Sar-Pomian Marta, Kurzeja Marta, Rudnicka Lidia, Olszewska Malgorzata
Department of Dermatology, Medical University of Warsaw, Warsaw, Poland.
An Bras Dermatol. 2014 Nov-Dec;89(6):1007-12. doi: 10.1590/abd1806-4841.20143830.
Trichoscopy is becoming increasingly popular in diagnosing hair and scalp diseases. Scalp involvement in pemphigus is common. The scalp may be the first or only site of clinical manifestation of the disease.
The aim of this study was to analyze whether trichoscopy may be useful in aiding differential diagnosis of scalp lesions in patients with pemphigus vulgaris and pemphigus foliaceus.
Trichoscopy was performed in 19 patients with scalp lesions in the course of pemphigus (9 patients with pemphigus vulgaris and 10 with pemphigus foliaceus). In all patients, the diagnosis of scalp pemphigus was confirmed by histopathology. The working magnification was 20-fold and 70-fold.
The most frequently observed trichoscopy features of pemphigus lesions were: extravasations (18/19; 94.7%) and yellow hemorrhagic crusts (11/19; 57.9%). Yellow dots with whitish halo were observed in 6/19 (31.6%) patients with pemphigus. White polygonal structures were observed in pemphigus foliaceus (6/10; 60%), but not in pemphigus vulgaris. Vascular abnormalities were more frequent in pemphigus vulgaris, when compared to pemphigus foliaceus, and were associated with a severe course of disease. Linear serpentine vessels were the most frequent vascular abnormality in patients with pemphigus vulgaris and pemphigus foliaceus (77.8% and 30%, respectively).
Trichoscopy may serve as a useful supplementary method in the differential diagnosis of pemphigus, especially in cases of desquamative or exudative lesions limited to the scalp. Extravasations, yellow hemorrhagic crusts, yellow dots with whitish halo, white polygonal structures and linear serpentine vessels are trichoscopy features which may suggest the diagnosis of pemphigus.
毛发镜检查在毛发和头皮疾病的诊断中越来越受欢迎。天疱疮累及头皮很常见。头皮可能是该疾病临床表现的首发或唯一部位。
本研究的目的是分析毛发镜检查是否有助于寻常型天疱疮和落叶型天疱疮患者头皮病变的鉴别诊断。
对19例患有天疱疮头皮病变的患者进行了毛发镜检查（9例寻常型天疱疮患者和10例落叶型天疱疮患者）。所有患者的头皮天疱疮诊断均经组织病理学证实。工作放大倍数为20倍和70倍。
天疱疮病变最常观察到的毛发镜特征为：外渗（18/19；94.7%）和黄色出血痂（11/19；57.9%）。6/19（31.6%）例天疱疮患者观察到有白色晕圈的黄色小点。落叶型天疱疮患者观察到白色多边形结构（6/10；60%），而寻常型天疱疮患者未观察到。与落叶型天疱疮相比，寻常型天疱疮的血管异常更常见，且与疾病的严重病程相关。线性蜿蜒血管是寻常型天疱疮和落叶型天疱疮患者最常见的血管异常（分别为77.8%和30%）。
毛发镜检查可作为天疱疮鉴别诊断的有用辅助方法，尤其是在仅限于头皮的脱屑性或渗出性病变的情况下。外渗、黄色出血痂、有白色晕圈的黄色小点、白色多边形结构和线性蜿蜒血管是毛发镜特征，可能提示天疱疮的诊断。
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