Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy.
Dermatology. 2017;233(6):462-470. doi: 10.1159/000484947. Epub 2017 Dec 14.
Dermoscopy of morphea and cutaneous lichen sclerosus (CLS) has been described by various studies, with none of them considering variability according to clinical phases and investigating dermoscopic-histological correlations.
To evaluate dermoscopic features in general and according to clinical stage, identify possible distinctive dermoscopic clues, and assess dermoscopy accuracy in detecting subclinical alterations in morphea and CLS.
A representative dermoscopic image of target lesions was evaluated for the presence of specific features, correlating them with clinical subtype (inflammatory, inflammatory-sclerotic, sclerotic, or sclerotic-atrophic). In case of clinical-dermoscopic discordance (inflammatory, sclerotic, and atrophic findings in noninflammatory, nonsclerotic, and nonatrophic lesions, respectively), dermoscopic-pathological correspondence was assessed.
A total of 86 lesions (51 morphea/35 CLS) were analyzed, with most of them displaying an inflammatory-sclerotic or sclerotic clinical pattern. The most common dermoscopic findings of morphea were "fibrotic beams," while CLS was mainly characterized by bright white/white-yellowish patches and yellowish-white keratotic follicular plugs; all these structures displayed complete specificity for the correspondent dermatosis. Additionally, pigmentary structures were significantly more frequent in morphea and white scaling and hemorrhagic spots in CLS. Only few dermoscopic features reached a statistical significance for a specific clinical stage. Regarding the clinical-dermoscopic discordance rate, it was significantly more common in morphea than CLS; in all cases there was a correspondence between dermoscopic and pathological findings.
Dermoscopy of morphea and CLS reveals distinctive dermoscopic clues which are often unrelated to clinical stage but show a constant histological correspondence, thus emphasizing its usefulness in diagnosis and therapeutic management of these conditions.
多项研究已经描述了硬斑病和皮肤硬化性苔藓（CLS）的皮肤镜表现，但没有一项研究考虑过根据临床阶段的变化来进行分析，也没有研究过皮肤镜与组织学之间的相关性。
评估硬斑病和 CLS 的一般皮肤镜表现，并根据临床阶段进行评估，确定可能存在的独特皮肤镜线索，并评估皮肤镜在检测硬斑病和 CLS 亚临床改变方面的准确性。
对目标病变的代表性皮肤镜图像进行评估，以确定是否存在特定特征，并将其与临床亚型（炎症型、炎症-硬化型、硬化型或硬化-萎缩型）相关联。如果存在临床-皮肤镜不相符的情况（分别在非炎症、非硬化和非萎缩性病变中出现炎症、硬化和萎缩性发现），则评估皮肤镜-组织病理学的一致性。
共分析了 86 个病变（51 个硬斑病/35 个 CLS），其中大多数表现为炎症-硬化或硬化的临床模式。硬斑病最常见的皮肤镜表现是“纤维化束”，而 CLS 主要表现为亮白色/黄白色斑块和黄色白色角化滤泡塞；所有这些结构对于相应的皮肤病都具有完全的特异性。此外，色素结构在硬斑病中更为常见，而在 CLS 中则更常见白色鳞屑和出血点。只有少数皮肤镜特征在特定的临床阶段具有统计学意义。关于临床-皮肤镜不相符的发生率，在硬斑病中明显高于 CLS；在所有病例中，皮肤镜和组织学发现之间均存在一致性。
硬斑病和 CLS 的皮肤镜表现揭示了独特的皮肤镜线索，这些线索通常与临床阶段无关，但与组织学表现有恒定的对应关系，因此强调了其在这些疾病的诊断和治疗管理中的有用性。
