头皮脂溢性皮炎RCM与皮肤镜特征分析及与头皮银屑病的鉴别

Reflectance Confocal Microscopy and Dermoscopy Features of Scalp Seborrheic Dermatitis and Differentiation of Scalp Psoriasis

目的总结头皮脂溢性皮炎的反射式共聚焦显微镜(RCM)与皮肤镜特征,并评估二者在鉴别头皮脂溢性皮炎与头皮银屑病的应用价值。方法纳入头皮脂溢性皮炎、头皮银屑病患者各30例,全部行RCM、皮肤镜检查,部分行皮肤组织病理学检查,汇总RCM及皮肤镜各特征的比例,统计诊断两种疾病的敏感度及特异度。结果头皮脂溢性皮炎RCM主要特征为:角化不全、海绵水肿、血管水平扩张、真皮炎细胞浸润、毛囊角栓;其中海绵水肿(灵敏度100.00%、特异度83.33%)及血管水平扩张(灵敏度90.00%、特异度86.67%)对于诊断有较高灵敏度及特异度;该病主要皮肤镜特征为:黄红色背景、分支状血管、非典型血管、血管灶性分布、黄色鳞屑、无结构区、蜂窝状色素网;蜂窝状色素网(灵敏度90.00%、特异度100.00%)、分支状血管(灵敏度90.00%、特异度90.00%)、无结构区(灵敏度86.67%、特异度93.33%)有较高的灵敏度及特异度。对鉴别头皮脂溢性皮炎与头皮银屑病有意义的RCM特征为:海绵水肿、血管水平扩张、毛囊内角栓、角化过度、Munro微脓肿、真皮乳头上移、真皮乳头扩张(P<0.05);有鉴别价值的皮肤镜特征:背景颜色(黄红色、亮红色)、血管分布(灶性、一致性)、血管形态(分支状、非典型及点状、小球状、发夹状、环状血管)、附加特征[鳞屑(黄色、白色)、无结构区、蜂窝状色素网]。结论头皮脂溢性皮炎具有相对独特的RCM及皮肤镜特征,RCM及皮肤镜在头皮脂溢性皮炎及头皮银屑病的鉴别中具有很大的应用价值。

Objective The characteristics of reflectance confocal microscopy(RCM)and dermoscopy in scalp seborrheic dermatitis were summarized,and the value of RCM and dermoscopy in distinguishing scalp seborrheic dermatitis from scalp psoriasis was evaluated.Methods Thirty patients with seborrheic dermatitis and 30 patients with psoriasis scalp were included in this study.All of them were examined by RCM and dermoscopy,while some of them were examined by histopathology.The characteristics of RCM and dermoscopic were summarized,as well as the sensitivity and specificity for the diagnosis of the two diseases.Results The main features of RCM in scalp seborrheic dermatitis were as follows:parakeratosis,spongiosis,horizontal dilated blood vessels,dermal inflammatory cell infiltration and follicular keratotic plugging.Spongiosis(sensitivity 100.00%,specificity 83.33%)and horizontal dilated blood vessels(sensitivity 90.00%,specificity 86.67%)had higher sensitivity and specificity on diagnosis.The main characteristics of the disease were yellow-red background,branching vessels,atypical vessels,focal distribution of vessels,yellow scales,featureless areas and honeycomb pigment.Honeycomb pigment(sensitivity 90.00%,specificity 100.00%),branched vessels(sensitivity 90.00%,specificity 90.00%)and featureless areas(sensitivity 86.67%,specificity 93.33%)had higher sensitivity and specificity on diagnosis.RCM features of significance in distinguishing scalp seborrheic dermatitis from scalp psoriasis were:spongiosis,horizontal dilated blood vessels,follicular keratotic plugging,hyperkeratosis,Munro microabscess,up-migrated dermal papillae,enlarged dermal papillae(P<0.05).Characteristics of dermoscopy with differential diagnosis:background color(yellow red,bright red),vascular distribution(focal,uniform),vascular morphology(branching,atypical and punctate,globular,hairpin,annular),additional features(yellow or white scale,featureless areas,honeycomb pigment).Conclusion Scalp seborrheic dermatitis has relatively unique characteristics of RCM and dermoscopy.RCM and dermoscopy are of great value in differentiating scalp seborrheic dermatitis from scalp psoriasis.