Santa Casa de Sao Paulo School of Medical Sciences, Unit of Vascular Surgery, Sao Paulo, Brazil.
Unit of Vascular Surgery, Hospital e Maternidade Christóvão da Gama, Santo André, Brazil.
Int Angiol. 2022 Oct;41(5):413-419. doi: 10.23736/S0392-9590.22.04909-4. Epub 2022 Jul 13.
Telangiectasias treatment can lead to skin hyperpigmentation, and pretreatment evaluation with dermoscopy was never performed. This study aimed to evaluate the applicability of dermatoscopy before telangiectasias treatment.
A prospective study evaluating patients of both sexes (18 to 60 years old), with telangiectasias (venous disease C2-C3 CEAP) of the lower limbs treated at outpatient clinics. Subjects who had never undergone previous interventional treatment for CVI and Fitzpatrick Classification up to phototype III, were included. Patients were submitted to both naked and dermoscopy evaluations of their skin and blindly evaluated by three vascular surgeons and an experienced dermatologist. Agreement by naked eye versus dermoscopy and among examiners was performed using Kappa correlation. Agreement by naked eye among patients and the examiners consensus were performed.
There was a more significant agreement between the most experienced examiners in the naked eye assessment. With the dermatoscopic device, the highest agreement was maintained among the more experienced examiners, with a predominance of choice of the purple pigment in 29 of the 38 limbs, which represents a simple agreement of 76.3% (95% CI: 62.8-89.8%) with a Kappa concordance Index of 0.178. There was an agreement between the patient and the consensus of the naked eye examiners in 41.2% (95% CI: 24.7-57.7%).
The dermatoscopy was not decisive for diagnosing skin pigmentation in areas of telangiectasia that had never been treated. The diagnostic accuracy was directly related to the clinical experience of the examiner. Dermatoscopy did not help in aligning expectations with treatment between physicians and patients.
毛细血管扩张症的治疗可能导致皮肤色素沉着，而之前从未对其进行过皮肤镜预处理评估。本研究旨在评估皮肤镜在毛细血管扩张症治疗前的适用性。
这是一项前瞻性研究，纳入了在门诊接受下肢毛细血管扩张症（静脉疾病 C2-C3 CEAP）治疗的男女患者（18 至 60 岁）。纳入标准为既往从未接受过慢性静脉功能不全的介入治疗且 Fitzpatrick 分级为 I 型至 III 型的患者。对患者的皮肤进行裸眼和皮肤镜评估，并由三名血管外科医生和一名经验丰富的皮肤科医生进行盲法评估。采用 Kappa 相关系数评估裸眼与皮肤镜的一致性以及评估者之间的一致性。还评估了患者的裸眼评估与评估者共识之间的一致性。
在裸眼评估方面，最有经验的评估者之间的一致性更为显著。使用皮肤镜设备时，最有经验的评估者之间保持了最高的一致性，在 38 条肢体中，有 29 条选择了紫色色素，这代表了简单的一致，即 76.3%（95%CI：62.8-89.8%），Kappa 一致性指数为 0.178。患者与裸眼评估者共识之间的一致性为 41.2%（95%CI：24.7-57.7%）。
皮肤镜在诊断未经治疗的毛细血管扩张区域的皮肤色素沉着方面并不具有决定性。诊断准确性与评估者的临床经验直接相关。皮肤镜无助于医生和患者在治疗方面达成一致的期望。
