Errichetti Enzo, Plozner Noemi, Enechukwu Nkechi A, Bhat Yasmeen J, Pietkiewicz Paweł, Salwowska Natalia, Zalaudek Iris, Stinco Giuseppe
Department of Medical Area, Institute of Dermatology, University of Udine, Udine, Italy.
Department of Internal Medicine, Nnamdi Azikiwe University/Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
Australas J Dermatol. 2025 Mar;66(2):69-74. doi: 10.1111/ajd.14406. Epub 2024 Dec 27.
Ultraviolet-based dermoscopy may support the recognition of scabies, yet neither accuracy analyses nor data on skin of colour are available. The aim of this multicentric observational retrospective was to investigate the diagnostic accuracy of polarised and ultraviolet-induced fluorescence (UVF) dermoscopic examination in both fair and dark skin, also assessing possible differences according to the skin tone.
Consecutive patients with a diagnosis of scabies were eligible. All the images were randomly evaluated by two independent experienced investigators to identify scabietic findings reported in the literature. Interobserver agreement was evaluated for both polarised and UVF dermoscopic pictures through Cohen's kappa coefficient, while Fisher's exact test with p-value set at 0.05 was used for comparative analyses between the two settings.
A total of 97 lesions from 43 patients (21 with fair skin and 22 with dark skin) were included. The comparative analysis highlighted a superiority of UVF dermoscopy to detect the burrow (p = 0.003) and scabietic eggs (p = 0.012) in skin of colour, while polarised dermoscopy was more accurate to show the mite in fair skin (p = 0.042). Additionally, a general higher accuracy of both settings in light phototypes was also found, with a higher prevalence (p < 0.05) of typical scabietic findings (i.e., serpiginous white tract, 'triangle' sign and grey-brown outlines of the burrow for polarised dermoscopy and green dot for UVF dermoscopy) compared to dark skin. Kappa values were 0.87 and 0.83 for polarised and UVF-dermoscopy, respectively.
UVF dermoscopy improves the recognition of scabies, though it should be considered complimentary to polarised light dermoscopic examination to increase diagnostic performance.
基于紫外线的皮肤镜检查可能有助于疥疮的诊断，但目前尚无准确性分析或关于有色人种皮肤的数据。这项多中心观察性回顾研究的目的是调查偏振光和紫外线诱导荧光（UVF）皮肤镜检查在浅色皮肤和深色皮肤中的诊断准确性，并评估根据肤色可能存在的差异。
连续诊断为疥疮的患者符合条件。所有图像由两名独立的经验丰富的研究人员随机评估，以识别文献中报道的疥疮特征。通过科恩kappa系数评估偏振光和UVF皮肤镜图像的观察者间一致性，而将p值设定为0.05的Fisher精确检验用于两种检查方法之间的比较分析。
共纳入43例患者的97个皮损（21例浅色皮肤患者和22例深色皮肤患者）。比较分析突出显示，UVF皮肤镜在检测有色人种皮肤中的隧道（p = 0.003）和疥虫卵（p = 0.012）方面具有优势，而偏振光皮肤镜在显示浅色皮肤中的螨虫方面更准确（p = 0.042）。此外，还发现两种检查方法在浅色皮肤类型中总体准确性更高，与深色皮肤相比，典型疥疮特征（即偏振光皮肤镜检查中的蜿蜒白色条纹、“三角形”征和隧道的灰棕色轮廓，以及UVF皮肤镜检查中的绿点）的患病率更高（p < 0.05）。偏振光和UVF皮肤镜检查的kappa值分别为0.87和0.83。
UVF皮肤镜检查可提高疥疮的诊断率，不过应将其视为对偏振光皮肤镜检查的补充，以提高诊断性能。
