不典型疥疮的皮肤镜、皮肤反射式共聚焦显微镜及组织病理学特征分析:附60例报告

Clinical, dermoscopic, reflectance confocal microscopic and histopathological features of atypical scabies: an analysis of 60 cases

目的总结分析不典型疥疮的皮肤镜、皮肤反射式共聚焦显微镜(RCM)及组织病理学的特征。方法对60例不典型疥疮患者的一般资料、病程、临床特点等进行分析,对皮疹进行皮肤镜、RCM观察,对其中25例行组织病理学检查。结果60例不典型疥疮患者年龄以18~65岁为主(24例,40.00%)。职业主要为退休人员(22例,36.67%)、学生(12例,20.00%)及务工人员(11例,18.33%)。平均病程为(38.12±22.56)d。27例(45.00%)患者有明确疥疮接触史。皮疹主要分布在手掌(52例,86.67%)、腹部(49例,81.67%)、腕部(44例,73.33%)及外阴(38例,63.33%)。原发性皮疹类型以丘疹(55例,91.67%)为主。大部分患者(45例,75.00%)都误诊2次以上。误诊类型以瘙痒症(17例,28.33%)、特应性皮炎(16例,26.67%)及湿疹(14例,23.33%)为主。误诊后使用药物种类以糖皮质激素类为主(38例,63.33%)。皮肤镜检查示,48例表现为白色隧道及其末端棕色或深褐色小三角形结构。42例可观察到灰界线。RCM检查示,55例可看出较为典型的虫体、隧道结构及粪便结构。25例行组织病理检查显示,17例角质层中可见虫体或虫卵,12例表皮可呈急性或亚急性海绵水肿性皮炎,18例真皮中主要以嗜酸性粒细胞为主,7例真皮中以淋巴细胞浸润为主。结论不典型疥疮临床特征具有异质性,皮肤镜、RCM及组织病理学检查对不典型疥疮具有一定的诊断价值。

Objective To analyze the dermoscopic,reflectance confocal microscopic and histopathological features of 60 cases of atypical scabies.Methods Sixty cases of atypical scabies were analyzed in terms of demographic data,disease duration,and clinical,dermoscopic and reflectance confocal microscopic features.Skin histopathology was performed in 25 patients.Results A larger portion of the patients were aged 18-65 years(40.00%).Retirees,students and migrant workers accounted for 36.67%(22 cases),20.00%(12 cases)and 18.33%(11 cases),respectively.The average disease duration was 38.12±22.56 days.Twenty-seven patients(45.00%)had a history of contact with patients with scabies.The commonly involved body sites were the palms(52 cases,86.67%),abdomen(49 cases,81.67%),wrists(44 cases,73.33%)and vulva(38 cases,63.33%).The most common skin rashes were papules(55 cases,91.67%).Most patients had been misdiagnosed more than twice.The misdiagnoses included pruritus(17 cases,28.33%),atopic dermatitis(16 cases,26.67%)and eczema(14 cases,23.33%).Over 60%of the misdiagnosed patients were treated with glucocorticoids(38 cases,63.33%).Dermoscopic features included white burrows with triangular structures in brown or dark brown color at the end of burrows(48 cases)and gray-edge lines(42 cases).The typical mite body,burrows and feces were observed in 55 cases under a reflectance confocal microscope.Histopathologically,mites or eggs were seen in the stratum corneum in 17 out of 25 cases,and acute or subacute dermatitis with spongy edema were observed in 12 cases.Dermal infiltrates of eosinophils and lymphocytes were seen in 18 and 7 cases,respectively.Conclusions Atypical scabies displays divergent clinical features.Dermoscopy,reflectance confocal microscopy and histopathology are helpful in the diagnosis of atypical scabies.