A case of primary cutaneous amyloidosis in the initial examination of a flying candidate selection and literature review
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目的 探讨招飞学生原发性皮肤淀粉样变病（primary cutaneous amyloidosis，PCA）的诊断、治疗及预防，提高航空医师和体检医师对皮肤病的鉴别诊断能力和航空医学鉴定水平。 方法 回顾性分析1例招飞初检学生PCA的临床诊治情况，并结合文献复习PCA的诊断和治疗。 结果 2022年1月招飞初检学生中检出1例PCA。该患者右下肢及右足背皮肤散在浅褐色斑疹，否认瘙痒等不适症状。患者曾于2007年因右下肢红褐色斑疹3年就诊，行右下肢皮损组织病理学检查，检出真皮乳头层内淀粉样蛋白沉积物，诊断为PCA。本病属于难以治愈的皮肤病，体检结论为不合格。 结论 PCA患者不适合飞行职业，招飞学生诊断为PCA者应予以招飞不合格结论。现役飞行人员明确诊断为PCA者，在治愈后或皮损面积减小、色素沉着消退、瘙痒减轻且随访期内无复发时可鉴定为合格或特许合格，航空医师应注意密切随访观察。 Objective To improve the ability of differential diagnosis of skin diseases and the level of aeromedical assessment by exploring the diagnosis, treatment and prevention of primary cutaneous amyloidosis (PCA) in flying candidate. Methods The clinical diagnosis and treatment of a case of PCA in a student recruited for the first inspection was retrospectively analyzed, and the diagnosis and treatment of PCA literature were reviewed. Results One case of PCA was detected in the students who were recruited for the initial examination in January of 2022. Physical examination revealed scattered light brown macules on the skin of the right lower extremity and dorsum of the right foot, and pruritus and other symptoms were denied. In 2007, the patient presented with a reddish-brown macule on the right lower extremity for 3 years. Histopathological examination of the right lower limb lesions revealed amyloid deposits in the dermal papillae, then the PCA was diagnosed. The disease belongs to the incurable skin disease, and the physical examination concluded as unqualified. Conclusions PCA patients are not suitable for flying occupations. The recruitment students diagnosed with PCA should be eliminated. Active flying personnel with a clear diagnosis of PCA can be identified as qualified or waivered after being cured or when the skin lesion area, pigmentation and pruritus are reduced, and no recurrence during the follow-up period. Flight surgeons should pay close attention to follow-up and observation.
Objective To improve the ability of differential diagnosis of skin diseases and the level of aeromedical assessment by exploring the diagnosis, treatment and prevention of primary cutaneous amyloidosis (PCA) in flying candidate. Methods The clinical diagnosis and treatment of a case of PCA in a student recruited for the first inspection was retrospectively analyzed, and the diagnosis and treatment of PCA literature were reviewed. Results One case of PCA was detected in the students who were recruited for the initial examination in January of 2022. Physical examination revealed scattered light brown macules on the skin of the right lower extremity and dorsum of the right foot, and pruritus and other symptoms were denied. In 2007, the patient presented with a reddish-brown macule on the right lower extremity for 3 years. Histopathological examination of the right lower limb lesions revealed amyloid deposits in the dermal papillae, then the PCA was diagnosed. The disease belongs to the incurable skin disease, and the physical examination concluded as unqualified. Conclusions PCA patients are not suitable for flying occupations. The recruitment students diagnosed with PCA should be eliminated. Active flying personnel with a clear diagnosis of PCA can be identified as qualified or waivered after being cured or when the skin lesion area, pigmentation and pruritus are reduced, and no recurrence during the follow-up period. Flight surgeons should pay close attention to follow-up and observation.
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