Lu Quansheng, Wang Shan, Wu Tong, Jiang Guan
Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Department of Dermatology, The People's Hospital of Jiawang District of Xuzhou, Xuzhou, China.
J Coll Physicians Surg Pak. 2021 Apr;31(4):450-454. doi: 10.29271/jcpsp.2021.04.450.
To describe the features of facial seborrheic keratosis, verruca plana, and nevus pigmentosus by dermatoscopy and reflective confocal microscope (RCM).
Cross-sectional observational study.
Dermatology Department of The Affiliated Hospital of Xuzhou Medical University from January 2017 to January 2019.
Patients of either gender and age, clinically diagnosed as seborrheic keratosis, verruca plana, and nevus pigmentosus without any prior treatment, were enrolled. Patients with extremities and trunk involvement were excluded. One typical skin lesion was chosen from each patient and subjected to dermatoscopy and RCM separately; imaging features were recorded and analysed.
A total of 402 patients (183 men and 219 women) between 6 and 88 years of age (mean age 41.8 years) were inducted. The duration of disease was between one week and 10 years. Seborrheic keratosis on dermatoscopy presented as acne-like openings (122/172; 70.93%, milia-like cysts (113/172; 65.70%), hairpin-like vessels (108/172; 62.79%, brain-like structures (103/172; 59.88%, worm-like pharyngeal margins (17/172; 9.88%), and fingerprint-like structures (8/172; 4.65%). On RCM, it showed epidermal cerebral gyrus structure (165/172; 95.93%), superficial vasodilatation and hyperemia (81/172; 47.09%), and keratinous cysts (73/172; 42.44%). Verruca plana on dermatoscopy showed a number of punctate hemorrhages scattered against a light-red background (108/114; 94.74%); on RCM it showed rose-like concentric structures (89/114; 78.07%). The features of nevus pigmentosus observed by dermatoscopy were homogeneous mode (23/52; 44.23%), light brown color (30/52; 57.69%) for intradermal nevus; mesh mode (18/41; 43.90%, dark brown color, little black dots and spherical structure (both 18/41; 43.90%) were visible for junctional nevus; globular mode, reticular and cobblestone structures (both 11/23; 47.83%) for compound nevus. On RCM, there were a few nevus cells visible within the dermal papilla (52/52; 100%) for intradermal nevus; bright pebble-like structures accumulated in the basal layer, nested round and elliptical nevus cells (40/41; 97.56%) for junctional nevus; nevus cells in the epidermis and dermis (21/23; 91.30%) for compound nevus.
Used in combination with clinical manifestations, the application of dermatoscopy and RCM may help distinguish seborrheic keratosis, verruca plana, and nevus pigmentosus on the basis of their respective dermatoscopic and RCM features. Key Words: Dermatoscopy, Reflective confocal microscope, Seborrheic keratosis, Verruca plana, Nevus pigmentosus, Brain-like structures, Rose-like structure.
通过皮肤镜和反射式共聚焦显微镜（RCM）描述面部脂溢性角化病、扁平疣和色素痣的特征。
横断面观察性研究。
2017年1月至2019年1月徐州医科大学附属医院皮肤科。
纳入年龄和性别不限、临床诊断为脂溢性角化病、扁平疣和色素痣且未接受过任何治疗的患者。排除四肢和躯干受累的患者。从每位患者身上选取一个典型皮肤病变，分别进行皮肤镜和RCM检查；记录并分析图像特征。
共纳入402例患者（男性183例，女性219例），年龄在6至88岁之间（平均年龄41.8岁）。病程在1周至10年之间。脂溢性角化病在皮肤镜下表现为粉刺样开口（122/172；70.93%）、粟丘疹样囊肿（113/172；65.70%）、发夹样血管（108/172；62.79%）、脑样结构（103/172；59.88%）、蠕虫样边缘（17/172；9.88%）和指纹样结构（8/172；4.65%）。在RCM下，表现为表皮脑回结构（165/172；95.93%）、浅表血管扩张和充血（81/172；47.09%）以及角质囊肿（73/172；42.44%）。扁平疣在皮肤镜下表现为淡红色背景上散在的点状出血（108/114；94.74%）；在RCM下表现为玫瑰样同心结构（89/114；78.07%）。色素痣在皮肤镜下的特征为皮内痣呈均匀模式（23/52；44.23%）、浅褐色（30/52；57.69%）；交界痣呈网状模式（18/41；43.90%）、深褐色、小黑点和球形结构（均为18/41；43.90%）；混合痣呈球形模式、网状和鹅卵石样结构（均为11/23；47.83%）。在RCM下，皮内痣在真皮乳头内可见少数痣细胞（52/52；100%）；交界痣在基底层可见明亮的鹅卵石样结构聚集，巢状圆形和椭圆形痣细胞（4I/41；97.56%）；混合痣在表皮和真皮内可见痣细胞（21/23；91.30%）。
结合临床表现，皮肤镜和RCM的应用可根据脂溢性角化病、扁平疣和色素痣各自的皮肤镜和RCM特征进行鉴别。关键词：皮肤镜；反射式共聚焦显微镜；脂溢性角化病；扁平疣；色素痣；脑样结构；玫瑰样结构。
