Department of Dermatology and Venereology, Faculty of Medicine, Tanta University Hospital, 31527, Al-Bahr St., Tanta, Egypt.
Dermatology Department, Faculty of Medicine Kasr Al-Ainy, Cairo University, Cairo, Egypt.
Arch Dermatol Res. 2024 Aug 23;316(8):562. doi: 10.1007/s00403-024-03259-8.
Diagnosis of cutaneous hypopigmentation can sometimes be challenging. Dermoscopy may play a role in identifying hypo or-depigmented dermatoses. The aim was to investigate which dermoscopic criteria represent potent indicators for the diagnosis of vitiligo, nevus depigmentosus, pityriasis alba, hypopigmented pityriasis versicolor, idiopathic guttate hypomelanosis, hypopigmented mycosis fungoides (MF), lichen sclerosus et atrophicus and ash leaf hypopigmented macules of tuberous sclerosis, and evaluate their diagnostic accuracy. 168 individuals diagnosed with one of these hypopigmented disorders were evaluated for the presence or absence of predetermined dermoscopic criteria. Evaluation of dermatoscopic characteristics in each condition and analysis for sensitivity and specificity of dermatoscopic diagnosis in these hypopigmented lesions was performed. The starburst pattern, micro-koebnerization, and trichrome pattern were unique to vitiligo diagnosis. Vitiligo had higher comet-tail appearance, perifollicular pigmentation, and perilesional hyperpigmentation than other hypopigmented illnesses. Other hypopigmented lesions had greater incidence of amoeboid pattern, faint or diminished pigment network, islands of pigmentation, ill-defined boundaries, pseudopods, and widespread scaling than vitiligo. Finally, perifollicular scaling, comedo-like openings, blue-gray specks, and fibrotic regions excluded vitiligo. Dermoscopy can help identify common hypopigmented skin lesions and reduce the need for skin biopsy. Nevus depigmentosus, pityriasis alba and idiopathic guttate hypomelanosis were the top three hypopigmented dermatoses that could be diagnosed by dermoscopy with 100% sensitivity. Vitiligo was in the second rank (94.7%), followed by lichen sclerosis et atrophicus (93.3%) then hypopigmented MF at 81.2% sensitivity. Dermoscopy sensitivity was lowest in pityriasis versicolor and ash leaf macules of tuberous sclerosis (52.6% and 46.7%, respectively).
皮肤色素减退的诊断有时具有挑战性。皮肤镜检查可能有助于识别色素减退或脱色素性皮肤病。目的是研究哪些皮肤镜标准是诊断白癜风、无色素痣、白色糠疹、色素减退性花斑癣、特发性点状色素减退症、色素减退性蕈样肉芽肿、硬化性苔藓和萎缩性苔藓以及结节性硬化症的灰叶状色素减退斑的有力指标，并评估其诊断准确性。对 168 名被诊断为这些色素减退性疾病之一的患者进行了评估，以确定是否存在预定的皮肤镜标准。对每种疾病的皮肤镜特征进行评估，并对这些色素减退性病变的皮肤镜诊断的敏感性和特异性进行分析。星爆模式、微 Koebner 化和三色模式是白癜风诊断的独特特征。白癜风的彗星尾外观、毛囊周围色素沉着和皮损周围色素沉着比其他色素减退性疾病更高。其他色素减退性病变的阿米巴样模式、色素网模糊或减弱、色素岛、边界不清晰、伪足和广泛鳞屑的发生率高于白癜风。最后，毛囊周围鳞屑、粉刺样开口、蓝灰色斑点和纤维化区域排除了白癜风。皮肤镜检查有助于识别常见的色素减退性皮肤病变，并减少皮肤活检的需求。无色素痣、白色糠疹和特发性点状色素减退症是皮肤镜检查可 100%敏感诊断的前三种色素减退性皮肤病。白癜风排在第二位（94.7%），其次是硬化性苔藓和萎缩性苔藓（93.3%），然后是色素减退性蕈样肉芽肿，敏感性为 81.2%。皮肤镜检查的敏感性在花斑癣和结节性硬化症的灰叶状色素减退斑中最低（分别为 52.6%和 46.7%）。
