皮肤镜图像分析技术在阴虱病诊断中的应用

阴虱（pediculus inguinalis）是爬行类寄生虫,不具飞翔和跳跃的能力,需要依靠吸食人的血液生存。阴虱病大多数通过性接触传播,也可通过非性途径传播,比如脱落的阴毛,衣物及寝具传播。’临床以显微镜镜下检出虫体或虫卵为确诊依据。皮肤镜体外常用的一种非侵袭性皮肤图像诊断工具,是皮肤科医生肉眼观察与皮肤病理之间的桥梁。国内目前尚无运用皮肤镜检查阴虱的报道。本文采用皮肤镜对32例阴虱病患者检查结果与临床肉眼观察以及显微镜法进行比较,探讨皮肤镜在阴虱病诊断中的临床意义。1     

皮肤镜在人虱类皮肤病诊断中的应用

目的:探讨皮肤镜在人虱类皮肤病诊断中的应用。方法:收集该院2017—2018年皮肤科门诊首诊诊断为头虱病、阴虱病及体虱病的12例患者,行皮肤镜下观察。结果:12例患者中阴虱病5例及头虱病7例。12例患者均可观察到虱卵,其中6例观察到成虫。结论:手持皮肤镜在体观察虱类疾病简便可行,有助于早期确诊。     

色素性紫癜性皮病32例皮肤镜特征分析

目的总结色素性紫癜性皮病的皮肤镜下图像的特征。方法收集本科门诊根据临床表现或组织病理检查确诊为色素性紫癜性皮病的32例患者共计162处皮损进行皮肤镜检查,分析其皮肤镜下的图像特征。结果色素性紫癜性皮病患者皮损处在皮肤镜下的特征主要表现为:淡红色云雾状背景下大小不一的红色点球状、斑片状结构及棕黄色片状结构,并可见褐色网状色素结构。结论色素性紫癜性皮病患者的皮损在皮肤镜下具有一定的特征性,皮肤镜检查可作为本病的无创性辅助诊断手段。     

皮肤镜诊断面部光线性角化病的初步研究

目的 评价皮肤镜在面部光线性角化病诊断中的价值.方法 面部疑似光线性角化病患者40例,其中男27例,女13例;年龄46～88岁;病程2～20年.分别对其行皮肤镜检查及组织病理学检查;以病理诊断为"金标准",通过诊断性试验的研究方法,研究皮肤镜诊断面部非色素性光线性角化病的敏感性、特异性及一致性.结果 与病理诊断比较,两位医生皮肤镜诊断面部非色素性光线性角化病的灵敏度、特异度、Youden指数及Kappa值分别为90.91%、88.89%、79.80%、0.798(χ2=0.25,P>0.05)和86.36%、94.44%、80.80%、0.800(χ2=0.25,P>0.05).结论 皮肤镜检查对面部非色素性光线性角化病诊断与病理组织检查结果存在较好的一致性.     

皮肤镜诊断脂溢性角化病的临床研究

目的:探讨皮肤镜在诊断脂溢性角化病中的价值。方法:选择120例临床拟诊为脂溢性角化病患者,由两名医生参照脂溢性角化病皮肤镜特点,盲法独立诊断,再以病理诊断为金标准,比较皮肤镜在诊断脂溢性角化病的灵敏度和特异度及与病理诊断的一致性。结果:120例患者中,86例经组织病理学诊断为脂溢性角化病;80例经医生A皮肤镜诊断为脂溢性角化病,82例经医生B皮肤镜诊断为脂溢性角化病。与组织病理诊断比较,医生A皮肤镜诊断脂溢性角化病的一致百分率、灵敏度、特异度、误诊率、漏诊率、Youden指数、Kappa值分别是91.67%、90.70%、94.12%、5.89%、9.30%、0.848、0.805,医生B诊断的上述各项值分别为93.33%、93.02%、94.12%、5.88%、6.98%、0.871、0.841。两名医生经皮肤镜诊断脂溢性角化病的水平经卡方检验无明显差异(2=0.08,P>0.05)。结论:脂溢性角化病皮肤镜诊断结果与组织病理学检查结果有较好的一致性,具有重要的诊断价值。     

外阴及腋窝同患阴虱病1例

 报告外阴及腋窝同患阴虱病1例。患者男,45岁,煤矿工人。因外阴瘙痒2周,加重伴腋窝瘙痒3天就诊。皮肤专科检查：阴毛及双侧腋毛区可见红斑及丘疹,部分毛发根部可见浅褐色、大小不超过1 mm的寄生物附着,观察可发现寄生物沿着毛根向上缓慢移行。诊断：阴虱病。经50%百部酊治疗3次,2周后复诊痊愈。     

皮肤镜在脂溢性角化病诊断中的意义

目的:探讨一种新的皮肤镜诊断法诊断临床非典型脂溢性角化病的准确率。方法:回顾性分析130例临床疑诊为其他疾病的脂溢性角化病患者的皮肤镜表现,分别采用两步法与新的诊断法对所有患者行皮肤镜诊断,计算2种方法诊断的准确率。结果:130例临床非典型的脂溢性角化病患者中,男68例,女62例,平均年龄58岁。两步法诊断的准确率为70%,新诊断法的准确率为90%。130例临床非典型脂溢性角化病中出现频率最高的皮肤镜指标依次为清楚的边界(70%)、沟壑样结构(49.2%)、乳黄色角栓(38.5%)、粉刺样开孔(36.9%)、多发性粟丘疹样囊性结构(24.6%)和云母样结构(23.1%)。最常见的皮肤镜模式为沟壑样模式、隐窝模式、云母样模式及均质性模式。结论:新的诊断法可显著提高临床非典型脂溢性角化病诊断的准确率。     

阴虱病77例临床分析

目的了解阴虱病患者的临床特点。方法回顾性分析2013年6月-2016年6月本科确诊的77例阴虱病患者的临床资料。结果 77例阴虱病患者中,男72例,女5例;年龄18~75岁,平均45.21±14.66岁,其中≥50岁者最多(36例,占46.75%);病程15天~6个月;文化程度方面以初中及以下居多(52例,占67.53%);有婚外性行为者34例;误诊48例(62.34%)。结论阴虱病易被忽视,注重病史及仔细查体是避免误诊的关键。     

Riehl黑变病激光共聚焦扫描显微镜和皮肤镜成像特征分析

目的 联合运用皮肤镜、激光共聚焦扫描显微镜（CLSM）观察Riehl黑变病的成像特点,并结合组织病理探讨其间的联系。 方法 皮肤科门诊收集确诊为Riehl黑变病患者10例,所有患者用皮肤镜与CLSM共同检测后做组织病理学检查。 结果 所有Riehl黑变病的患者经皮肤镜与CLSM检测后的主要特征为：网络状结构,基底层液化变性及色素失禁。 结论 皮肤镜及CLSM可以作为Riehl黑变病的无创性辅助诊断技术。     

老年复发性阴虱病1例

阴虱病是常见的性传播疾病之一,性接触是主要的传播方式,尤其在18~40岁的性活跃期人群中常见,治疗上外用杀虫剂以及剃除阴毛即可治愈,很少出现复发1,2。近期在门诊收治1例老年复发性阴虱病患者,现报道如下。临床资料患者,男,68岁。1999年出现会阴部瘙痒,一直按湿疹治疗,疗效不佳,波及肛周。2001年外院发现阴虱,按阴虱病诊治,并嘱剃除阴毛。2003年4月出现类似症状,同样处理后缓解,12月再次复发就诊于我院门诊。回顾病史曾于发病前有外出居住史,既往治疗过程中仅剃除阴毛,尚遗留肛毛未处置。检查局部皮肤,见外阴部皮肤有丘疹、抓痕及血痂,阴毛…     

儿童纵行黑甲皮肤镜模式分析

目的了解儿童纵行黑甲的皮肤镜特点,探索通过皮肤镜模式分析诊断儿童纵行黑甲的方法。方法收集2013年6月—2015年9月就诊于首都医科大学附属北京儿童医院皮肤科的50例纵行黑甲患儿,分析其术前皮肤镜模式,对其中42例患儿行手术治疗,分析其术中皮肤镜模式。结果术前皮肤镜检查为灰色模式的8例患儿,均未行手术治疗,行手术治疗的42例患儿,术前甲板皮肤镜显示棕色条带的4例术中皮肤镜为棕色模式,组织病理证实为雀斑样痣。术前皮肤镜显示黑色条带的7例,术中表现为规则的棕色模式伴有色素球及色素斑,组织病理证实为甲母痣。术前显示规律的棕色线条组成的条带18例,术中皮肤镜为规则的棕色模式伴有色素球14例,规则棕色模式4例,组织病理分别证实为甲母痣和雀斑样痣。术前显示规律的棕色线条组成的条带伴色素球13例,术中皮肤镜为规则的棕色模式伴有色素球,组织病理证实其中12例为甲母痣,1例为黑素细胞活化。结论术前及术中皮肤镜检查及模式分析对儿童纵行黑甲的诊断具有显著意义。     

Clinical selection of melanocytic lesions for dermoscopy decreases the identification of suspicious lesions in comparison with dermoscopy without clinical preselection

BACKGROUND: In most cases dermoscopy is performed only on lesions selected by clinical inspection which present worrying clinical features or appear to deviate from the patient's average type of naevus. Thus, possible early malignant melanomas (MMs) or MM precursors, lacking typical clinical characteristics, may elude the dermoscopic examination. OBJECTIVES: To perform a comparison between two different approaches to the patient's examination, one based on a clinical preselection of lesions to be examined by dermoscopy, and the other consisting of the dermoscopic scrutiny of all melanocytic lesions with a diameter>or=2 mm (total dermoscopy). METHODS: Sixty-three consecutive patients with MM, undergoing periodic dermoscopic examinations of their naevi, were enrolled in the study. The patients first underwent an assessment of the entire skin with the unaided eye for the identification of lesions for dermoscopy. Subsequently, the patients underwent dermoscopic examination of all melanocytic lesions. Images of naevi identified by clinical examination or by total dermoscopy as having dermoscopic aspects characteristic of a suspicious lesion, i.e. necessitating either surgical excision or follow-up examinations, were separately recorded, classified and described employing the ABCD rule of dermoscopy and the seven-point checklist. RESULTS: Five hundred and fifty-one lesions were chosen by clinical inspection for subsequent dermoscopic examination; among these, 117 were considered for excision or follow-up. Ninety-two further lesions were identified for excision or follow-up by employing only total dermoscopy. Dermoscopy scores of lesions selected by clinical inspection plus dermoscopy were similar to those identified by dermoscopy alone. In the former group, 13 lesions showed either an ABCD or a seven-point score corresponding to a suspicious lesion, whereas eight such lesions were identified only by total dermoscopy. Thus, by clinical selection plus dermoscopy we were able to identify only 62% of dermoscopically suspicious lesions. CONCLUSIONS: Clinical selection of melanocytic lesions for dermoscopic examination is associated with the 'loss' of a conspicuous number of lesions which deserve surgical excision or follow-up examinations. Total dermoscopy, enabling the detection of suspicious lesions, together with storage, retrieval and sequential comparison of their images, could enhance MM diagnosis by follow-up, in comparison with clinical preselection for dermoscopy.     

Dermoscopy improves diagnosis of tinea nigra: a study of 50 cases

Background/Objectives: Tinea nigra is a relatively uncommon dematiaceous fungal infection of the palms and soles, which clinically may mimic a melanocytic lesion. We sought to ascertain how frequently misdiagnosis of this infection occurred and whether the use of dermoscopy helped in its diagnosis. Methods: Fifty consecutive cases of tinea nigra diagnosed at a dermatopathology laboratory were examined with regard to the clinical diagnosis, use of dermoscopy and the mode of management. Results: Of the 50 cases, 21 (42.0%) were treated by shave or surgical excision. The clinical diagnosis of tinea nigra was made in five cases (10.0%) and suggested along with other diagnoses in a further two cases (4.0%). The dermatologists (n = 9) gave the correct diagnosis in four patients (44.4%), the general practitioners (n = 38) gave the correct diagnosis in one patient (2.6%) and the three surgeons involved did not give the correct diagnosis. When dermoscopy was used, in seven of 13 (53.8%) cases tinea nigra was suggested as a probable diagnosis but when dermoscopy was not used (n = 37) tinea nigra was not clinically diagnosed (P < 0.001). Conclusions: The diagnosis of tinea nigra is significantly improved by dermoscopy, the disease should be considered as a cause of palmar or plantar pigmentation.     

Availability of digital dermoscopy in daily practice dramatically reduces the number of excised melanocytic lesions: results from an observational study

Background Digital dermoscopy has been shown to permit an earlier detection of melanoma. However, few studies have investigated its added value in reducing unnecessary excisions in everyday clinical practice. Objectives To compare, in daily practice, the efficiency of three dermoscopy methods: dermoscopy alone with little training, dermoscopy alone with adequate training and dermoscopy with adequate training and access to digital dermoscopy, and to confirm the safety of this latter approach. Methods Thirty‐six dermatologists working without digital dermoscopy were divided into two groups according to their training in dermoscopy. The third group constituted of two dermatologists working in a pigmented lesion clinic with access to the digital dermoscopy technique and eight additional dermato‐logists working in the same dermatology department. These 46 dermatologists included all presumed melanocytic lesions excised over a period of 1 year. The primary endpoint was the melanoma/nonmelanoma ratio (M/NM‐R); secondary endpoints were the ratio of ‘problem’ naevi to common naevi (PN/CN‐R), specificity and sensitivity for the diagnosis of melanoma, in situ/invasive melanoma ratio, and the mean Breslow thickness. Results In total, 1865 excised lesions, including 231 melanomas, were included. In the digital dermoscopy availability group (DD‐G) the M/NM‐R was significantly better (1/2·43), as was the PN/CN‐R (1/1·48) (P < 0·001 in both cases). The specificity was significantly higher in the DD‐G and significantly higher for trained examiners as compared with examiners with little training. More that one‐third of all melanomas discovered by digital dermoscopy were in situ, and the mean Breslow thickness was 0·32 mm for the invasive ones. Conclusions The reduction of unnecessary excisions when using digital dermoscopy compared with dermoscopy alone in our study suggests that access to digital dermoscopy offers a better management of pigmented lesions in daily practice. The high number of early lesions diagnosed by this technique confirms that its use is safe.     

儿童色素减退性蕈样肉芽肿在皮肤镜及反射式共聚焦显微镜下的特征

目的 探讨临床表现为色素减退的儿童蕈样肉芽肿在皮肤镜及反射式共聚焦显微镜（RCM）下的特征,分析皮肤镜联合RCM与组织病理诊断色素减退性蕈样肉芽肿的一致性。方法 2014年11月至2015年10月皮肤科门诊收集皮肤镜及RCM下疑似色素减退性蕈样肉芽肿患者15例,获取并分析影像资料。所有患者均经组织病理、免疫组化及相关检查。结果 皮肤镜联合RCM诊断疑似色素减退性蕈样肉芽肿15例,其中13例经病理证实为色素减退性蕈样肉芽肿。色素减退性蕈样肉芽肿皮肤镜下特征表现为皮纹明显,可见白色糠秕状鳞屑;色素减退呈网格状、斑马样或波点状模式;血管呈点状、短细线状、精子样或星状模式。RCM特征为表皮各层及真表皮交界处较多高折光细胞,部分可见Pautrier微脓疡,基底层色素环折光减弱,色素环外较多高折光细胞分布。结论 色素减退性蕈样肉芽肿在皮肤镜和RCM下有特征性表现,可作为儿童色素减退性蕈样肉芽肿早期筛查及辅助诊断的方法。     

皮肤镜在微小色素型基底细胞癌诊断中的初步研究

目的 评价皮肤镜在微小色素型基底细胞癌诊断中的价值.方法 体表疑似微小(皮损直径＜5 mm)色素型基底细胞癌患者58例,男19例,女39例;年龄16～82岁;病程3个月至25年.对每例皮损进行皮肤镜检查,留皮肤镜照片.由两名医生参照色素型基底细胞癌皮肤镜特点,仅根据照片盲法独立进行诊断.以病理诊断为金标准,通过诊断性试验的研究方法,研究皮肤镜在微小色素型基底细胞癌诊断中的敏感度、特异度及一致性.结果 58例患者中36例经组织病理学诊断为基底细胞癌,医生A皮肤镜诊断为色素型基底细胞癌41例,不是色素型基底细胞癌17例;医生B皮肤镜诊断为色素型基底细胞癌40例,不是色素型基底细胞癌18例.与病理诊断相比,两名医生皮肤镜诊断色素型基底细胞癌的灵敏度、特异度、Youden指数及Kappa值分别为97.22％、72.73％、69.95％、0.732 (P＞ 0.05)和97.22％、77.27％、74.49％、0.772(P＞0.05).结论 皮肤镜对微小色素型基底细胞癌诊断与组织病理学检查结果有较好的一致性.     

Dermoscopy: Ex vivo visualization of fleas head and bag of eggs confirms the diagnosis of Tungiasis

Tungiasis, caused by the impregnated female sand flea Tunga penetrans, is increasingly common in returned travellers from endemic areas. Clinical suspicion is raised by the clinicodermoscopic correlation, leading to rapid treatment which involves extraction of the intact flea. Ex vivo dermoscopy demonstrates the parasite's head and distended abdomen full of eggs, confirming the diagnosis.     

Pre-operative diagnosis of pigmented skin lesions: in vivo dermoscopy performs better than dermoscopy on photographic images

BACKGROUND: Epiluminescence microscopy (ELM) (dermoscopy, dermatoscopy) is a technique for non-invasive diagnosis of pigmented skin lesions that improves the diagnostic performance of dermatologists. Little is known about the possible influence of associated clinical features on the reliability of dermoscopic diagnosis during in vivo examination. OBJECTIVE: To compare diagnostic performance of in vivo dermoscopy (combined clinical and dermoscopic examination) with that of dermoscopy performed on photographic slides (pure dermoscopy). DESIGN: This case series comprised 256 pigmented skin lesions consecutively identified as suspicious or equivocal during examination in a general dermatological clinic. Clinical examination and in vivo dermoscopy were performed before excision by two trained dermatologists. The same observers carried out dermoscopy on photographic slides at a later time, and these three diagnostic classifications were reviewed together with the histological findings for the individual lesions. This was carried out in a university hospital. RESULTS: In vivo dermoscopy performed better than dermoscopy on photographic slides for classification of pigmented skin lesions compared with histological diagnosis, and both performed better than general clinical diagnosis. In vivo dermoscopic diagnosis of melanoma showed 98.1% sensitivity, 95.5% specificity and 96.1% diagnostic accuracy while dermoscopic diagnosis of melanoma on photographic slides was less reliable with 81.5% sensitivity, 86.7% specificity and 85.2% diagnostic accuracy. In particular, diagnosis of melanoma based on photographic slides led to nine false negative cases (three in situ, six invasive; thickness ranges 0.2-1.5 mm). CONCLUSIONS: In vivo dermoscopy, i.e. combined clinical and dermoscopic examination, is more reliable than dermoscopy on photographic slides. In clinical practice, therefore, in vivo dermoscopy cannot be considered independent from associated clinical characteristics of the lesions, which help the trained observer to reach a more precise classification. This may have implications on the reliability of ELM diagnosis made by an observer not fully trained in the clinical diagnosis of pigmented skin lesions or by a remote observer during digital ELM teleconsultation.     

Dermoscopic features of nonpigmented eccrine poromas in association with their histopathological features

Background Nonpigmented eccrine poromas (EPs) occasionally mimic various skin tumours, but their dermoscopic features have not been clarified. Objectives To evaluate the dermoscopic features of nonpigmented EPs in association with their histopathological features. Methods Retrospective analysis of the dermoscopic features of 10 histopathologically proven cases of nonpigmented EP at the Department of Dermatology, Shinshu University Hospital (Matsumoto, Japan). Results Specific features in vascular structures were observed in five of 10 nonpigmented EPs. Three cases showed a polymorphous vascular pattern: two cases of a combination of hairpin and dotted vessels, and one case of a combination of hairpin, dotted and linear‐irregular vessels. In addition, there were two cases of monomorphous vascular pattern: one case of linear‐irregular vessels, and one case of hairpin vessels. We did not observe arborizing, crown or comma vessels. Comedo‐like openings, milia‐like cysts, cerebriform pattern and ulceration were observed in one case each. Furthermore, nine of 10 cases showed the characteristic feature, described as well‐circumscribed reddish globule/lacuna‐like structures with separation of mesh bands, which were reminiscent of frog eggs aggregation. This characteristic feature on dermoscopy was explained by the histopathological features of horizontal sections at a depth of 300–400 μm from the surface. Island‐shaped oedematous stroma with numerous microvessels, which were surrounded by poroid cells in mesh‐like forms, were seen. Conclusions Vascular structures and ‘frog eggs‐like appearance’ are important features on dermoscopic examination of nonpigmented EP. Further studies are required to evaluate their diagnostic accuracy to differentiate nonpigmented EP from other tumours.     

皮肤镜和反射式共聚焦显微镜检查在幼年黄色肉芽肿中的诊断价值

目的：总结幼年黄色肉芽肿（JXG）在皮肤镜及反射式共聚焦显微镜（RCM）下特征,探讨皮肤镜、RCM及二者联合应用对JXG的诊断价值。方法：分析43例拟诊为JXG患儿皮损的皮肤镜及RCM镜下表现,由4名皮肤科医师采用五级法诊断,绘制受试者工作特征（ROC）曲线,行DeLong检验。结果：(1)皮损组织病理检查确诊40例为JXG,1例皮脂腺异位,1例spitz痣,1例肥大细胞瘤。(2)确诊患儿皮肤镜图像特征：15例皮损外观呈“落日征”,中央线状、分枝状血管;23例外观“落日征”,中央黄色小球云、棕褐色色素沉着、白色纤维条;2例呈“云状”棕黄色。(3)确诊患儿RCM图像特征：34例真皮层见大量形状不规则中等折光细胞,不等量环状靶形细胞;4例未见环状靶形细胞;2例角化过度,灶状角化不全,棘层以下显影不清。(4)RCM与皮肤镜单独诊断JXG的ROC曲线下面积比较,差异无统计学意义（P>0.05）;单用皮肤镜、单用RCM分别与二者联合应用诊断JXG的ROC曲线下面积比较,差异均有统计学意义（P<0.05）。结论：皮肤镜及RCM可作为JXG早期筛查方法,二者联合比单独诊断更有价值。