Department of Dermatology, Medical University of Warsaw, Warsaw, Poland.
Int J Dermatol. 2017 Oct;56(10):996-1002. doi: 10.1111/ijd.13725. Epub 2017 Aug 30.
Scalp is a common location of autoimmune bullous diseases. Trichoscopy is a noninvasive method for diagnosing hair and scalp diseases. Data on trichoscopy in autoimmune bullous diseases are limited to the studies on pemphigus including a small number of patients. Trichoscopic characteristics of bullous pemphigoid and dermatitis herpetiformis were not reported to date. The aim of the study was to determine the value of trichoscopy in the differential diagnosis of pemphigus vulgaris, pemphigus foliaceus, bullous pemphigoid, and dermatitis herpetiformis.
Trichoscopy was used to evaluate scalp lesions in 68 patients (26 with pemphigus vulgaris, 17 with pemphigus foliaceus, 17 with bullous pemphigoid, and 8 with dermatitis herpetiformis). The working magnification was 20-fold and 70-fold.
The most frequent trichoscopic feature of autoimmune bullous diseases was extravasations. They occurred in 76.9% of patients with pemphigus vulgaris, 70.6% of patients with pemphigus foliaceus, 76.5% of patients with bullous pemphigoid, and 100% of patients with dermatitis herpetiformis. Yellow hemorrhagic crusts occurred in, respectively, 73.1%, 70.6%, 64.7%, and 35.5% of the cases. Yellow diffuse scaling and tubular scaling occurred more frequently in pemphigus foliaceus (52.9% and 41.2%, respectively). Clustered dotted vessels were characteristic for dermatitis herpetiformis (5/8, 62.5%). Dotted vessels with whitish halo were a hallmark of pemphigus vulgaris. A trichoscopic algorithm for the differential diagnosis of autoimmune bullous diseases was developed.
Autoimmune bullous diseases present characteristic trichoscopic patterns. Trichoscopy can be regarded as a rapid in-office preliminary diagnostic method in the differential diagnosis of these diseases.
头皮是自身免疫性大疱性疾病的常见部位。毛发镜检查是非侵入性诊断头发和头皮疾病的方法。有关自身免疫性大疱性疾病的毛发镜检查的数据仅限于包括少数患者的天疱疮研究。到目前为止，还没有报道大疱性类天疱疮和疱疹样皮炎的毛发镜检查特征。本研究的目的是确定毛发镜检查在鉴别诊断寻常型天疱疮、落叶型天疱疮、大疱性类天疱疮和疱疹样皮炎中的价值。
使用毛发镜检查评估 68 例患者（寻常型天疱疮 26 例、落叶型天疱疮 17 例、大疱性类天疱疮 17 例和疱疹样皮炎 8 例）的头皮病变。工作放大倍数为 20 倍和 70 倍。
自身免疫性大疱性疾病最常见的毛发镜检查特征是渗出。寻常型天疱疮患者中有 76.9%、落叶型天疱疮患者中有 70.6%、大疱性类天疱疮患者中有 76.5%和疱疹样皮炎患者中有 100%出现渗出。分别有 73.1%、70.6%、64.7%和 35.5%的患者出现黄色血性痂皮。黄色弥漫性鳞屑和管状鳞屑在落叶型天疱疮中更为常见（分别为 52.9%和 41.2%）。簇状点状血管是疱疹样皮炎的特征性表现（8 例中有 5 例，占 62.5%）。点状血管伴白色晕圈是寻常型天疱疮的特征性表现。开发了一种用于鉴别自身免疫性大疱性疾病的毛发镜检查算法。
自身免疫性大疱性疾病具有特征性的毛发镜检查模式。毛发镜检查可作为这些疾病鉴别诊断中的一种快速门诊初步诊断方法。
