Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Int J Dermatol. 2017 Dec;56(12):1395-1399. doi: 10.1111/ijd.13782. Epub 2017 Oct 3.
Acquired dermal macular hyperpigmentation (ADMH) is a hypernym encompassing Riehl's melanosis, lichen planus pigmentosus, and ashy dermatoses that show significant clinicopathological overlap. We sought to describe the dermatoscopic features of ADMH and correlate them with histopathological findings.
This was a prospective observational study performed in two phases. A detailed clinical and dermatoscopic examination was performed, and skin biopsies were obtained in 51 patients. Two dermatologists and a blinded dermatopathologist studied archived dermatoscopic images and histopathology specimens, respectively.
Dermatoscopic features noted were (i) pigment structures; dots (82.4%), globules (66.7%) and blotches (56.9%) that spared the eccrine and hair follicle openings; (ii) telangiectasia (82.4%); (iii) accentuation of the normal pseudoreticular pigmentary network (33.3%); (iv) owl's eye structures (15.7%). Four dermatoscopic grades of disease severity were identified: grade 1 - dotted; grade 2 - Chinese letter; grade 3 - reticulate; and grade 4 - diffuse. Density of melanin incontinence on histopathology correlated positively with size of pigment structures (r = 0.7, P < 0.000) and grades of disease severity (r = 0.75, P < 0.000) on dermatoscopy.
Increasing grades of disease severity can be detected dermatoscopically, which correlate well with histopathological features. A carefully performed dermatoscopy aids in better patient counseling regarding disease severity.
获得性皮肤斑状色素沉着（ADMH）是一个广义术语，包括 Riehl 黑变病、扁平苔藓色素沉着和灰色皮肤病，它们具有显著的临床病理重叠。我们旨在描述 ADMH 的皮肤镜特征，并将其与组织病理学发现相关联。
这是一项在两个阶段进行的前瞻性观察研究。对 51 例患者进行了详细的临床和皮肤镜检查，并获取了皮肤活检。两位皮肤科医生和一位盲法皮肤科病理学家分别研究了存档的皮肤镜图像和组织病理学标本。
注意到的皮肤镜特征包括：（i）色素结构；斑点（82.4%）、小球（66.7%）和斑块（56.9%），这些结构避开了小汗腺和毛囊开口；（ii）毛细血管扩张（82.4%）；（iii）正常假网状色素网的强化（33.3%）；（iv）猫头鹰眼结构（15.7%）。确定了疾病严重程度的四个皮肤镜等级：等级 1 - 点状；等级 2 - 汉字；等级 3 - 网状；等级 4 - 弥漫性。组织病理学上黑色素溢出的密度与色素结构的大小（r = 0.7，P < 0.000）和皮肤镜下疾病严重程度的等级（r = 0.75，P < 0.000）呈正相关。
皮肤镜下可以检测到疾病严重程度的增加，并且与组织病理学特征密切相关。仔细进行皮肤镜检查有助于更好地向患者提供有关疾病严重程度的咨询。
