology, University of Iowa. September 1995. Retrieved 17 May 2012.

UpToDate Contents

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1. 黒色表皮腫 acanthosis nigricans
2. 成人における刺激性接触皮膚炎 irritant contact dermatitis in adults
3. カウデン症候群などのPTEN過誤腫症候群 pten hamartoma tumor syndrome including cowden syndrome
4. 小児における尖圭コンジローム（肛門性器疣贅） condylomata acuminata anogenital warts in children
5. 外陰部病変の鑑別診断 differential diagnosis of vulvar lesions

English Journal

Using trichloroacetic acid in the treatment of acanthosis nigricans: a pilot study.

Zayed A, Sobhi RM, Abdel Halim DM.Author information The Department of Dermatology, Kasr El-Ainy University Hospital, Cairo University , Cairo , Egypt.AbstractBackground: Despite several therapeutic modalities, acanthosis nigricans (AN) remains a difficult dermatosis to treat. Objective:This study aims to test the safety and efficacy of trichloroacetic acid (TCA) as a chemical peel in the treatment of AN in a random sample of Egyptian female patients. Method: Six females with AN lesions were included in this pilot study. All patients received chemical peeling sessions using TCA over the affected skin lesions. Sessions were carried out to all patients once per week. Treatment was continued for 1 month. Treatment efficacy was evaluated by determining the average rate of response of the lesions to the treatment on a weekly basis. Results: All patients showed improvement as regard hyperpigmentation, thickening, and the overall appearance. The physician assessment was excellent in three lesions, moderate in five, and was mild in two. No side effects had been reported. Conclusion: The study may present TCA as a safe, easy, and an effective method for the treatment of AN.
The Journal of dermatological treatment.J Dermatolog Treat.2014 Jun;25(3):223-5. doi: 10.3109/09546634.2012.674194. Epub 2012 Jun 10.
Background: Despite several therapeutic modalities, acanthosis nigricans (AN) remains a difficult dermatosis to treat. Objective:This study aims to test the safety and efficacy of trichloroacetic acid (TCA) as a chemical peel in the treatment of AN in a random sample of Egyptian female patients. Met
PMID 22494198

Oral malignant acanthosis nigricans associated with endometrial adenocarcinoma.

Chu HW1, Li JM2, Chen GF1, Ma JY3.Author information 1Department of Oral and Maxillofacial Surgery, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.2Hangzhou Stomatological Hospital, Hangzhou, China.3Department of Oral Medicine, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.AbstractWe report a 59-year-old patient with malignant acanthosis nigricans associated with metastasis of endometrial carcinoma. The patient presented papillomatosis lesions that appeared to be benign on multiple skins of body folds, particularly on lips. The lesions in lips and axilla had histological characteristic appearances of acanthosis nigricans, while the masses in abdomen and pelvis were metastasis endometrial adenocarcinoma. The article highlights the importance of biopsy and histopathological diagnosis in presumed benign lesions and the role of doctors in screening for body internal tumors.International Journal of Oral Science (2014) 6, doi:10.1038/ijos.2014.1; published online 10 January 2014.
International journal of oral science.Int J Oral Sci.2014 Jan 10. doi: 10.1038/ijos.2014.1. [Epub ahead of print]
We report a 59-year-old patient with malignant acanthosis nigricans associated with metastasis of endometrial carcinoma. The patient presented papillomatosis lesions that appeared to be benign on multiple skins of body folds, particularly on lips. The lesions in lips and axilla had histological char
PMID 24406633

Reproductive Endocrine Health in Pubertal Females with Epilepsy on Antiepileptic Drugs: Time to Screen?

Rauchenzauner M1, Roscia S2, Prieschl M2, Wildt L3, Haberlandt E4, Baumann M4, Rostasy K4, Agostinelli S5, Pizzolorusso A5, Luef G2, Verrotti A5.Author information 1Department of Paediatrics, Saint Vincent Hospital Zams, Zams, Austria.2Department of Neurology, Epilepsy Unit, Medical University Innsbruck, Innsbruck, Austria.3Department of Gynaecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Innsbruck, Austria.4Department of Paediatrics I, Division of Pediatric Neurology, Medical University Innsbruck, Innsbruck, Austria.5Department of Paediatrics, University of Chieti, Chieti, Italy.AbstractObjectives Although previous studies suggest that valproate (VPA) may induce reproductive endocrine disorders, the effects of newer antiepileptic drugs (AEDs) on reproductive endocrine health have not been widely investigated and compared with those of older AEDs. Therefore, this multicenter cross-sectional study aimed to evaluate the prevalence of reproductive endocrine dysfunctions in pubertal females with epilepsy receiving VPA, lamotrigine (LTG), or levetiracetam (LEV) monotherapy. Patients and Methods Pubertal girls on VPA (n = 11), LTG (n = 8), or LEV (n = 13) monotherapy for at least 6 months were recruited. Healthy sex-matched and age-matched subjects were enrolled as controls (n = 32). Each participant underwent a comprehensive physical examination concerning signs of hyperandrogenism. The Ferriman-Gallwey score of hirsutism was assessed. In addition, all patients completed a standardized questionnaire regarding epilepsy, menstrual cycle, and hirsutism features. Adiposity indices were measured and weight gain was documented for each subject. Results Hirsutism score, occurrence of hyperandrogenism features, and adiposity indices were significantly higher in the VPA group when compared with LEV and control groups. VPA therapy was more frequently associated with weight gain when compared with LTG and controls, whereas no significant differences with regard to signs of hyperandrogenism were found between VPA and LTG groups. Furthermore, no differences in menstrual disorders were observed between groups. Conclusions Pubertal girls with epilepsy receiving VPA monotherapy were more likely to develop signs of hyperandrogenism, that is, hirsutism and acanthosis, than those on LEV or controls. However, no differences in occurrence of menstrual disorders and other reproductive dysfunctions were found between VPA, LTG, LEV, and control groups. These findings do not allow us to clearly determine whether or not VPA, LEV, and LTG monotherapies considerably affect reproductive endocrine health in pubertal girls with epilepsy. Therefore, further prospective studies of larger sample sizes are needed to establish if screening tests should be recommended.
Neuropediatrics.Neuropediatrics.2014 Jan 9. [Epub ahead of print]
Objectives Although previous studies suggest that valproate (VPA) may induce reproductive endocrine disorders, the effects of newer antiepileptic drugs (AEDs) on reproductive endocrine health have not been widely investigated and compared with those of older AEDs. Therefore, this multicenter cross
PMID 24407471

Japanese Journal

皮疹を契機に肺扁平上皮癌が発見された悪性黒色表皮腫の1例 (特集角化症・炎症性角化症)

石崎康子,渡部絢子,長岡愛子 [他]
皮膚科の臨床 55(9), 1097-1100, 2013-09
NAID 40019803673

症例 Generalized Acanthosis Nigricansの1例

米倉直美,三砂範幸,古場慎一 [他]
西日本皮膚科 = The Nishinihon journal of dermatology : 日本皮膚科学会西部支部機関誌 75(4), 309-312, 2013-08
NAID 40019781375

症例胃癌発見の契機となった悪性黒色表皮腫の1例

高塚純子,竹之内辰也,佐藤俊大
皮膚科の臨床 54(7), 991-994, 2012-07
NAID 40019379588

Related Pictures

★リンクテーブル★

リンク元	「乾癬」「扁平苔癬」「尋常性乾癬」「表皮肥厚」「acanth」

「乾癬」

　　[★]

英: psoriasis
関: 角化症

概念

慢性再発性難治性の炎症性角化症
代表的炎症性疾患のひとつで原因は不明：遺伝因子＋環境因子(生活習慣、気候、薬物)　→　HLA-B27と関連していることからautoimmune diseaseとも考えられている。
青年から中年に好発。厚い銀白色の麟屑を伴った紅斑・丘疹が出没、表皮の炎症と表皮細胞のターンオーバーの亢進を認める。

乾癬の階層

角化症

後天性角化症

炎症性角化症

乾癬

病型

尋常性乾癬 psoriasis vulgaris

四肢で著名で厚い麟屑を付着した紅斑

滴状乾癬 guttate psoriasis

背部に散在する軽度の麟屑を伴う紅斑、丘疹　Gibertばら色粃糠疹との区別が重要
先行感染(溶連菌)や慢性経過の乾癬が存在していることが多い。

膿疱性乾癬 pustular psoriasis

広範囲の皮膚の潮紅　紅潮皮膚の上に環状に配列する無菌性膿疱
通常尋常性乾癬を伴う　　長期間のコントロールが必要
難病指定

乾癬性紅皮症 psoriatic erythroderma

膜様の麟屑を伴う　全身皮膚潮紅

乾癬性関節炎 psoriatic arthritis

関節炎を伴う
爪の租造化

爪の租造化は水虫でも見られる

手指の関節の著名な変形
尋常性乾癬を伴うことがある

病因

遺伝的+誘発因子, 悪化因子

誘発因子、悪化因子(外傷、感染症、日光、薬剤、低Ca血症、肥満、妊娠、アルコール摂取、ストレス)

遺伝的背景

家族内発症率→多因子遺伝が発症に関与

両親が乾癬：50%、片親：16.4%、家族歴：4倍
HLA-Cw6と相関

HLA-A1, HLA-B13, HLA-BW16, HLA-B17, HLA-B37, HLA-CW6, HLA-DR7も関連

HLA-B27

疫学

初発年齢：20歳前後に大きなピーク。60歳代に小さなピーク。
白人1-2%(5%に達する国もある), 日本人0.1%　←人種者あり

病変形成＆病理

keratinocyteとlymphocyteの相互作用

乾癬患者と正常者の角化細胞を比べると、乾癬患者の方がT細胞の増殖への影響が大きい
乾癬患者のT細胞は正常者の表皮に乾癬を生じさせた
表皮細胞の遊走能などをTNF-α、IL-8などによって促進
炎症部位に好中球や樹上細胞などを呼び寄せるようなケモカインが出される
血管増殖因子を出す

transglutaminaseが感染患者では表皮全てで発現？

keratinocyteの分化に関わる

通常は顆粒層のみで発現

樹状細胞の関与？

表皮細胞がケモカインを放出→樹状細胞がT細胞を刺激(IL-12/IL-23で抑制される)→T細胞がケラチノサイトの増殖させる。

病理組織像

表皮肥厚 acanthosis：規則的に波打っている
顆粒層消失　→　ケラトヒアリン顆粒を作らないうちに角層に移行するため。
錯核化 parakeratosis：角質層に核が残る
ムンロ微小膿瘍（好中球による無菌性膿瘍）
真皮上層までリンパ球浸潤。好中球、樹状細胞の浸潤が認められる。

病変部、非病変部移行部のkeratin16発現

keratinocyteの最終分化に関与
ケラチン16は炎症がひどいときに発現する

症状

角化性丘疹が癒合した大小さまざまな紅色の局面を特徴とし、表面には典型的な鱗屑が付着

診断

検査

蝋片現象陽性：皮疹の爪を爪などでこすった際に白色鱗屑が見られる
Auspitz現象陽性：鱗屑を剥がすと点状出血を認める(顆粒層減少と毛細血管拡張による)
Kobner現象陽性：しヒンのない部位に外傷などの刺激が加わるとそこに乾癬の皮疹ができる。

治療

完全に治癒することはなく慢性に経過し、悪化・軽快の反復。日常生活に支障がなくなる程度まで直す。

軽症

外用療法(つまり、局所療法)

第一選択薬は活性型ビタミンD3　→　再発までの期間を延長できる

ボンアルファ、ボンアルファハイ、カルシポトリオール(ボネックス)、オキサロール

効果が不十分な場合はステロイド外用も考慮
ただし、very strong以上のステロイドを漫然と投与することは避けるべき
少量のステロイドとビタミンD3の併用療法がトレンドらしい？

ビタミンD3による高カルシウム血症に注意

全身療法

紫外線照射、ビタミンA酸誘導体内服、免疫抑制薬内服

中等症

紫外線治療(PUVA、narrow band UVB）

作用メカニズム；表皮角化細胞の増殖抑制、免疫抑制作用

副作用；火傷、発癌作用（ほかの免疫抑制剤との併用禁忌）、色素沈着(UVAの場合、まだら模様になりうる→narrow band UVBなら防ぐことができる)

PUVA：オキソラレン+UVA。
narrow band UVB：311nm。発癌↓

重症

全身療法

シクロスポリン

作用メカニズム:T cellの活性化抑制
副作用:腎機能障害（血清クレアチニンが30％以上上昇した場合、投与量を少なくするか、投与を中止することが必要）。紫外線療法との併用は禁忌(発癌リスク↑)

エトレチナート

作用メカニズム:分化誘導作用
副作用；催奇形性（女性2年、男性6ヶ月の避妊が必要）、骨形成阻害（小児への長期投与は慎重に）、肝機能障害、高脂血症。(高頻度)口唇炎、手指の落屑。

メトトレキサート

副作用が強いので最後の手段として使用する。
作用メカニズム:表皮角化細胞の増殖抑制
副作用:肝機能障害

日常生活治療、指導、補助

痒みに対する処置～抗ヒスタミン剤、入浴、食べ物(刺激の強い食べ物)
肥満、糖尿病、高脂血症の予防
アルコールの抑制、肝機能障害
スキンケア

角化傾向が強い場合はサリチル酸

参考

1. [charged] Epidemiology, pathophysiology, clinical manifestations, and diagnosis of psoriasis - uptodate [1]
2.

http://sweetmemory.sakura.ne.jp/kansen/kansen03_1.html

USMLE

Q book p.289 9
A 30-year-old woman has chronic, silver-white, scaly patches with an erythematous border on the skin of her knees and elbows.

「扁平苔癬」

　　[★]

ラ: lichen planus
同: 扁平紅色苔癬 lichen ruber planus、紅色苔癬 lichen ruber
関: 角化症

概念

頂上に白色の角質(鱗屑)をつけた多角形の、境界明瞭な灰青色から紫紅色調の扁平隆起性紅斑または丘疹を特徴とする、角化異常を示す皮膚疾患

四肢屈側や口腔に扁平で隆起した灰青色～紫紅色の局面を形成

病因

特発性
薬剤性：

潜在性に進行する(insidiously)。体部のどこ病変がでもみられる。口腔粘膜の病変は30-70%の症例でみられる。粘膜病変は有痛性であり、潰瘍化する。ベーターブロッカー、メチルドパ、ペニシラミン、キニジン、NSAID、ACE阻害薬、SU薬、カルバマゼピン、金製剤、リチウム、キニンが本疾患と関連している。(参考1)
薬剤、化学物質、金属アレルギーでも起こりうる(NDE.251)。