皮肤镜在外阴部乳房外Paget病与慢性湿疹鉴别诊断中的意义

Value of dermoscopy in differential diagnosis of extramammary Paget′s disease and chronic eczema of the vulva

目的描述外阴乳房外Paget病(EMPD)和慢性湿疹的皮肤镜特征,探讨其在两病的诊断及鉴别诊断中的应用价值。方法回顾性分析2017年1月至2018年4月在中国医学科学院皮肤病医院就诊行并经皮肤组织病理检查确诊的20例外阴EMPD和16例慢性湿疹患者的皮肤镜特征。采用Fisher精确检验判断两种疾病的各项特征百分比是否存在统计学差异。结果EMPD患者皮损皮肤镜下19例为乳红色背景,而慢性湿疹患者乳红色背景仅1例,背景颜色差异有统计学意义(P<0.001);白色鳞屑均为最常见的脱屑形态,分别为9例、13例(P=0.128)。EMPD患者皮肤镜下血管结构均呈一致性分布,19例出现点-球状血管,14例见线状血管;慢性湿疹血管结构则均呈片状或簇集状分布,16例均出现点-球状血管,7例可见线状血管,两组分布差异均有统计学意义(P<0.001)。EMPD患者中19例见亮白色条纹、20例见亮白色无结构区及19例纹网状结构,而慢性湿疹患者中均只有1例可见以上结果,两组3种特殊结构差异均有统计学意义(均P<0.001)。结论外阴部位EMPD和慢性湿疹具有特征性的皮肤镜下表现,皮肤镜在EMPD的诊断和鉴别诊断中具有重要价值。

Objective To describe the dermoscopic features of extramammary Paget′s disease (EMPD) and chronic eczema of the vulva, and to explore the value of dermoscopy in the diagnosis and differential diagnosis of the above diseases. Methods Dermoscopic images were collected from 20 patients with histopathologically confirmed vulvar EMPD and 16 patients with clinically confirmed chronic eczema of the vulva in Hospital for Skin Diseases, Chinese Academy of Medical Sciences and Pekin Union Medical College from January 2017 to April 2018, and retrospectively analyzed. Fisher′s exact test was used to compare the prevalence of dermoscopic features between the two groups. Results As dermoscopy showed, the milky red background was observed in 19 EMPD patients and in only 1 patient with chronic eczema, and there was a significant difference in the prevalence of milky red background between the two groups (P < 0.001). White scales were the most common desquamation, and were observed in 9 EMPD patients and 13 patients with chronic eczema (P = 0.128). Blood vessels were uniformly distributed in EMPD patients, including dotted-globular vessels in 19 and linear vessels in 14 , while blood vessels were distributed in a patchy or clustered pattern in the patients with chronic eczema, including dotted-globular vessels in 16 and linear vessels in 7. There was a significant difference in the prevalence of different distribution patterns of blood vessels between the two groups (P < 0.001). Bright white streaks, bright white structureless area and reticular structure were observed in 19, 20 and 19 EMPD patients respectively, and in 1, 1 and 1 patient with chronic eczema respectively, and there were significant differences in the prevalence of the above 3 structures between the two diseases (all P < 0.001). Conclusion Vulvar EMPD and chronic eczema both show characteristic dermoscopic features, and dermoscopy is of great value to the diagnosis and differential diagnosis of EMPD.