皮肤镜辅助诊断挪威疥1例

A case of Norwegian scabies diagnosed with the aid of dermoscopy

报告采用皮肤镜辅助诊断挪威疥1例。患者男,78岁,全身反复丘疹、丘疱疹、结节伴瘙痒2年。曾在外院及我院门诊反复以“湿疹”“结节性痒疹”“丘疹性荨麻疹”等为诊断治疗,反复使用抗组胺药及糖皮质激素类药膏外擦,皮疹稍缓解,瘙痒缓解不明显。皮肤科检查:躯干、四肢可见密集性丘疹、丘疱疹、结节,尤以双上肢肘关节、腋下、臀部及双大腿为主,部分皮疹上可见鳞屑,双手、双手(足)指(趾)缝、臀部可见大量厚层糠秕样痂皮,局部闻及腥臭味。皮肤镜镜检:镜下可见白色隧道,隧道呈喷气飞机轨迹状,隧道内可见虫卵及分泌物,隧道一端呈棕色小三角形结构。显微镜下:疥螨可见颚体、螯肢、须肢、刚毛。诊断:挪威疥。治疗:25%硫磺软膏联合地奈德乳膏外擦,2次/d;口服依匹斯汀胶囊,以及中药汤剂银地土茯苓汤加减。治疗2周后瘙痒及皮疹均有明显好转。随访2个月,未复发。

To report a case of Norwegian scabies diagnosed with the aid of dermoscopy.A 78-year-old man suffered from generalized papules,papulovesicles and nodules with pruritus for 2 years.Patient had been repeatedly diagnosed as eczema or nodular prurigo or urticaria.Topical antihistamines and glucocorticoids only slightly improved lesions,but not pruritus.Dermatological examination showed dense papules,papulovesicles and nodules on the trunk and limbs,especially on the elbows,armpits,buttocks and thighs.Some lesions were covered with scales.Chaffy scales were present on the hands,fingers/toe gaps and buttocks,with fishy odour smell.Dermoscopy showed white burrows in appearance of delta-wing jet.Mites and secretion were observed in the burrows along with triangular structure on the other end of the burrows.A diagnosis of Norwegian scabies was made.Pruritus and skin lesions were significantly improved after 2-week twice-daily treatment with topical 25%sulfur ointment plus desonide cream in addition to oral epinastine capsule and decoction of Chinese medicine.No recurrence was observed during a 2-month follow-up.