常见甲病的皮肤镜表现

【摘要】 指（趾）甲类疾病病因多样,临床表现类似。皮肤镜为无创检查,可通过观察甲小皮、甲皱襞、甲板等部位,快速、全面地观察早期病甲的变化,可用于甲病的诊断及治疗或手术效果评价。本文结合2017年6月至2019年2月中南大学湘雅医院皮肤科明确诊断的指（趾）甲类疾病的皮肤镜表现,总结常见甲病的皮肤镜表现,以期提高临床医师对甲病的认识。     

部分甲基质切除甲沟重建治疗嵌甲

目的研究1种利用甲侧襞皮瓣改变甲体与甲沟的位置结构,从而彻底治愈嵌甲的手术方法。方法切除部分甲体、甲床,并利用甲侧襞皮瓣重建甲床、甲沟、甲侧襞联合结构。结果2000年1月～2003年5月对158 例嵌甲患者,足趾209、手指3,共276侧嵌甲进行甲沟重建手术。随访6月～2年,效果满意。结论该手术从根本上治愈嵌甲,且并发症少,复发率极低。     

Severe Nail Fold Psoriasis Extending from Nail Psoriasis Resolved with Ustekinumab: Suggestion of a Cytokine Overflow Theory in the Nail Unit

Because nail psoriasis is difficult to treat, therapy with many biological drugs has been attempted. Ustekinumab is approved for chronic plaque psoriasis and psoriatic arthritis (PsA), with some trials reporting nail improvement using this agent. A 51-year-old man with severe chronic plaque psoriasis had severe involvement of all fingernails and toenails, with accompanying nail fold psoriasis. He also had PsA of the small joints of the fingers. Despite multiple conventional therapies, the nail lesions did not improve, and his nail psoriasis severity index score was 97. After a fourth ustekinumab injection, most of the fingernail psoriasis was resolved, and only hyperkeratosis remained on both large toenails. Because the nail plate, nail fold, and small joints of the fingers are closely apposed structures within a small area, cytokines produced from the nail units overflow to the nail fold and small joints and can induce nail fold psoriasis and PsA.     

鲍温病的皮肤镜特征分析

分析2018年8月至2019年12月我院门诊行皮肤镜检查并经组织病理学确诊的28例鲍温病患者的皮肤镜特征。最常见的皮肤镜表现为无结构区（20处，71.43%）和局灶性、线状分布的肾小球样血管（19处，67.86%），其他表现依次为结痂（14处，50%），鳞屑（10处，35.71%），点、球状血管（7处，25%）棕，放射性条纹及色素性点、球状结构共存（6处，21.43%），肾小球样血管与点、球样血管共存（2处，7.14%），毛囊角栓（1处，3.57%）。     

Dermoscopy of cutaneous leishmaniasis

Summary Background  Dermoscopy has been proposed as a diagnostic tool in the case of skin infections and parasitosis but no specific dermoscopic criteria have been described for cutaneous leishmaniasis (CL). Objectives  To describe the dermoscopic features of CL. Methods  Dermoscopic examination (using the DermLite Foto; 3Gen, LLC, Dana Point, CA, U.S.A.) of 26 CL lesions was performed to evaluate specific dermoscopic criteria. Results  We observed the following dermoscopic features: generalized erythema (100%), ‘yellow tears’ (53%), hyperkeratosis (50%), central erosion/ulceration (46%), erosion/ulceration associated with hyperkeratosis (38%) and ‘white starburst‐like pattern’ (38%). Interestingly, at least one vascular structure described in skin neoplasms was observed in all cases: comma‐shaped vessels (73%), linear irregular vessels (57%), dotted vessels (53%), polymorphous/atypical vessels (26%), hairpin vessels (19%), arborizing telangiectasia (11%), corkscrew vessels (7%) and glomerular‐like vessels (7%). Combination of two or more different types of vascular structures was present in 23 of 26 CL lesions (88%), with a combination of two vascular structures in 13 cases (50%) and three or more in 10 cases (38%). Conclusions  Characteristic dermoscopic structures have been identified in CL. Important vascular patterns seen in melanocytic and nonmelanocytic tumours are frequently observed in this infection.