皮肤镜在疥疮诊断中的应用

Application of Dermoscopy in Detection of Scabies

目的探讨皮肤镜在皮肤科临床中诊断、指导治疗疥疮的应用价值。方法选取杭州市第三人民医院皮肤科就诊的皮损的疑似疥疮患者206例,用皮肤镜随机检测3个皮损部位并诊断,观察经皮肤镜确诊为疥疮患者皮损的隧道形态、“褐色三角”并记录。选取皮肤镜方法检测到“褐色三角”形态的20例患者,在该处进行刮出物涂片法进行光学显微镜检查验证。随访统计确诊为疥螨患者接受杀虫、抗炎治疗3个月后临床疗效。结果患者平均年龄(41.0±28.3)岁。经皮肤镜检测,疥疮诊断率47.6%(98/206)。其中2~6岁患者检出率62.9%,7~24岁患者检出率64%,25~65岁患者检出率28.2%,>65岁患者检出率36.4%。确诊疥疮的98例患者共294处皮损,可见隧道的皮损共284处(96.6%),可见虫卵的皮损共22处(7.5%),可见“褐色三角”的皮损共276处(93.9%),提示需进行杀虫抗炎治疗。20例检查到虫体的患者挤刮物涂片镜检,证实为疥螨感染。随访发现98例确诊为疥螨患者接受杀虫、抗炎治疗1个月后均痊愈,治愈率为100%。结论皮肤镜成像技术对疥螨感染的诊断效率较高,隧道、“褐色三角”是确诊疥疮的特异性皮肤镜图像,皮肤镜有在体、无创、无痛苦、实时的诊断疥疮,并指导治疗。

Objective In order to explore the application value of dermoscopy in the clinical diagnosis of dermatology and guiding the treatment for scabies.Methods Totally 206 suspected patients of scabies that consulted in the department of dermatology,Hangzhou third people's hospital,as a result of skin lesion were selected into this study.Three skin lesions were randomly detected and diagnosed through dermoscopy;and the tunnel as well as"brown triangle"signs in patients diagnosed with scabies through dermoscopy were observed and recorded.Meanwhile,20 patients with brown triangle sign detected by dermoscopy were selected,and squeegee smear microscopy was performed at that site for verification.Afterwards,the clinical efficacy of dermoscopy-confirmed patients that received insecticidal and anti-inflammatory treatment for two weeks was followed up and calculated.Results The average age of suspected patients was(41.0±28.3)years old.The diagnostic rate of scabies upon dermoscopy was 47.6%(98/206).Among them,the detection rate among patients aged from two to six years was 62.9%,that among patients aged from 7 to 24 years was 64%,that among patients aged from 25 to 65 years was 28.2%,and that among patients aged over 65 years was 36.4%.There were altogether 294 skin lesions among the 98 patients of scabies,among which,284 had displayed the tunnel sign(96.6%),while 276 had shown the"brown triangle"sign(93.9%),which had revealed the necessity of insecticidal treatment.For the 20 patients detected with"brown triangle"sign,the squeegee smear microscopy at that site had confirmed infection with pathogen of Sarcoptes scabiei.Moreover,it was discovered through one month follow-up,all the 98 patients diagnosed with scabies had recovered from insecticidal and anti-inflammatory treatment,yielding the recovery rate of 100%.Conclusion Dermoscopic imaging technique has displayed high diagnostic efficiency specific to scabies;and tunnel and"brown triangle"signs are the dermoscopic findings of diagnosing scabies.Dermoscopy can diagnose disease in an in vivo,non-invasive,painless and real-time manner,which can also be utilized to guide treatment.