儿童色素减退型扁平疣的皮肤镜和反射性共聚焦显微镜图像特征分析

Imaging characteristics of hypopigmented verruca plana in children

目的:探讨儿童色素减退型扁平疣的反射性共聚焦显微镜(RCM)和皮肤镜影像学特征,为明确诊断、鉴别儿童其他色素减退性疾病提供有力依据。方法:应用RCM和皮肤镜检查12例临床拟诊为色素减退型扁平疣的患儿皮损,分析色素减退型扁平疣的皮肤影像特征。结果:色素减退型扁平疣皮肤影像学表现与经典型有较高一致性,其RCM图像特征:皮损区颗粒层及棘层上部可见多量体积较大细胞不规则分布,部分区域可见玫瑰花环样结构,较大细胞直径0.021~0.035 mm,玫瑰花环直径0.08~0.24 mm,基底层色素减少,真皮浅层毛细血管明显扩张,可见稀疏炎性细胞浸润。皮肤镜:粉白色背景下白色丘疹,可见点状血管结构。结论:RCM和皮肤镜检查为无创诊断儿童色素减退型扁平疣提供有力的皮肤影像依据,对减少误诊、鉴别儿童其他色素减退性疾病有较高的临床应用价值。

Objective: To investigate the imaging characteristics of hypopigmented verruca plana using reflectance confocal microscopy(RCM) and dermoscopy, and provide a strong basis for the diagnosis and differentiation of hypopigmentation diseases in children. Methods: RCM and dermoscopy were used to examine the skin lesions of 16 children clinically diagnosed with hypopigmented verruca plana, and the skin imaging characteristics were analyzed. Results: The imaging characteristics of hypopigmented verruca plana were highly consistent with those of the classic type. The RCM characteristics were as follows:clear boundary of the lesion area, slightly thickened epidermis, and a large number of large cells(diameter:0.021~0.035 mm) irregularly distributed in the granular layer and the upper part of the echinoderm and rosette-like structure(diameter:0.08~0.24 mm), reduced pigment in the basal layer, obviously dilated superficial capillaries, some infiltrated inflammatory cells, and vacuole cells sized 0.021~0.032 mm. Dermoscopy revealed a pink white background, and punctate vascular structures. Conclusion: RCM and dermoscopy can provide a strong imaging basis for the diagnosis of hypopigmented verruca plana in children, and have a high value for the differentiation of hypopigmentation diseases in children.