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。

High-frequency skin ultrasonographic and dermoscopic features of seborrheic keratosis

Wang Shiqi, Liu Jie, Liu Zhaorui, Chi Cheng, Liu Yuehua, Jin HongzhongDepartment of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, ChinaCorresponding author: Liu Jie, Email:Liujie04672@pumch.cn【Abstract】 Objective To describe high-frequency skin ultrasonographic and dermoscopic features of seborrheic keratosis （SK）. Methods Between August and December in 2017, 46 outpatients with SK were enrolled from the Department of Dermatology of Peking Union Medical College Hospital, and 50 SK lesions were observed by 50- and 20-MHz high-frequency skin ultrasonography and dermoscopy. The high-frequency ultrasonographic and dermoscopic features of SK lesions were summarized and analyzed. Statistical analysis was done by using chi-square test for comparisons of evaluation results of SK lesions between 50- and 20-MHz ultrasonography, and the correspondence between high-frequency skin ultrasonographic and dermoscopic features of SK was analyzed by calculating the simple matching coefficient. Results As 50- and 20-MHz ultrasonography showed, ultrasonographic features of SK lesions from top to bottom were enhanced hyperecho （48/50 vs. 39/50, respectively, P = 0.007）, enhanced hyperechoic masses or spots in the stratum corneum （22/50 vs. 11/50, respectively, P = 0.019）, sound shadows behind the epidermis （34/50 vs. 13/50, respectively, P < 0.001）, skin lesions with regular shapes and clear borders （46/50 vs. 41/50, respectively, P = 0.137）, heterogeneous hypoechoic areas in the lesions （50/50 vs. 47/50, respectively, P = 0.079） and internal hyperechoic spots （25/50 vs. 2/50, respectively, P < 0.001）, the lesional bottom being at the same level （40/50 vs. 36/50, respectively, P = 0.349）, and reduced dermal echogenicity below the lesion （50/50 vs. 28/50, respectively, P < 0.001）. In regard to the overall evaluation of the above 8 ultrasonographic characteristics, 50-MHz ultrasonography was superior to 20-MHz ultrasonography （P = 0.002）. The common dermoscopic features of the 50 SK lesions were clear borders （n = 50）, comedo-like openings （n = 45）, ridge or cerebriform pattern （n = 31）, hairpin-like vessels （n = 30）, multiple milia-like cysts （n = 24）, moth-eaten border （n = 21） and shiny white streaks （n = 3）. Under 50- and 20-MHz ultrasonography, the simple matching coefficients between enhanced hyperechoic masses or spots in the stratum corneum and comedo-like openings under dermoscopy were 42% （21） and 20% （10） respectively, and the simple matching coefficients between internal hyperechoic spots and multiple milia-like cysts （> 3） under dermoscopy were 58% （29） and 48% （24） respectively. Conclusion High-frequency skin ultrasonography and dermoscopy both are of great value to the assessment of SK lesions, and 50-MHz ultrasonography is superior to 20-MHz ultrasonography for imaging skin lesions.