头皮银屑病和脂溢性皮炎的皮肤镜特征分析

目的确定皮肤镜下头皮银屑病和脂溢性皮炎的皮肤镜特征。方法共选取55例进展期或静止期头皮银屑病患者和45例头皮脂溢性皮炎患者。其研究指标为鳞屑颜色、血管形态、血管排列模式。结果头皮银屑病皮肤镜下主要特征为低倍镜下白色或类银白色鳞屑、点/球状血管、规则排列成线状/环状、高倍镜下肾小球状血管。其中,白色或类银白色鳞屑、规则排列、肾小球状血管同时存在时灵敏度为65%,特异度为98%。头皮脂溢性皮炎为黄色鳞屑、低倍下多种血管、高倍下细分支血管和不典型血管,不规则排列。结论皮肤镜下头皮部位银屑病和脂溢性皮炎的不同模式,可用于临床辅助诊断。某些皮肤镜特征同时存在有助于鉴别诊断银屑病。     

反射式共聚焦显微镜在头皮银屑病早期诊断中的应用

目的:探讨头皮银屑病的反射式共聚焦显微镜(RCM,简称皮肤CT)图像特征,分析皮肤CT在其诊治中的临床意义。方法:选取临床拟诊为头皮银屑病患者55例,分别行皮肤CT扫描检查和组织病理检查,分析皮肤CT对头皮银屑病的特征表现及诊断准确度。结果:头皮银屑病皮肤CT的主要特征为角化不全,Munro微脓肿,真皮乳头上顶、真皮乳头密度增加、规则排列,真皮乳头内明显迂曲扩张充血的血管。皮肤CT诊断银屑病47例(85.5%),通过病理检查确诊银屑病49例(89.1%),以病理检查为金标准,皮肤CT检查诊断的灵敏度为91.8%(45/49),特异度为66.7%(4/6),准确度89.1%(49/55),误诊率33.3%(2/6),漏诊率8.2%(4/49),Youden指数为0.585,Kappa值为0.510(P<0.05)。结论:RCM(皮肤CT)扫描检查对头皮银屑病具有辅助诊断及提供鉴别诊断线索的作用,值得临床推广。     

皮肤镜在面部脂溢性皮炎和酒渣鼻诊断和鉴别诊断中的应用

目的:总结面部脂溢性皮炎和酒渣鼻的皮肤镜特征,并评估皮肤镜在二者鉴别诊断中的意义。方法:收集2014年1月—6月在该科就诊的17例面部脂溢性皮炎和19例酒渣鼻患者,行皮肤镜检查,评估皮肤镜下皮损背景、血管形态、血管分布、毛囊性异常等特征出现的频率,以及各特征对于诊断两种疾病的敏感度及特异度。结果:面部脂溢性皮炎常见的皮肤镜表现为红色或黄红色背景,灶性分布的非典型血管或线性分支状血管,毛囊周围淡黄红色油滴状晕,后者在之前的文献中尚无报道;酒渣鼻在皮肤镜下常表现为深红色背景,线性分支状血管弥漫性分布组成多角形血管网,部分患者可见毛囊性脓疱。结论:面部脂溢性皮炎和酒渣鼻具有不同的皮肤镜特征,皮肤镜在二者的诊断和鉴别诊断中具有良好的应用价值。     

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

目的观察点滴型银屑病在反射式共聚焦激光扫描显微镜(RCM)和皮肤镜下的图像特征,为诊断及鉴别点滴型银屑病提供参考依据。方法选取组织病理学确诊的32例点滴型银屑病患者和30例斑块型银屑病患者,每例选1处皮损行RCM及皮肤镜检查,记录并统计各项图像特征。结果点滴型银屑病RCM下主要特征为角化过度、角化不全、Munro微脓肿、颗粒层变薄或缺如、棘层增厚、真皮乳头内毛细血管迂曲扩张、基底细胞层液化、真皮乳头层炎性细胞浸润等。其中Munro微脓肿及基底细胞层液化,在点滴型银屑病中发生率明显高于斑块型银屑病(P0.05);银屑病增生模式在点滴型银屑病中发生率低(P0.05)。点滴型银屑病皮肤镜下主要表现为低倍镜下亮红色背景、白色鳞屑、血管多种排列模式(点/球状、点/球+线状、短棒状血管);高倍镜下发夹样/环状、肾小球状血管。其中短棒状血管及血管灶性分布在点滴型银屑病中更常见(P0.05)。结论 RCM和皮肤镜可作为点滴型银屑病的无创检测方法。     

皮肤镜在面部激素依赖性皮炎和脂溢性皮炎诊断中的应用评价

目的总结面部激素依赖性皮炎和脂溢性皮炎的皮肤镜特征,评估皮肤镜在二者鉴别诊断中的意义。方法选择2015年9月-2016年1月本院收治的面部激素依赖性皮炎(FCAD,47例)和脂溢性皮炎(SD,39例),分析该两组疾病皮肤镜下特点(背景颜色、血管形态、血管排列方式、毛囊异常、鳞屑表现及其他相关指征)。结果该两组疾病患者均见玫瑰花团结构。FCAD患者皮肤镜下见红色或深红色背景下的多形性或分支状血管呈网状或不规则性分布,点状或线状血管比例较低。SD患者为黄红色或红色背景下的多形性或点状血管呈不规则性或簇状排列,多见黄色鳞屑,部分可见毛囊周围黄红色油滴状晕样结构,毛囊角栓。结论 FCAD患者和SD患者皮肤镜下特征截然不同,皮肤镜检查有助于诊断和鉴别诊断该两组疾病。     

2%酮康唑洗剂治疗头皮脂溢性皮炎和头皮银屑病疗效观察

我科于1996年3～6月,用西安杨森制药有限公司生产的2%酮康唑洗剂(采乐)治疗头皮脂溢性皮炎和银屑病共54例,现报道如下。一、病例选择选取门诊诊治的头皮脂溢性皮炎28例中男15例,女13例;年龄8～52岁,平均2929±1404岁;病期1个月至10年。头皮银屑病26例,男16例,女10例;年龄19～58岁,平均3871±1034岁;病期半个月至25年。入选病例为未经治疗或已停治疗一个月者。二、治疗方法温水洗头后,把2～5ｍｌ采乐均匀地搽在头皮上并搓洗头发,使药物在头皮上保留5分钟,然后用水冲净。每周2次,共4周。三、疗效观察头皮脂溢性皮炎主要观察5项指标:头屑、潮红…     

寻常性银屑病、慢性湿疹和玫瑰糠疹187例皮肤镜特征分析

目的 :探讨寻常性银屑病、慢性湿疹、玫瑰糠疹在皮肤镜下的皮损特征。方法 :选取117例寻常性银屑病、50例慢性湿疹和20例玫瑰糠疹患者,使用皮肤镜观察其皮损的背景颜色、鳞屑颜色、鳞屑分布、血管形态、血管排列模式和血管走行方向。结果:皮肤镜下主要特征:寻常性银屑病为低倍下红色背景、白色鳞屑、规则排列模式、点状血管和高倍下肾小球状血管,其特异度依次为29%、44%、26%、77%、96%、97%,红色背景、点状血管、规则排列同时存在时灵敏度为98%,特异度为97%。慢性湿疹为红色背景、黄色鳞屑、不规则排列模式、点状血管和高倍下多种血管形态。玫瑰糠疹为黄色背景,外周内缘游离鳞屑。结论:皮肤镜下寻常性银屑病、慢性湿疹及玫瑰糠疹的不同模式,可用于临床辅助诊断。     

探讨反射式共聚焦显微镜联合皮肤镜在儿童银屑病检查中的应用价值

目的 探讨反射式共聚焦显微镜（RCM）联合皮肤镜在儿童银屑病中的应用价值。方法 收集天津市儿童医院龙岩院区2019年7月—2021年7月收治的746例红斑鳞屑患儿的临床资料,对其中2名以上医师不能确诊为银屑病的78例患儿行RCM、皮肤镜和组织病理学检查,同时对检查结果进行比较及统计学分析。结果 临床不能确诊为银屑病的78例患儿中,经组织病理学诊断实际为银屑病的患儿为65例,仅行RCM的阳性检出率为80.0%(52/65),仅行皮肤镜检查的阳性检出率为69.2%(45/65),行RCM联合皮肤镜检查后,阳性检出率为95.4%(62/65)。以组织病理活检为“金标准”,RCM联合皮肤镜组合检测的敏感度为95.4%(62/65),特异度为81.3%(13/16)。结论 RCM联合皮肤镜的无创检查组合对诊断儿童银屑病有较高的敏感度和特异度,同时此无创检查的组合有无创、实时、动态及可重复性的优点,更适合应用于儿童银屑病的诊断。     

含脂羟酸洗发剂改善头皮脂溢性皮炎及轻中度头皮银屑病患者的头皮损害和生活质量

头皮是一种毛囊密度大且皮脂分泌旺盛的特殊皮肤部位,这些特点导致头皮易患浅表真菌感染(头皮屑、脂溢性皮炎和头癣,前两者发病与真菌的关系密切)、寄生虫感染(头虱病)和某些炎症性皮肤病(银屑病).在上述头皮问题中,头皮屑最常见,50%的人(任何种族和性别)都会罹患,并对他们的生活质量产生较严重影响.     

头皮屑和头皮脂溢性皮炎患者头皮脂类水平及马拉色菌数量的检测

目的:测定有头皮屑及头皮脂溢性皮炎患者与正常受试者头皮表面脂类水平及马拉色菌数量的差异。方法:使用sebumeter于洗发后连续4天测量受试者额、顶、枕部头皮皮脂,并于第4天真菌镜检马拉色菌,记录马拉色菌数量。结果:有头皮屑及头皮脂溢性皮炎组与正常对照组相比,马拉色菌数量显著增高,具有统计学意义(P<0.05)。头皮脂溢性皮炎组较头皮屑组的马拉色菌数量显著增高,具有统计学意义(P<0.05)。在头皮屑及头皮脂溢性皮炎组中,随着炎症程度加重,检出的马拉色菌孢子数增多。结论:马拉色菌感染可能与头皮屑多和脂溢性皮炎有关。     

Confocal microscopic features of scarring alopecia: preliminary report

Background Lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) are the most common causes of lymphocytic primary cicatricial alopecia. The management of scarring alopecia can be difficult. The combination of clinical, dermoscopy and reflectance confocal microscopy (RCM), a noninvasive, high‐resolution imaging technique, examinations have already been demonstrated to be useful for choosing the correct biopsy site in patients with inflammatory skin disease and obtaining microscopic diagnostic criteria. Objectives We evaluated the usefulness in practice of RCM for the identification of criteria for LPP and DLE involving the scalp and their management during therapeutic follow‐up. Methods Seven white patients with a previously established histological diagnosis of DLE (three) and LPP (four), were included in the study. RCM criteria for primary scarring alopecia were selected: epidermal disarray, spongiosis, exocytosis of inflammatory cells in the epidermis, interface dermatitis, peri‐ and intra‐adnexal infiltration of inflammatory cells, dilated vessels in the dermis, dermal infiltration of inflammatory cells and melanophages and dermal sclerosis. All patients were followed up using RCM during the treatment. During follow‐up the RCM evolution of the epidermal, junctional and dermal inflammation were evaluated. Results A series of RCM features of scalp LPP and DLE were identified that show correlation with the histopathological evaluation. During the treatment follow‐up of the cases RCM was shown to be sensitive for the identification of therapeutic response. Conclusion In our preliminary study the effective usefulness of RCM for the diagnosis of scarring alopecia and follow‐up seemed to be evident. Moreover, RCM seems to be also promising for differential diagnosis between the different entities.     

Dermoscopic Findings in Scalp Psoriasis and Seborrheic Dermatitis; Two New Signs; Signet Ring Vessel and Hidden Hair

Background:

Psoriasis and seborrheic dermatitis are both chronic erythemato-squamous dermatoses that can involve the scalp. It may be difficult to differentiate these two diseases when there is isolated scalp involvement. Recently, trichoscopy is commonly used to differentiate noncicatricial alopecias including psoriasis and seborrheic dermatitis that can lead to telogen effluvium (TE).

Objectives:

The objective of this study is to evaluate the trichoscopic figures that may help to differentiate scalp psoriasis and seborrheic dermatitis.

Materials and Methods:

Thirty one with scalp psoriasis and 112 patients with seborrheic dermatitis were enrolled. Trichoscopic examinations were performed using a videodermatoscope (MoleMax 3^®). Trichoscopic findings of scalp psoriasis and seborrheic dermatitis were compared with each other, with 100 healthy individuals and with other noncicatricial alopecias including female androgenetic alopecia (FAGA) (n: 138), male androgenetic alopecia (n: 63), FAGA of male pattern (FAGA.M) (n: 5), alopecia areata (39), TE (n: 22) and trichotillomania (n: 4).

Results:

Atypical red vessels, red dots and globules (RDG), signet ring vessels (SRV), structureless red areas and hidden hairs (HH) were statistically more common in psoriasis while twisted red loops and comma vessels (CV) in seborrheic dermatitis. RDG were considered as the characteristic videodermatoscopic figure for psoriasis and arborizing red lines and CV for seborrheic dermatitis. In comparison with previous reports, our study yielded two new trichoscopic structures supporting the diagnosis of psoriasis; HH and SRV. Besides, according to our study, CV were described for the first time in seborrheic dermatitis and considered to be specific for seborrheic dermatitis.

Conclusion:

This study confirmed that trichoscopy might be useful in differentiating scalp psoriasis and seborrheic dermatitis from each other and from other noncicatricial alopecia with three trichoscopic structures as HH, SRV and CV.     

Histological differential diagnosis of psoriasis vulgaris and seborrheic eczema of the scalp]

The clinical differential diagnosis between seborrheic dermatitis and psoriasis vulgaris of the scalp can be difficult. We, therefore, tried to elaborate histopathological criteria for a differentiation of the two dermatoses. Forty excisional biopsies were analysed without knowing the clinical diagnosis. The histopathological substrate within the epidermis is characterized in psoriasis by dermatitis-like and in seborrheic dermatitis by psoriasis-like alterations. Therefore, in some cases a definite histopathological diagnosis could not be made. Strong criteria favouring psoriasis are: moderate condensed hyperkeratosis with alternating parakeratosis, PAS-reactive serum inclusions and Munro abscesses within the horny layer, spongiform pustles and neutrophilic leukocytes within the epidermis. Strong criteria for seborrheic dermatitis are: irregular acanthosis with relatively thin condensed orthoor parakeratotic horny layer, spongiosis and spongiotic vesicles, exocytosis of lymphocytes and the lack of any hard criterias for psoriasis. The results may suggest that seborrheic dermatitis of the scalp may transform into psoriasis in patients with a genetical disposition ("psoriatic diathesis", "latent psoriasis") via a K?bner reaction. The existence of the seborrheic dermatitis (Morbus Unna) is not doubted by these investigations.     

Videocapillaroscopy in the differential diagnosis between psoriasis and seborrheic dermatitis of the scalp

BACKGROUND: Videocapillaroscopy (VCP) can be used to explore microcirculatory modifications in skin diseases. Psoriasis shows specific capillary alterations reflecting typical histopathological changes. OBJECTIVE: To compare capillary morphology, distribution and density in psoriasis and seborrheic dermatitis of the scalp for differential diagnosis. METHODS: VCP was performed on histology-confirmed scalp lesions of 30 patients with chronic plaque psoriasis, 30 age- and sex-matched patients with seborrheic dermatitis and 30 healthy subjects. The morphology, mean density per mm(2) and mean diameter of capillary loops was measured. RESULTS: Scalp psoriasis exhibited homogeneously tortuous and dilated capillaries (bushy pattern), with a 73 +/- 17 mum (mean +/- standard deviation) diameter of capillary bushes. In contrast, scalp seborrheic dermatitis presented a multiform pattern, with mildly tortuous capillary loops and isolated dilated capillaries, but a substantial preservation of local microangioarchitecture. Mean diameter of capillary bush was significantly lower (27 +/- 4 microm; p < 0.001) and similar to that of the scalp of healthy subjects (21 +/- 5 microm). Capillary loop density was similar in patients with psoriasis (23 +/- 5/mm(2)) seborrheic dermatitis (24 +/- 2/mm(2)) and healthy scalp skin (24 +/- 3/mm(2)). CONCLUSION: VCP could be a useful noninvasive approach for differentiating between psoriasis and seborrheic dermatitis, especially when the scalp is the only affected site.     

Dermoscopy can be useful in differentiating scalp psoriasis from seborrhoeic dermatitis

Background Psoriasis and seborrhoeic dermatitis are common erythematous‐squamous dermatoses that may present with scaly erythematous patches on the scalp. Owing to the similar clinicopathological features of these dermatoses, their differentiation poses a diagnostic challenge, particularly when the lesions on the scalp are isolated. Objectives To evaluate the usefulness of dermoscopy in the clinical differentiation of scalp psoriasis and seborrhoeic dermatitis. Methods This was a retrospective observational study to evaluate the characteristic dermoscopic features of scalp psoriasis and seborrhoeic dermatitis. The study included a total of 96 patients with lesions; these patients were recruited from two tertiary teaching hospitals in Korea (Pusan National University Hospital and Kyungpook National University Hospital). Among these, 55 patients had scalp psoriasis and 41 patients had seborrhoeic dermatitis. Results The most significant dermoscopic features of scalp psoriasis were red dots and globules, twisted red loops, and glomerular vessels. In contrast, seborrhoeic dermatitis was characterized by arborizing vessels and atypical red vessels with the absence of red dots and globules. Featureless areas devoid of any particular vascular patterns were also frequently observed in seborrhoeic dermatitis. Dermoscopic findings of red lines and other vascular patterns were not considered useful for differentiation because these were uncommon features in both diseases. Although scales were observed commonly in both diseases, there was no significant difference in the frequency and characteristics of the scales when they were observed using dermoscopy. Conclusions Our study shows that the investigation of vascular patterns by using dermoscopy can be valuable for the clinical diagnosis and differentiation of scalp psoriasis and seborrhoeic dermatitis.     

Pilot study on the sensitivity and specificity of in vivo reflectance confocal microscopy in the diagnosis of allergic contact dermatitis

The validity, reproducibility, and specificity of patch-testing in the diagnosis of allergic contact dermatitis (ACD) have repeatedly been addressed. In vivo reflectance confocal microscopy (RCM) has been used for real-time evaluation of the histopathologic features of ACD. This pilot study was designed to determine the sensitivity and specificity of RCM in diagnosing ACD in reference to patch-testing. Sixteen participants were patch tested with allergens and control substances. Clinical scoring, digital photography, and RCM evaluation were performed at 72 hours, and RCM images were subjected to blinded evaluation. RCM evaluation parameters included stratum corneum (SC) disruption, parakeratosis, stratum spinosum (SS) and stratum granulosum (SG) spongiosis, and exocytosis. Overall, there was high specificity for all RCM features, ranging from 95.8% to 100%. Sensitivity ranged from 51.9% to 96.3%. Significant parameters with high sensitivity and specificity included spongiosis and exocytosis at the level of SS. Logistic regression analysis was performed on significant variables; P values were determined by chi2 analysis. RCM is a promising noninvasive technology for the evaluation of ACD. SC changes are not helpful in the diagnosis of ACD, although the presence of SG spongiosis and SS spongiosis shows high sensitivity in diagnosing ACD. Larger sensitivity and specificity studies are needed and the identification of ACD has to be based on a defined diagnostic algorithm. A limitation of this study is the small sample size; larger sensitivity and specificity studies are needed to confirm these findings. In addition, individual allergens have to be subjected to further evaluations in order to demonstrate the applicability of our findings for other contact allergens. In that regard, RCM may be considered as an adjunctive tool, rather than a substitute, to clinical evaluation.     

Wound myiasis: the role of entodermoscopy

Although wound or traumatic myiasis is common in tropical countries, only recently cases associated with underlying dermatoses, such as seborrheic dermatitis and psoriasis, have been reported. We describe a patient with seborrheic dermatitis and an ulcerated lesion on the scalp, in which the dermatological examination with the aid of dermoscopy allowed the identification of larvae (maggots) compatible with infestation by Cochliomyia hominivorax. Treatment was performed with oral and topical ivermectin, followed by manual extraction of the larvae.     

[Translated article] Sensitive Scalp: Diagnosis and Practical Management

Sensitive scalp is sensitive skin located on the scalp. Sensitivity is considered primary in the absence of an associated scalp disorder and secondary when caused by conditions such as psoriasis, seborrheic dermatitis, and atopic dermatitis.The clinical manifestations of primary sensitive scalp are subjective. Common presenting symptoms are burning, itching, trichodynia, and dysesthesia, often coinciding with hair loss. Clinically, the skin appears normal or red. An objective diagnosis based on laboratory or histologic findings is not possible. Triggers may be endogenous (e.g., stress and emotional or psychopathological disturbances) or exogeneous (e.g., topical products and cosmetics). Treatment must be individualized. Options include pimecrolimus, hydration with hyaluronic acid, and mesotherapy with plasma rich in growth factors.     

扁平疣皮肤镜和反射式共聚焦显微镜图像特征分析

目的 采用皮肤镜和反射式共聚焦显微镜(RCM)观察扁平疣的图像特征.方法 临床未经治疗的扁平疣患者88例,每例选1处典型皮损先后行皮肤镜及RCM检查,记录并统计各项图像特征.结果 88例扁平疣患者皮肤镜检测显示,48例(54.55％)可见淡红色背景,40例(45.45％)可见淡黄色背景,84例(95.45％)可见散在数量不等的点状出血.RCM检测显示,48例(54.55％)可见类似洋葱皮样的同心圆结构.病程大于1年的57例患者中,44例(77.19％)可见类似洋葱皮样的同心圆结构;病程小于1年的31例患者中,仅有4例(12.90％)可见类似结构,两组检出率差异有统计学意义(x2=33.47,P＜0.05).88例中,86例(97.73％)真表皮交界处可见基底层色素增加,真皮乳头环完整,真皮乳头内血管扩张充血,真皮乳头内可见1～2个增生的毛细血管管腔.8例患者治疗2周后皮肤镜及RCM下观察,上述特征明显消失.结论 结合临床表现,皮肤镜和RCM的图像特征可能为扁平疣的诊断提供帮助.     

Reflectance confocal microscopy in the diagnosis of partially and completely amelanotic melanoma: report on seven cases

Background The clinical diagnosis of amelanotic melanoma is often challenging, because the classical clinical and dermoscopic features of pigmented melanoma are usually missing. The reflectance confocal microscopy (RCM) offers an additional possibility of an in vivo diagnosis of both pigmented and amelanotic melanoma lesions. Objectives To test the value of RCM in vivo in the preoperative prediction of melanoma lesions lacking significant pigment and to compare the results with the evaluation by dermoscopy and histopathology. Methods We examined seven patients with the clinically uncertain differential diagnosis of partially or completely amelanotic melanoma by RCM and dermoscopy prior to surgical excision of the lesions according to the previously suggested dermoscopy algorithm and RCM score for melanoma. The following RCM features were evaluated: major criteria scored +2 (non‐edged papillae, cytological atypia at the dermo‐epidermal junction) and minor criteria +1 (roundish pagetoid cells, widespread pagetoid infiltration, nucleated cells within dermal papillae, cerebriform cell clusters). The dermoscopic evaluation included the following criteria: polymorphous vessels, dotted and linear irregular vessels, hairpin vessels, pink‐erythematous colour, milky red areas, irregularly shaped depigmentation, blue‐grey dots and subtle pigmentation. Results The preoperative in vivo RCM analysis revealed common features of melanoma also found in pigmented melanoma lesions. All lesions showed a score above three in the applied RCM algorithm which was proposed earlier as the threshold for malignancy. In dermoscopy, five of seven lesions showed characteristic vascular changes. Conclusion In vivo RCM is a valuable tool in the preoperative diagnosis of partially and completely amelanotic tumours suspicious for melanoma in addition to dermoscopic evaluation.