皮肤镜联合反射式共聚焦显微镜在头皮银屑病和脂溢性皮炎诊断及鉴别中的应用

betway必威登陆网址（betway.com ）学报››2021,Vol. 42››Issue (2): 89-91.DOI:10.3969/j.issn.1004-7115.2021.02.003

皮肤镜联合反射式共聚焦显微镜在头皮银屑病和脂溢性皮炎诊断及鉴别中的应用

袁瑾¹, 郭平², 屠秀顾¹, 李桂琼¹, 吴泳¹, 蔡良奇¹

厦门大学附属第一医院,1.皮肤科;
2.肝胆胰血管外科,福建厦门 361003

收稿日期:2020-10-10发布日期:2021-09-01
通讯作者:蔡良奇(1968—)男,主任医师,本科,研究方向:炎症性皮肤病。E-mail:clq196806@126.com 。
作者简介:袁瑾(1988—),女,湖南邵阳人,医师,博士,主要从事临床自身免疫性皮肤病工作。E-mail:591845242@qq.com。
基金资助:
福建省卫生计生科研人才培养项目(编号2018-ZQN-83)。

Application of dermoscopy combined with reflective confocal microscope in the diagnosis and differentiation of scalp psoriasis and seborrheic dermatitis

YUAN Jin¹, GUO Ping², TU Xiu-gu¹, LI Gui-qiong¹, WU Yong¹, CAI Liang-qi¹

The First Affiliated Hospital of Xiamen University, 1. Dept. of Dermatology;
2. Hepatobiliary Pancreatic and Vascular Surgery, Xiamen 361003 Fujian, China

Received:2020-10-10Published:2021-09-01

摘要/Abstract

摘要：目的分析皮肤镜联合反射式共聚焦显微镜(RCM)在头皮银屑病和脂溢性皮炎诊断及鉴别中的应用价值。方法纳入25例头皮银屑病(SP)和27例头皮脂溢性皮炎(SD)患者,分析皮损在皮肤镜和RCM下的特征表现,并分析皮肤镜和 RCM诊断灵敏度和特异度。结果对 SP 有较高诊断及鉴别诊断意义的皮肤镜特征包括发夹样血管、环状血管、一致性分布及红色背景,RCM 特征包括真皮乳头上延、真皮乳头扩张和Munro微脓肿。而对 SD 有较高诊断及鉴别诊断意义的皮肤镜特征有非典型血管、灶性分布、无结构区域及黄红色背景,RCM 特征有毛细血管水平扩张及毛囊角栓。结论 SP和SD具有相对特异的皮肤镜和RCM特征,皮肤镜联合RCM在二者诊断和鉴别诊断中具有较高的应用价值。

关键词:头皮银屑病,脂溢性皮炎,皮肤镜,RCM,鉴别诊断

Abstract:Objective:To analyze the application value of dermoscopy combined with reflective confocal microscope (RCM) in the diagnosis and differentiation of scalp psoriasis and seborrheic dermatitis.Methods:25 cases of scalp psoriasis (SP) and 27 cases of scalp seborrheic dermatitis (SD) were included, and the characteristics of skin lesions under dermoscopy and RCM were analyzed, and the sensitivity and specificity of dermoscopy and RCM were analyzed.Results:Dermoscopic features with high diagnostic and differential diagnostic significance for SP included hairpin-like blood vessels, ring-shaped blood vessels, uniform distribution, and red background. RCM features included dermal papilla extension, dermal papillary dilatation, and Munro microabscess. Dermoscopic features with high diagnostic and differential diagnostic significance for SD included atypical blood vessels, focal distribution, unstructured areas, and yellow-red background. RCM features included horizontal expansion of capillaries and follicular horn thrombi. Conclusion: SP and SD have relatively specific characteristics of dermoscopy and RCM. Dermoscopy combined with RCM has high application value in the diagnosis and differential diagnosis of the two.

Key words:scalp psoriasis,seborrheic dermatitis,dermoscopy,RCM,differential diagnosis

中图分类号:

R751

袁瑾, 郭平, 屠秀顾, 李桂琼, 吴泳, 蔡良奇. 皮肤镜联合反射式共聚焦显微镜在头皮银屑病和脂溢性皮炎诊断及鉴别中的应用[J]. betway必威登陆网址（betway.com ）学报, 2021, 42(2): 89-91.

YUAN Jin, GUO Ping, TU Xiu-gu, LI Gui-qiong, WU Yong, CAI Liang-qi. Application of dermoscopy combined with reflective confocal microscope in the diagnosis and differentiation of scalp psoriasis and seborrheic dermatitis[J]. Journal of Shandong First Medical Unversity & Shandong Academy of Medical Sciences, 2021, 42(2): 89-91.

参考文献

[1] 朱冠男,王刚.白细胞介素17A在银屑病发病及治疗中的研究进展[J].中华皮肤科杂志,2020,53(5):390-394.
[2] 刘容君,徐淼,吕仁杰.银屑病患者趋化素样因子1、T淋巴细胞亚群及炎性因子的水平分析[J].国际检验医学杂志,2020,41(6):757-759.
[3] 张杰,缪红莉.健康教育联合药物治疗对头皮脂溢性皮炎患者健康行为及临床疗效的影响[J].医学临床研究,2020,37(3):457-459.
[4] 徐晨琛, 陈典, 刘洁, 等.皮肤镜在头皮银屑病和脂溢性皮炎诊断及鉴别诊断中的应用[J]. 中华医学杂志, 2014,44: 3467-3470.
[5] Grajdeanu IA,Statescu L,Vata D, et al. Imaging techniques in the diagnosis and monitoring of psoriasis[J]. Experimental and therapeutic medicine, 2019, 18(6): 4974-4980.
[6] Kim GW,Jung HJ,Ko HC, et al. Dermoscopy can be useful in differentiating scalp psoriasis from seborrhoeic dermatitis[J]. The British journal of dermatology, 2011, 164(3): 652-656.
[7] Agozzino M,Berardesca E,Donadio C, et al. Reflectance confocal microscopy features of seborrheic dermatitis for plaque psoriasis differentiation[J]. Dermatology (Basel, Switzerland), 2014, 229(3): 215-221.
[8] 王玉兰,李艳,张丽媛,等.头皮脂溢性皮炎RCM与皮肤镜特征分析及与头皮银屑病的鉴别[J]. 中国皮肤性病学杂志,2020,34(3):272-279.
[9] 陈丽萍,黄晓燕,肖易,等.我国特应性皮炎、银屑病、痤疮和荨麻疹的患病率及危险因素[J].中南大学学报(医学版),2020,45(4):449-455.
[10] 李玲娜,李田,高钰寒,等.视网膜颞上分支静脉阻塞合并黄斑水肿的SD-OCT特征及视野分析[J].眼科新进展,2020,40(5):449-452.
[11] 蔡玉辉,胡克甦,张逸.乳酸化壳聚糖/透明质酸复合海绵的生物安全性评价[J].中国组织工程研究,2019,23(10):1558-1563.
[12] 彭红娟,方林彬,郑彪.基于频域光学相干断层扫描(SD-OCT)的视盘周围视网膜总厚度在早期视盘水肿诊断中的应用[J].眼科新进展,2020,40(1):42-45.
[13] 王子杨,杨文利,李栋军,等.IOLMaster 700对白内障术前患者黄斑疾病的筛查价值[J].眼科新进展,2020,40(12):1180-1184.
[14] Lacarrubba F,Ardigò M,Di Stefani A, et al. Dermatoscopy and Reflectance Confocal Microscopy Correlations in Nonmelanocytic Disorders[J]. Dermatologic clinics, 2018, 36(4): 487-501.
[15] 刘洁,邹先彪.《皮肤科学(非肿瘤性皮肤病)中皮肤镜术语和基本参数的标准化:国际皮肤镜协会专家共识》解读[J].中华皮肤科杂志,2020,53(6):409-414.
[16] 鲁丽霞,陈明亮,李芳芳,等.常见甲病的皮肤镜表现[J].中华皮肤科杂志,2020,53(6):479-483.
[17] 鲁功荣,许爱娥.皮肤镜对常见色素减退性疾病的临床图像特征分析技术的建立[J].临床皮肤科杂志,2017,46(6):401-405.
[18] 王诗琪,刘洁,朱庆莉,等.皮肤高频超声和皮肤镜在基底细胞癌术前精确评估中的应用[J].中华皮肤科杂志,2020,53(1):51-55.
[19] 熊斯颖,刘炜钰,李薇,等.反射式共聚焦显微镜在头皮银屑病早期诊断中的应用[J].皮肤性病诊疗学杂志,2019,26(2):78-81.
[20] 秦朋,刘永斌.点滴型银屑病反射式共聚焦激光扫描显微镜和皮肤镜图像特征[J].中国中西医结合皮肤性病学杂志,2020,19(4):333-336.