扁平苔藓样角化病临床及皮肤镜特征分析

Analysis of clinical and dermoscopic features of lichen planus-like keratosis

目的探讨扁平苔藓样角化病(LPLK)的临床表现及皮肤镜特征。方法回顾性分析2017年1月至2019年9月在上海市皮肤病医院门诊就诊并行皮肤镜及皮肤组织病理检查确诊的21例扁平苔藓样角化病患者的临床及皮肤镜特征。结果21例患者年龄(64.69±13.29)岁,男女比例为1∶2。18例皮损位于面部,3例位于小腿。10例皮损呈斑块样型,6例扁平色素斑型,5例扁平红斑样型。7例皮损呈红/紫红色,5例棕红色,8例棕/灰色,1例棕/红色。皮肤镜检查显示,12例为非色素型LPLK,9例为色素型LPLK。色素颗粒见于13例皮损中,且在色素型和非色素型LPLK中的发生率差异无统计学意义(P=0.07);色素颗粒多呈弥漫分布(9/13),且多见于色素型LPLK(8/9);4例色素颗粒呈局灶分布,均见于非色素型LPLK皮损。10例(10/13)可见色素粗颗粒,其中色素型8例,非色素型2例,色素粗颗粒在两组中分布差异有统计学意义(P=0.002)。色素特殊分布模式中,环状颗粒模式为8例(8/13),胡椒粉样色素颗粒模式7例(7/13),色素型和非色素型LPLK两组间分布差异无统计学意义(P>0.05)。13例(13/21)可见鳞屑,7例(7/21)血管结构,两种结构在色素型和非色素型LPLK组间发生率差异无统计学意义(P值分别为0.67、0.16)。结论LPLK好发于面部,可表现为单发的红色、棕红色和棕灰色斑块或斑片,表面可覆鳞屑;特征性皮肤镜特征为出现色素颗粒,以弥漫分布的粗颗粒为主,多见于色素型LPLK。

Objective To investigate clinical manifestations and dermoscopic characteristics of lichen planus-like keratosis(LPLK).Methods Clinical data were collected from 21 patients with LPLK who visited Shanghai Skin Disease Hospital and underwent both dermoscopic and histopathological examinations from January 2017 to September 2019,and clinical and dermoscopic features were retrospectively analyzed.Results These patients were aged 64.69±13.29 years,and the ratio of males to females was 1∶2.Skin lesions were located on the face of 18 cases and legs of 3 cases,and were red/violaceous in color in 7 cases,reddish-brown in 5,brown/gray in 8,and brown/reddish in 1.There were 3 types of kin lesions,including plaque-like type in 10 cases,flat pigmented patch type in 6,and flat erythema-like type in 5.As dermoscopy showed,12 cases were non-pigmented LPLK,and 9 were pigmented LPLK.Pigment granules were found in 13 lesions,and there was no significant difference in the incidence of pigment granules between pigmented and non-pigmented LPLK(P=0.07);pigment granules were often diffusely distributed(9/13),and the diffuse distribution pattern was common paticularly in pigmented LPLK(8/9);locally distributed pigment granules were found in 4 cases of non-pigmented LPLK.Coarse pigment granules were seen in 10 cases(10/13),including 8 of pigmented LPLK and 2 of non-pigmented LPLK,and the incidence rate of coarse pigment granules significantly differed between the pigmented LPLK and non-pigmented LPLK groups(P=0.002).Moreover,special distribution patterns of pigment granules included the annular granular pattern(8/13)and peppered pattern(7/13),and no significant difference was observed in the incidence of the 2 special distribution patterns between the pigmented LPLK and non-pigmented LPLK groups(both P>0.05).Scales were seen in 13 cases(13/21),and vascular structures in 7(7/21),and there was no significant difference in the incidence of the 2 structures between the pigmented and non-pigmented LPLK groups(P=0.67,0.16,respectively).Conclusion LPLK mostly occurs on the face,and manifests as solitary red,reddish-brown or brownish-gray plaques or patches,whose surfaces may be covered with scales.The characteristic dermoscopic feature of LPLK is the presence of pigment granules,which are coarse,often diffusely distributed,and commonly observed in pigmented LPLK.