Autoimmune Bullous Diseases Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Int J Dermatol. 2021 Jan;60(1):81-87. doi: 10.1111/ijd.15231. Epub 2020 Oct 5.
Pemphigus is an autoimmune intraepidermal bullous disease which can affect skin and∕or mucous membranes. Trichoscopy is a non-invasive tool that can help in the clinical diagnosis especially if the patient is presented with only scalp lesions. We conducted this study to investigate the trichoscopic features of pemphigus scalp lesions.
A total of 100 patients with confirmed diagnosis of pemphigus entered the study; Seventy-nine patients were diagnosed as pemphigus vulgaris (PV) and 21 as pemphigus foliaceus (PF). Trichoscopy of the scalp lesions was performed, and three dermatologists examined separately the trichoscopic images of each patient. The results were re-checked simultaneously by the examiners. Association between variables was analyzed by using different tests including: chi-square test or Fischer's exact test, independent T-Test or Mann-Whitney nonparametric test and logistic regression model when applicable.
Mean age of the patients was 45.41 ± 11.13 years, and 58% of cases were male. The most common trichoscopic features observed among all cases were diffuse scaling (71/100), presence of any types of vessels (67/100), and extravasation (63/100). Positive anagen pull test, extravasation, yellow hemorrhagic crust, and polymorphic vessels were more commonly seen in PV than PF cases (P value < 0.05), and by having data of these variables, we can differentiate between PV and PF scalp lesions with 74% sensitivity and 91% specificity.
Trichoscopy can help in clinical diagnosis of pemphigus scalp lesions but should be followed by other modalities such as biopsy and direct immunofluorescence for definite diagnosis.
天疱疮是一种自身免疫性表皮内大疱病，可影响皮肤和/或黏膜。皮肤镜是一种非侵入性工具，可帮助进行临床诊断，特别是当患者仅出现头皮病变时。我们进行这项研究是为了调查天疱疮头皮病变的皮肤镜特征。
共有 100 名确诊为天疱疮的患者进入研究；79 名患者被诊断为寻常型天疱疮（PV），21 名患者被诊断为落叶型天疱疮（PF）。对头皮病变进行皮肤镜检查，三位皮肤科医生分别检查每位患者的皮肤镜图像。检查者同时对结果进行复查。使用不同的测试，包括卡方检验或 Fisher 确切检验、独立 T 检验或 Mann-Whitney 非参数检验以及逻辑回归模型，分析变量之间的关联，当适用时。
患者的平均年龄为 45.41±11.13 岁，58%为男性。所有病例中最常见的皮肤镜特征是弥漫性鳞屑（71/100）、存在任何类型的血管（67/100）和渗出（63/100）。阳性生长期牵拉试验、渗出、黄色出血性结痂和多形性血管在 PV 中比 PF 更常见（P 值<0.05），并且通过这些变量的数据，我们可以将 PV 和 PF 头皮病变区分开来，敏感性为 74%，特异性为 91%。
皮肤镜检查有助于临床诊断天疱疮头皮病变，但应结合活检和直接免疫荧光等其他方式进行明确诊断。
