外阴硬化性苔藓的皮肤镜特征分析

目的 探讨外阴硬化性苔藓的皮肤镜特征。方法 回顾性分析2015年8月至2017年6月在北京协和医院皮肤科门诊就诊并行皮肤镜及皮肤组织病理检查的17例外阴硬化性苔藓患者的75处皮损的皮肤镜特征。结果 外阴硬化性苔藓皮损75处常见的皮肤镜特征为黄白色无结构区67处占89.3%,紫红色小球、斑片58处占77.3%,褐色或蓝灰色色素结构37处占49%,亮白色条纹30处占40%,不规则分布的点状21处占28%、线状44处占58.7%、发夹样5处占6.7%、逗号样10处占13%及树枝状血管15处占20%。3处（4%）皮肤镜下可见到玫瑰花瓣征,3处（4%）粉刺样开口,1处（1%）角栓。结论 外阴硬化性苔藓在皮肤镜下具有黄白色无结构区、紫红色小球、斑片、色素结构、多种形态血管等特征性表现。     

硬化萎缩性苔藓15例皮肤镜特征

目的 探讨硬化萎缩性苔藓的皮肤镜表现。 方法 对15例门诊确诊为硬化萎缩性苔藓患者的27处生殖器及生殖器外瓷白色皮损进行皮肤镜特征分析。 结果 皮肤镜检查显示,27处皮损中24处见黄白色无结构区,25处可见线状血管,27处见白色斑片,17处见角栓样结构;4例患者的7处皮损见特征性四叶草样结构,符合硬化萎缩性苔藓。 结论 硬化萎缩性苔藓临床表现不典型,在皮肤镜下可表现出部分特异性模式。     

【开放获取】儿童外阴硬化性苔藓79例皮肤镜特征分析

【摘要】 目的 探讨儿童外阴硬化性苔藓的皮肤镜特征。方法 回顾2019年1月至2021年5月昆明市儿童医院79例外阴硬化性苔藓初诊及复诊时的皮肤镜特征。结果 外阴硬化性苔藓女性患儿79例，年龄2.4 ~ 12岁，发病年龄（5.6 ± 2.12）岁，病程（14.23 ± 12.36）个月，其中30例规律复诊及治疗。初诊329处皮损中，149处（45.3％）可见特征性血管形态，包括线状血管（129处）、点状血管（25处）、盘绕状血管（19处）、发夹样血管（12处）等；207处（62.92%）可见退行性结构及色素异常，包括蓝灰色色素结构（136处）、褐色色素结构（51处）、胡椒粉样模式（15处）等；280处（85.1％）见黄白色无结构区，97处（29.5％）毛囊角栓，66处（20％）紫红色小球、斑片等。复诊238处皮损中，100处（42％）可见特征性血管形态，其中线状血管87处、树枝状血管21处、点状血管4处，未见发夹样血管；154（64.70%）处见退行性结构及色素异常，其中褐色色素结构93处、蓝灰色色素结构57处、胡椒粉样模式4处；165处（69.3％）见黄白色无结构区，62处（26.1％）毛囊角栓，8处（3.4％）紫红色小球、斑片。复诊皮损中观察到的蓝灰色色素结构、黄白色无结构区、紫红色小球、斑片及点状血管、发夹样血管、盘绕状血管比例均低于初诊（均P < 0.05），而褐色色素结构高于初诊（均P < 0.05）。结论 儿童硬化性苔藓皮肤镜下黄白色无结构区具较高特异性，监测镜下褐色色素结构及蓝灰色色素结构、黄白色无结构区、紫红色小球、斑片及血管结构等特征可反映疗效，在辅助诊断及随访观察中有一定应用价值。     

色素性扁平苔藓皮肤镜下特征分析

目的明确色素性扁平苔藓在皮肤镜下图像特征。方法分析45例经组织病理确诊为色素性扁平苔癣的患者,共选取144处皮损皮肤镜下图像特征进行整理分析。结果皮肤镜下18处(12.5%)皮损可见Wickham纹,Wickham纹呈现白色。117处(81.25%)可见尘灰样色素颗粒改变,27处(18.75%)可见色素球、弥漫的色素改变;皮肤镜下共129处(89.58%)可见血管构型变化,其变化为点状或线状。结论皮肤镜可以提高色素性扁平苔藓的临床诊断率,可作为色素性扁平苔藓的辅助诊断手段。     

原发性皮肤淀粉样变研究进展

原发性皮肤淀粉样变(PCA)是一种多病因的综合征,主要表现为真皮乳头层大量的淀粉样蛋白沉积.本病属常染色体显性遗传,可能存在遗传异质性.最新的遗传学研究将其致病基因定位于染色体1q23和染色体5p13.1-q11.2两个区域.临床上主要分为丘疹型(苔藓样)、斑疹型、结节型(肿胀型)和家族性原发性限局性皮肤淀粉样变.皮损好发于两小腿胫前、臂外侧、背部、大腿、躯干和颈部.典型的临床表现为针头大小的褐色斑点,渐变为针头样丘疹,以后发展为苔藓状或结节状或皮肤异色,可伴有剧烈瘙痒.本文就其遗传机制、临床表现、诊断及治疗等做一综述.     

皮肤镜和反射式共聚焦显微镜分析结缔组织痣一例北大核心CSCD

目的探讨结缔组织痣的皮肤镜和反射式共聚焦显微镜（RCM）特征。方法对1例结缔组织痣患者病程1年以内和1年以上的皮损分别进行皮肤镜和RCM观察,结合组织病理进行分析。结果结缔组织痣皮肤镜特征：1年以上的皮损中央呈灰白色斑疹,边界清晰,在灰白色斑疹区域可见白色网纹样结构、棕色小球、红斑、点状或逗状血管,有时可见毳毛及毛周围色素环,在白色斑疹周围环绕较均匀的棕褐色色素,皮损境界清晰;1年以内的皮损中央呈灰白色斑疹,边界清晰,在灰白色斑疹区域有少许散在棕褐色色素、毳毛及毛周围色素环。RCM特征：1年以内皮损,表皮大小形状不同的真皮乳头呈环形拥挤在一起,形成蜂窝状或鹅卵石样结构,其真皮乳头环密度和亮度明显增加,真皮胶原纤维束折射增强,可见胶原束与真皮乳头相连接,个别区域交织或呈漩涡状排列;1年以上皮损,由于表皮增厚,Z轴方向2—3mm深度处组织结构折射光减弱,胶原纤维束不明显,仅见少数淋巴细胞。结论结缔组织痣有独有的皮肤镜特征,并与组织病理和RCM图像有明确的对应关系。RCM对1年以内的早期皮损诊断有帮助。     

反射式共聚焦显微镜联合皮肤镜在经典与色素性扁平苔藓诊断中的应用

目的探讨经典与色素性扁平苔藓在反射式共聚焦显微镜(RCM)及皮肤镜下的主要敏感图像特征。方法收集RCM及皮肤镜下疑似扁平苔藓的患者30例(经典扁平苔藓17例、色素性扁平苔藓13例),选定1处皮损行RCM及皮肤镜检查,然后对该皮损附近或对侧的正常皮肤行RCM及皮肤镜检查,最后取该处皮损进行组织病理检查,记录并分析图像特征。结果皮损处RCM主要敏感图像特征:真表皮交界处指环状结构破坏或部分破坏(基底细胞液化变性)、真皮乳头及其周围或真皮浅层较多大的类圆形或不规则形高折光噬色素细胞及小的圆形较高折光炎细胞浸润。皮损处皮肤镜主要敏感图像特征:经典扁平苔藓为白色网状条纹(Wickham纹);色素性扁平苔藓为蓝灰色色素颗粒、片状均质黄棕色色素。结论反射式共聚焦显微镜联合皮肤镜可作为经典与色素性扁平苔藓的无创诊断手段。     

反射式共聚焦扫描显微镜在原发性皮肤淀粉样变诊断中的应用

目的 探讨原发性皮肤淀粉样变在反射式共聚焦扫描显微镜(RCM)下的主要敏感图像特征.方法 收集17例RCM下疑似原发性皮肤淀粉样变的病例,取该处皮损进行组织病理检查并结晶紫染色,记录并分析图像特征.结果 皮损处RCM主要敏感图像特征:角化过度,棘层轻度增厚,个别真皮乳头内见中低折光团块样物质,浅层血管周围可见嗜黑素细胞...     

脂溢性角化病的皮肤高频超声及皮肤镜特征分析

目的 描述脂溢性角化病（SK）的常见皮肤高频超声及皮肤镜特征。方法 收集2017年8 - 12月在北京协和医院皮肤科门诊就诊的46例SK患者,对其50处SK皮损行50 MHz和20 MHz皮肤高频超声和皮肤镜检查。对SK皮肤高频超声和皮肤镜特征进行总结分析。采用χ2检验比较50 MHz和20 MHz超声对SK的评估结果差异,并对SK皮肤高频超声和皮肤镜下特征的对应关系通过简单匹配系数进行分析。结果 SK皮损特征自上而下50 MHz和20 MHz超声表现分别为增强高回声（48处和39处,P = 0.007）、角质层块状或点状增强高回声（22处和11处,P = 0.019）、伴后方声影（34处和13处,P < 0.001）、皮损形态规则且边界清晰（46处和41处,P = 0.137）、皮损内不均质低回声（50处和47处,P = 0.079）和点状高回声（25处和2处,P < 0.001）、基底位于同一水平面（40处和36处,P = 0.349）、皮损下方真皮回声减低（50处和28处,P < 0.001）。50 MHz超声对SK皮损的8个皮肤高频超声特征整体评价显著优于20 MHz超声（P = 0.002）。50处SK皮损常见皮肤镜下特征为边界清楚（50处）,粉刺样开口（45处）,沟嵴/脑回状模式（31处）,发卡样血管（30处）,多发粟粒样囊肿（24处）,虫蚀状边缘（21处）和亮白色条纹（3处）。50 MHz和20 MHz超声下,SK皮损角质层块状或点状增强高回声与皮肤镜下粉刺样开口的简单匹配系数分别为42%（21处）和20%（10处）,皮损内点状高回声与皮肤镜下多发粟粒样囊肿（> 3个）的简单匹配系数分别为58%（29处）和48%（24处）。结论 皮肤高频超声和皮肤镜对SK皮损评估具有较好的应用价值,且50 MHz超声比20 MHz超声对SK的皮损成像更具优势。     

点阵CO2激光治疗原发性皮肤淀粉样变病疗效评价

目的：评价点阵CO₂激光治疗原发性皮肤淀粉样变病的疗效。方法：采用点阵CO₂激光治疗躯干及四肢原发性皮肤淀粉样变病，60～80 mJ/脉冲,每4周1次，共治疗3次。根据皮损大小、色素沉着及瘙痒对皮损进行评分。结果：共收集2017年12月至2018年12月10例患者，其中苔藓样淀粉样变性4例，斑状淀粉样变性6例。皮损大小、色素沉着及瘙痒由治疗前的36分，35分，38分下降至9分,12分，4分。三次治疗后的总有效率为100%，显效率为90%。未出现严重不良反应。结论：点阵CO₂激光治疗原发性皮肤淀粉样变病安全有效。     

Clinicopathological correlation of pigmented skin lesions using dermoscopy

Dermoscopy (dermatoscopy, epiluminescence microscopy) is an additional measure for making the diagnosis of pigmented skin lesions more accurate. It enables the clinician to visualize features not discernible by the naked eye. By applying enhanced digital dermoscopy and a standardized gross pathology protocol to pigmented skin lesions, a precise clinicopathological correlation of relevant dermoscopic features can be made. Histological specimens of four pigmented skin lesions (melanoma in situ, Clark's nevus, Reed's nevus, seborrheic keratosis) were processed using a standardized gross pathology protocol and viewed along with the clinical photographs and digital dermoscopic images that were magnified and enhanced to better visualize the corresponding dermoscopic structures. Furthermore, measurements of dermoscopic structures using digital equipment were correlated with histometric findings. Our understanding of dermoscopic features, especially the broadened pigment network - a specific dermoscopic criterion for melanoma - was refined by this detailed case-by-case correlation. In addition, some not yet fully characterized dermoscopic features, such as black lamella, radial streaks, and exophytic papillary structures, were described in detail dermoscopically and histopathologically. Moreover, measurements of these dermoscopic features and the underlying histological structures were found to be similar. Linking dermoscopy more closely with cutaneous pathology may help refine the definitions and diagnostic criteria of pigmented skin lesions for dermatologists as well as dermatopathologists.     

Characteristic dermoscopic features of primary cutaneous amyloidosis: a study of 35 cases

Background Primary cutaneous amyloidosis (PCA) is a relatively common skin disorder among Asians and South Americans. It is usually diagnosed clinically. However, for cases with atypical presentations, the diagnosis can be a challenge and skin biopsy may be necessary. Dermoscopy has been proved to be a valuable, noninvasive tool in the diagnosis of cutaneous pigmented diseases. Most lesions of PCA show hyperpigmentation and the major histopathological abnormalities of PCA occur in the epidermis and dermal papillae. Dermoscopy might be a powerful tool to provide valuable information for the diagnosis of PCA. Objectives We aimed to find characteristic dermoscopic features of PCA. Materials and methods Cases with typical clinical presentations of PCA, either macular or lichen subtypes, were included in this study. All were evaluated using a hand-held, polarized and nonpolarized dermoscope. Results A total of 35 patients with clinically diagnosed PCA were enrolled. Eighteen patients had lesions consistent with macular amyloidosis and 17 with lichen amyloidosus. We found two major dermoscopic patterns characteristic of PCA. The most common dermoscopic finding of PCA was a central hub, which could be either white or brown, surrounded by various configurations of pigmentation. For cases of lichen amyloidosus with prominent hyperkeratosis, the central hub was replaced by a scar-like morphology. Conclusions This is the first study to report the characteristic dermoscopic features of PCA. We demonstrate that the use of a dermoscope may assist in achieving an accurate diagnosis of PCA.     

A comparison of dermoscopic features among lentigo senilis/initial seborrheic keratosis, seborrheic keratosis, lentigo maligna and lentigo maligna melanoma on the face

Clinical differentiation of facial lentigo senilis/initial seborrheic keratosis (LS/ISK), seborrheic keratosis (SK), lentigo maligna (LM), and lentigo maligna melanoma (LMM) can be difficult. Dermoscopy improves the diagnoses in pigmented skin lesions (PSLs), but it is not helpful for the sun-exposed face because of the flat rete ridges without network-derived features. Therefore, development of new diagnostic criteria for this particular localization is a current issue of dermatology. In this retrospective study, dermoscopic slides of facial pigmented skin lesions of 66 patients referred to two clinics in Turkey were evaluated. Our aim was to determine the reliability of dermoscopy in the differentiation of these entities. The facial PSLs of 66 patients (34 males and 32 females) (median age: 58.2) were photographed with a Dermaphot (Heine, Hersching, Germany) over a five year period from November of 1995 to May of 2000. All of the dermoscopic slides were analysed according to 27 dermoscopic criteria developed by Schiffner et al. This data set contained 22 histologically proven malignant (14 LM, 8 early LMM) and 44 benign (18 SK, 26 LS/ISK) PSLs. In general, asymmetric pigmented follicular openings, dark streaks, slate-gray streaks, dark globules, slate-gray globules, dark dots, dark rhomboidal structures, light brown rhomboidal structures, dark homogeneous areas and dark pseudonetworks were statistically significant for malignant growth. On the other hand, milia-like cysts, pseudofollicular openings, cerebriform structures, light brown globules, light brown dots, light brown homogeneous areas, yellow opaque homogeneous areas, and light brown pseudonetworks were statistically significant for benign growth. This research emphasizes that dermoscopic features on the face differ from criteria used in other locations of the body. Analysis of the data suggests that dermoscopy can be used in the differentiation of LS/ISK, SK, LM and LMM from each other.     

Dermoscopy patterns of fibroepithelioma of pinkus

BACKGROUND: Fibroepithelioma of Pinkus (FeP) is a rare variant of basal cell carcinoma that may clinically mimic a number of benign skin tumors. While the dermoscopic features of basal cell carcinoma have been studied extensively, little is known about the dermoscopic features of FeP. OBSERVATIONS: Retrospective evaluation of clinical records and digital clinical dermoscopic images of 10 histopathologically proved FePs (6 nonpigmented and 4 pigmented) was performed. Clinically, no FeP was correctly identified and, in half of all patients, a clinical differential diagnosis of purely benign skin lesions was made. Dermoscopy enabled the correct diagnosis in 9 of 10 FePs, based on the presence of fine arborizing vessels, either alone or associated with dotted vessels, and white streaks (in 100%, 70%, and 90% of lesions, respectively). In the 4 pigmented FePs, a structureless gray-brown area of pigmentation and variable numbers of gray-blue dots were observed, in addition. CONCLUSIONS: Dermoscopy is helpful in diagnosing FeP and in differentiating this variant of basal cell carcinoma from other benign skin tumors commonly included in the clinical differential diagnosis. This presumes, however, that dermoscopy is used as a first-line examination for all skin lesions, not only for those that are clinically suspect.     

Conventional and polarized dermoscopy features of dermatofibroma

OBJECTIVE: To evaluate dermoscopic features and patterns of dermatofibromas using conventional and polarized light dermoscopy. DESIGN: Dermatofibromas were imaged using conventional nonpolarized contact dermoscopy (NPD), polarized contact dermoscopy (PCD), and polarized noncontact dermoscopy, followed by evaluation and comparison of dermoscopic features of the lesions. SETTING: Dermatology clinic specializing in pigmented lesions. Patients Fifty patients with dermatofibromas. RESULTS: The most common features of dermatofibromas observed with NPD and PCD were central white scarlike patches (37 [74%] and 42 [84%], respectively), brown globulelike structures (21 [42%] and 22 [44%]), vascular structures (24 [48%] and 22 [44%]), and a peripheral fine pigmented network (36 [72%] for both). A newly described feature observed with PCD was a central white patch characterized by shiny white streaks. With polarized noncontact dermoscopy, the most characteristic feature was a central pink hue or "vascular blush" (44 [88%]) and visibility of blood vessels (41 [82%]). The most common pattern identified with NPD and PCD was the combination of a peripheral pigmented network and a central white patch in 28 (56%) and 31 (62%) of lesions, respectively. With polarized noncontact dermoscopy, the most common pattern was a central pink hue with a peripheral pigmented network (23 [46%]). There was good to excellent agreement when comparing NPD with PCD images, but there was a variable level of agreement when polarized noncontact dermoscopy images were compared with NPD and PCD images. CONCLUSIONS: Conventional and polarized light dermoscopy are not equivalent but may be complementary. This study highlights some salient differences. We were able to identify new dermoscopic features and patterns not previously described with conventional dermoscopy. These new criteria can aid in the diagnosis of dermatofibroma.     

Relationship between dermoscopy and pathology in a case of clonal‐type pigmented Bowen's disease: Observation with vertical‐view dermoscopy

Pigmented Bowen's disease (pBD) is a subtype of Bowen's disease, which presents clinically as a well‐circumscribed, hyperpigmented plaque. Its clinical manifestations are not fully characterized, and differential diagnoses include various pigmented skin lesions. Dermoscopy could be useful for the diagnosis, although nothing has been reported on the dermoscopic features of clonal‐type pBD. We herein report a first case of clonal‐type pBD on the sole and its dermoscopic features. Dermoscopy showed brown to blue‐gray dots/globules and focally anastomosing lines on the non‐weight‐bearing area, while the weight‐bearing area had a brown to blue‐gray fibrillar‐like pattern. To investigate the relationship between dermoscopy and histopathology, we focused on the melanin distribution in the horny layer of the epidermis, and used vertical dermoscopy observation. We investigated the relationship between dermoscopy and pathology by melanin depth estimation using a color lightness value.     

Dermoscopic examination of the nail bed and matrix

Abstract Background Dermoscopy has furthered advances in the differential diagnosis of longitudinal melanonychia; however, fewer details observed in the nail, as compared to skin lesions, make interpretation difficult. Methods Ten cases of longitudinal melancholia, from several etiologies, were submitted to direct dermoscopic examination of the nail bed and matrix. Results We observed the presence of globules, streaks, and pigment network in the nail bed and matrix, which are dermoscopic features not seen in the nail plate. Conclusions This procedure enables visualization of dermascopic features not seen in the nail plate, making the diagnosis of melanocytic lesions easier.     

Dermoscopy for the Pediatric Dermatologist Part III: Dermoscopy of Melanocytic Lesions

Melanocytic nevi encompass a variety of lesions, including blue, Spitz, congenital, and acquired nevi. These nevi can occasionally manifest clinical morphologies resembling melanoma, and the presence of such nevi in children can elicit anxiety in patients, parents, and clinicians. Dermoscopy has been shown to increase the diagnostic accuracy for melanoma and to help differentiate melanoma from nevi, ultimately aiding in the decision‐making process as to whether to perform a biopsy. Dermoscopy is the perfect instrument to use during the evaluation of pigmented skin lesions in children because it is painless and provides important information for the clinician that can assist in formulating appropriate management decisions. This review highlights the most common benign dermoscopic patterns encountered in nevi and discuss the 10 most common dermoscopic structures seen in melanomas. Lesions manifesting a benign dermoscopic pattern and lacking any melanoma‐specific structures do not need to be excised and can safely be monitored. In contrast, melanomas will invariably deviate from the benign nevus patterns and will usually manifest at least 1 of the 10 melanoma‐specific structures: atypical network, negative network, streaks, crystalline structures, atypical dots and globules, irregular blotch, blue‐white veil, regression structures, peripheral brown structureless areas, and atypical vessels. It is important to be cognizant of the fact that melanomas in childhood usually do not manifest the clinical ABCD features. Instead, they are often symmetric, amelanotic, nodular lesions. Although the clinical appearance may not be alarming, with dermoscopy they will invariably manifest at least one melanoma‐specific structure, the most common being atypical vascular structures and crystalline structures.     

Dermoscopy in vitiligo: diagnosis and beyond

Background

Vitiligo is essentially a clinical diagnosis, and dermoscopy may aid in noninvasive confirmation of diagnosis by excluding other clinically simulating hypopigmentary conditions. More importantly, dermoscopy is rapidly gaining ground as an important adjunct tool to evaluate disease activity.

Aim

To study the dermoscopic features of vitiligo and ascertain their correlation with disease activity.

Methods

Retrospective analysis of dermoscopy of 60 cases suffering from vitiligo was undertaken. Dermoscopy was performed using Dermlite II hybrid m dermatoscope at 10× magnification in polarized mode, and photographs were captured by Apple iphone 6. Variables assessed in the dermoscopic evaluation included perifollicular changes, perilesional changes, altered pigmentary network, and presence of specific features such as the starburst appearance, comet tail appearance, leukotrichia, telangiectasia, and any new findings.

Results

Sixty patients with stable, progressive, or repigmenting vitiligo were retrospectively studied. While perifollicular depigmentation (PFD) was predictive of stable vitiligo, perifollicular pigmentation (PFP) was characteristic of active disease. Starburst appearance, altered pigment network, and comet tail appearance, were also noted, and these were typical of progressive vitiligo. A new dermoscopic feature, the ‘tapioca sago’ appearance (sabudana), was observed in the skin adjacent to the vitiligo lesion only in patients with progressive vitiligo .

Conclusion

Dermoscopy is useful in assessing the stage of evolution and the status of disease activity in vitiligo. The most useful dermoscopic clues are observed in the perifollicular region, since progressive lesions display perifollicular pigmentation and stable/remitting lesions display perifolliclar depigmentation.