扁平疣皮肤镜和反射式共聚焦显微镜图像特征分析

Analysis of dermoscopy and reflectance confocal microscopy features of verruca plana

目的采用皮肤镜和反射式共聚焦显微镜（RCM）观察扁平疣的图像特征。方法临床未经治疗的扁平疣患者88例，每例选1处典型皮损先后行皮肤镜及RCM检查，记录并统计各项图像特征。结果88例扁平疣患者皮肤镜检测显示，48例（54．55％）可见淡红色背景，40例（45．45％）可见淡黄色背景，84例（95．45％）可见散在数量不等的点状出血。RCM检测显示，48例（54．55％）可见类似洋葱皮样的同心圆结构。病程大于1年的57例患者中，44例（77．19％）可见类似洋葱皮样的同心圆结构；病程小于1年的31例患者中，仅有4例（12．90％）可见类似结构，两组检出率差异有统计学意义（X2=33．47，P〈0．05）。88例中，86例（97．73％）真表皮交界处可见基底层色素增加，真皮乳头环完整，真皮乳头内血管扩张充血，真皮乳头内可见1～2个增生的毛细血管管腔。8例患者治疗2周后皮肤镜及RCM下观察，上述特征明显消失。结论结合临床表现，皮肤镜和RCM的图像特征可能为扁平疣的诊断提供帮助。

Objective To evaluate imaging features of verruca plana by dermoscopy and reflectance confocal microscopy （RCM）. Methods Totally, 88 untreated patients with verruca plana were enrolled into this study. One typical skin lesion was chosen from each patient and subjected to dermoscopy and RCM separately, and imaging features were recorded and analyzed. Results Dermoscopy revealed a light red background in 48 cases （54.55%）, a light yellow background in 40 cases （45.45%）, and a various number of punctate hemorrhages in 84 cases （95.45%）. RCM showed concentric onion-skin-like structures in 48 patients （54.55%）. Among 57 patients with disease duration 〉 1 year, 44 （77.19%） had the concentric onion-skin-like pattern, while only 4 （12.90%） patients had similar structures among 31 patients with disease duration 〈 1 year. A significant difference in the prevalence of concentric onion-skin-like structures was observed between patients with disease duration 〉 1 year and those with disease duration 〈 1 year （A2 = 33.47, P 〈 0.05）. Of 88 patients, 86 （97.73%） had hyperpigmentation in the basal layer at the dermoepidermal junction, intact dermal papillary rings, vasodilatation, hyperemia and 1- 2 dilated capillaries in the dermal papillae. Eight patients were treated for 2 weeks, and the above features disappeared after the treatment under dermoscopy and RCM. Conclusion Based on clinical manifestations, dermoscopy and RCM features may be helpful for the diagnosis of verruca plana.