53例面部日光性角化病皮肤镜及病理特征分析

Dermoscopic and Histopathological Features of 53 Cases of Facial Actinic Keratosis

目的总结分析日光性角化病的临床、皮肤镜、病理特点,提高对日光性角化病的再认识,指导临床诊断、治疗。方法纳入2019年1月—2023年1月53例常德市第一人民医院皮肤科记录完整且经皮肤病理确诊为面部日光性角化病患者临床资料,对其流行病学、临床特征、皮肤镜及病理特征进行分析。结果①发病年龄主要在60~80岁,平均年龄(69.43±9.02)岁;女性多见(75.5%);病程1周~14年;皮疹以多发为主(60.4%);病程>1年、皮疹多发为日光性角化病进展为原位鳞状细胞癌危险因素。②临床以红斑鳞屑(50.9%)、褐色斑片或丘疹(49.1%)为主,3例伴皮角、4例伴发角化棘皮瘤改变;31例首诊符合日光性角化病(58.5%),临床容易误诊为脂溢性角化病(17.0%)、基底细胞癌(5.7%)、鲍温病(5.7%)。③皮肤镜特征依次为红色背景(52.8%)、褐色假网状结构(45.3%)、褐色色素沉着(41.5%)、毛囊角栓(41.5%)、黄白色或黄褐色鳞屑结痂(39.6%)例;皮肤镜分级为I级(15例,28.3%)、Ⅱ级(25例,47.2%)、Ⅲ级(9例,17.0%)、无法判断(4例,7.5%);44例(83.02%)皮肤镜下可见不同程度的色素沉着。④组织病理表现多样包括萎缩型(20例,37.7%)、鲍温型(19例,35.8%)、色素型(17例,32.1%)、肥大型(13例,24.5%)、苔癣样型(11例,20.8%),各型可重叠;病理分级包括Ⅰ级(12例,22.6%)、Ⅱ级(22例,41.5%)、Ⅲ级(19例,35.8%);30例(56.6%)皮肤镜和病理分级一致,其中萎缩型日光性角化病皮肤镜分级容易低判(7例,13.2%)。结论面部日光性角化病多发生于老年女性,病程较长,容易多发,病程>1年、皮疹多发为日光性角化病进展为原位鳞状细胞癌危险因素。其临床表现多样,易误诊为脂溢性角化病、基底细胞癌等,皮肤镜具有特征有助于早期识别及分级,与病理分级一致性可达56.6%,萎缩型日光性角化病皮肤镜分级容易低判,应引起临床医生重视。

Objectives To summarize and analyze the clinical,dermoscopic and pathological features of actinic keratosis,so as to improve the recognition and guide the diagnosis and treatment of it.Methods From January 2019 to January 2023,the clinical data of 53 patients with facial actinic keratosis confirmed by histopathology and complete dermatological records were included.The epidemiology,clinical features,dermoscopic and pathological features of facial actinic keratosis were analyzed.Results①The age of onset was between 60 and 80 years old,the average age was(69.43±9.02)years old;more often in women(75.5%);Course of disease was during 1 week to 14 years;Most of them were multiple rash(60.4%).The duration>1 year,multiple rashes were the risk factors for actinic keratosis progress for squamous cell carcinoma in situ.②The clinical manifestations were mainly erythematous scaling(50.9%),brown patches or papules(49.1%),3 cases with cutaneous horn and 4 cases with keratoacanthoma.31 cases were consistent with actinic keratosis at first diagnosis(58.49%),and it was easily misdiagnosed as seborrheic keratosis(17%),basal cell carcinoma(5.7%),and Bowen disease(5.7%).③The dermoscopic features included red background(52.8%),brown pseudoreticular structure(45.3%),brown pigmentation(41.5%),follicular plug(41.5%),yellowish-white or yellowish-brown scaly scabs(39.6%).The dermoscopic grading included Grade I(15,28.3%),Grade II(25,47.2%),Grade III(9,17.0%),and undefined(4,7.5%).④The histopathological features were varied,including atrophic types(20,37.7%),Bowen type(19,35.8%),pigmented type(17,32.1%),hypertrophic type(13,24.5%),lichenoid type(11,20.8%).The histopathologic grading included Grade I(12,22.6%),grade II(22,41.5%),grade III(19,35.8%);in 30 cases(56.6%),dermoscopic grading was consistent with pathological grading,and atrophic dermoscopic classification was easy to be lower than pathological grading(7,13.2%).Conclusion Facial actinic keratosis developed in older women,with long course of disease,and multiple rashes.The duration>1 year,multiple rashes were the risk factors for actinic keratosis progress for squamous cell carcinoma in situ.The clinical manifestations were varied,and it was easy to be misdiagnosed as seborrheic keratosis,basal cell carcinoma,etc.The dermoscopic features are helpful for early identification and grading,and the consistency with pathological grading is up to 56.6%.The dermoscopic grading for atrophic actinic keratosis was lower than pathological grading,which should arouse clinicians'attention.