皮肤镜联合反射式共聚焦显微镜在点滴型银屑病中特殊表现的探讨

Exploration of dermoscopy combined with reflectance confocal microscopy in the special manifestations of guttate psoriasis

目的:描述点滴型银屑病和斑块型银屑病的皮肤镜及反射式共聚焦显微镜(RCM)特征,探讨皮肤镜联合RCM在点滴型银屑病中的特殊表现的应用价值。方法:回顾分析2017年11月~2019年4月在中日友好医院皮肤科门诊就诊行皮肤镜及RCM检查的点滴型银屑病和斑块型银屑病患者,共62例。比较2组患者皮损的皮肤镜及RCM特征,评估点滴状银屑病不同于典型银屑病皮肤镜特征的特殊表现。结果:点滴型银屑病在皮肤镜下更容易观察到油滴样结构(P=10^-6);在RCM下,点滴型银屑病较斑块型银屑病更易观察到Munro微脓肿(P<10^-9);多数在RCM观察到Munro微脓肿的皮损在皮肤镜下可观察到油滴样结构。结论:点滴型银屑病具有特征性的皮肤镜(油滴样结构)及RCM表现(Munro微脓肿),皮肤镜联合RCM在未来随访银屑病是否处于反复状态的评估中有一定价值。

Objective:To describe the features of dermoscopy and reflective confocal microscope(RCM)in guttate psoriasis and plaque psoriasis,and to explore the application value of dermoscopy combined with RCM in the special manifestations of guttate psoriasis.Methods:A total of 62 patients with guttate psoriasis or plaque psoriasis undergoing dermatoscopy and RCM examinations were recruited from the Department of Dermatology of China-Japan Friendship Hospital from November 2017 to April 2019.The features of dermoscopy and RCM of skin lesions were compared between two groups,and the special manifestations of the dermoscopy of guttate psoriasis compared with the typical psoriasis were evaluated.Results:Oil droplet structure could be more easily observed under dermoscopy in guttate psoriasis(P=10^-6).Munro microabscess was more easily observed in guttate psoriasis than plaque psoriasis under RCM(P<10^-9).Most skin lesions of Munro microabscess observed in RCM could be observed with oil droplet structure under dermoscopy.Conclusion:Guttate psoriasis has the characteristic manifestation of dermoscopy(oil droplet structure)and RCM(Munro microabscess),and dermoscopy combined with RCM is valuable in the future follow-up evaluation of whether psoriasis is in repeated state.