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[皮肤镜在银屑病和湿疹鉴别诊断中的作用]

[Roles of dermoscopy in differential diagnosis of psoriasis and eczema].

作者信息

Xu Chenchen, Liu Jie, Chen Dian, Liu Yuehua, Sun Qiuning

机构信息

Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.

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出版信息

Zhonghua Yi Xue Za Zhi. 2014 Sep 30;94(36):2833-7.

Abstract

OBJECTIVE

To describe the dermoscopic patterns of plaque psoriasis and chronic eczema and explore the roles of dermoscopy in their diagnosis and differential diagnosis.

METHODS

A total of 68 patients with plaque psoriasis or chronic eczema were recruited from our department from December 2013 to May 2014 to undergo dermoscopic and histopathological examinations. Dermoscopic features of vascular morphology, vascular arrangement, background color, scale color and scale distribution were evaluated. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for predefined dermoscopic criteria in relation to the diagnosis of plaque psoriasis.

RESULTS

Thirty-one patients with plaque psoriasis and 37 patients with chronic eczema were included. Dotted vessels in a regular arrangement (sensitivity 80.6%, specificity 73.0%) over a light red background (sensitivity 71.0%, specificity 75.7%) and white scales (sensitivity 71.0%, specificity 83.8%) were highly predictive for the diagnosis of plaque psoriasis. And chronic eczema more commonly showed yellow scales and dotted vessels in a patchy arrangement over a dull red background. Characteristic vascular structures of hairpin vessels and red loops were also found to be highly specific (91.9%, 94.6%) for the diagnosis of psoriasis.

CONCLUSIONS

Plaque psoriasis shows specific dermoscopic patterns compared with chronic eczema. And dermoscopy is valuable in the diagnosis and differential diagnosis of psoriasis.

摘要

目的

描述斑块状银屑病和慢性湿疹的皮肤镜表现,并探讨皮肤镜在其诊断及鉴别诊断中的作用。

方法

2013年12月至2014年5月,从本科室招募了68例斑块状银屑病或慢性湿疹患者,进行皮肤镜及组织病理学检查。评估血管形态、血管排列、背景颜色、鳞屑颜色及鳞屑分布等皮肤镜特征。计算针对斑块状银屑病诊断的预定义皮肤镜标准的敏感性、特异性、阳性预测值和阴性预测值。

结果

纳入31例斑块状银屑病患者和37例慢性湿疹患者。规则排列的点状血管(敏感性80.6%,特异性73.0%)、淡红色背景(敏感性71.0%,特异性75.7%)及白色鳞屑(敏感性71.0%,特异性83.8%)对斑块状银屑病的诊断具有较高预测性。慢性湿疹更常见表现为黄色鳞屑及斑片状排列的点状血管,暗红色背景。发夹状血管和红色袢等特征性血管结构对银屑病诊断也具有高度特异性(91.9%,94.6%)。

结论

与慢性湿疹相比,斑块状银屑病具有特定的皮肤镜表现。皮肤镜在银屑病的诊断及鉴别诊断中具有重要价值。

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