Dupuy Alain, Dehen Laure, Bourrat Emmanuelle, Lacroix Claire, Benderdouche Mazouz, Dubertret Louis, Morel Patrice, Feuilhade de Chauvin Martine, Petit Antoine
Service de Dermatologie 2, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France.
J Am Acad Dermatol. 2007 Jan;56(1):53-62. doi: 10.1016/j.jaad.2006.07.025. Epub 2006 Nov 13.
BACKGROUND: Scabies is a contagious skin infestation caused by the human mite Sarcoptes scabiei. The usual reference method for definitive diagnosis is ex vivo identification of the mite with microscopic examination of skin scrapings. We compared diagnostic accuracy of in vivo dermoscopic (DS) mite identification using a pocket handheld low-magnification DS with the reference method. METHODS: We conducted a prospective, nonrandomized, evaluator-blinded, noninferiority study to compare sensitivities (main outcome) and other diagnostic properties of DS and microscopic examination of skin scrapings. Among 756 patients with a presumptive diagnosis of scabies consulting in one center, 238 were sequentially submitted to the two diagnostic procedures. Three dermoscopists (one expert, two inexperienced) were involved. Diagnostic strategies using clinical skills only, DS results, and a combination of both were compared. RESULTS: Sensitivities were 91% (95% confidence interval: 86-96) for DS and 90% (95% confidence interval: 85-96) for microscopic examination of skin scrapings (P = .005 for noninferiority). Specificities were 86% (95% confidence interval: 80-92) for DS and 100% (by definition) for microscopic examination of skin scrapings. DS sensitivities were similar for the expert and inexperienced dermoscopists, whereas differences were observed in specificities. However, diagnostic accuracy of inexperienced dermoscopists steadily increased during the study. Compared with clinical-based, DS-based treatment decision rule minimized the number of false-positive and false-negative findings, whereas a treatment decision rule based on combination of clinical presumption and DS result drastically reduced the number of patients with scabies left untreated. LIMITATIONS: There is no definitive standard for ruling out the diagnosis of scabies. CONCLUSIONS: Standard DS with a handheld DS is a useful tool for diagnosing scabies, with high sensitivity, even in inexperienced hands. It greatly enhances clinical skills for making treatment decisions.
背景：疥疮是由人疥螨引起的一种传染性皮肤寄生虫病。确诊的常用参考方法是通过对皮肤刮片进行显微镜检查在体外鉴定疥螨。我们将使用便携式手持低倍皮肤镜（DS）进行体内疥螨鉴定的诊断准确性与参考方法进行了比较。 方法：我们进行了一项前瞻性、非随机、评估者盲法、非劣效性研究，以比较DS和皮肤刮片显微镜检查的敏感性（主要结果）及其他诊断特性。在一个中心就诊的756例疑似疥疮患者中，238例依次接受了这两种诊断程序。有三名皮肤镜检查医师参与（一名专家，两名经验不足者）。比较了仅使用临床技能、DS结果以及两者结合的诊断策略。 结果：DS的敏感性为91%（95%置信区间：86 - 96），皮肤刮片显微镜检查的敏感性为90%（95%置信区间：85 - 96）（非劣效性P = 0.005）。DS的特异性为86%（95%置信区间：80 - 92），皮肤刮片显微镜检查的特异性为100%（根据定义）。专家和经验不足的皮肤镜检查医师的DS敏感性相似，但在特异性方面存在差异。然而，经验不足的皮肤镜检查医师的诊断准确性在研究过程中稳步提高。与基于临床的治疗决策规则相比，基于DS的治疗决策规则将假阳性和假阴性结果的数量降至最低，而基于临床推测和DS结果相结合的治疗决策规则则大幅减少了未接受治疗的疥疮患者数量。 局限性：目前尚无排除疥疮诊断的确切标准。 结论：使用手持皮肤镜的标准皮肤镜检查是诊断疥疮的有用工具，即使是经验不足者使用也具有高敏感性。它极大地提高了做出治疗决策的临床技能。
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