反射式共聚焦显微镜联合皮肤镜在经典与色素性扁平苔藓诊断中的应用

Application of Reflectance Confocal Microscopy Combined with Dermatoscopy in the Diagnosis of Classic Lichen Planus and Lichen Planus Pigmentosus

目的探讨经典与色素性扁平苔藓在反射式共聚焦显微镜(RCM)及皮肤镜下的主要敏感图像特征。方法收集RCM及皮肤镜下疑似扁平苔藓的患者30例(经典扁平苔藓17例、色素性扁平苔藓13例),选定1处皮损行RCM及皮肤镜检查,然后对该皮损附近或对侧的正常皮肤行RCM及皮肤镜检查,最后取该处皮损进行组织病理检查,记录并分析图像特征。结果皮损处RCM主要敏感图像特征:真表皮交界处指环状结构破坏或部分破坏(基底细胞液化变性)、真皮乳头及其周围或真皮浅层较多大的类圆形或不规则形高折光噬色素细胞及小的圆形较高折光炎细胞浸润。皮损处皮肤镜主要敏感图像特征:经典扁平苔藓为白色网状条纹(Wickham纹);色素性扁平苔藓为蓝灰色色素颗粒、片状均质黄棕色色素。结论反射式共聚焦显微镜联合皮肤镜可作为经典与色素性扁平苔藓的无创诊断手段。

Objective In order to investigate the main sensitive image features of classic lichen planus（LP） and lichen planus pigmentosus（LPP） by reflectance confocal microscopy（RCM） and dermatoscopy. Methods A total of 30 patients with suspected LP were enrolled in this study, including 17 patients with classic LP and 13 patients with LPP. The lesions of 30 patients and the normal skin near or in the contralateral side of the lesions were examined by RCM and dermatoscopy, and then the biopsy was taken for histopathologic examination, meanwhile the image features were recorded and analyzed. Results The main sensitive image features of lesions by RCM： the ring feature of dermoepidermal junction was destroyed or partly destroyed（ liquefaction of basal cells） and many big, round or irregularly shaped, bright melanophages and small, round, bright inflammatory cells infiltrated the dermal papilla and its surrounding or the upper dermis. The main sensitive image features of lesions by dermatoscopy showed that classic LP was white, reticular stiae（Wickham stiae）; and LPP was blue-gray pigment granules and sheet, homogeneous, yellow-brown pigment. Conclusion RCM combined with dermatoscopy can be used as a noninvasive method for the diagnosis of classic LP and LPP.