寻常痤疮120例皮肤镜特征研究

Analysis of Dermoscopic Characteristics of 120 Patients with Acne Vulgaris

目的 利用皮肤镜采集不同形态皮损、严重程度的寻常型痤疮图像,并结合该皮损处组织病理特点评价不同形态皮损的皮肤镜表现与组织病理学的一致性关系,获得不同严重程度、不同形态痤疮的皮肤镜特征。方法 选取符合痤疮诊断标准患者共120例,按照Pillsbury分级标准分为Ⅰ~Ⅳ级,并选取粉刺、丘疹、脓疱、瘢痕等不同形态皮损采集图像。对照组:年龄、性别匹配的无痤疮的正常健康人。结果 (1)不同严重程度痤疮(轻、中、重度)的皮肤镜表现比较:血管形态、毳毛增多在不同严重程度痤疮中差异无统计学意义(P>0.05),轻度痤疮的淡红色背景、血管局灶性分布、毛孔粗大、毛囊周围淡黄色晕、肉芽组织样结构,中度痤疮的红色/黄红色背景、局灶性血管分布、毛孔粗大、毛囊周围淡黄色晕、肉芽组织样结构,重度痤疮的黄红色背景、弥漫性血管分布、毛孔粗大、毛囊周围淡黄色晕、肉芽组织样结构差异分别具有统计学意义(P<0.05)。(2)不同形态痤疮皮损的皮肤镜表现比较:粉刺以淡红色背景、点状血管、局灶性分布差异有统计学意义;脓疱以红色背景、花环状血管、弥漫性分布、毛周“红点征”差异有统计学意义;丘疹以黄红色背景、花环状血管、局灶性分布、毛周“红点征”差异有统计学意义;瘢痕黄红色背景、非典型血管、弥漫性分布差异有统计学意义(P<0.05)。结论 不同严重程度、皮损形态的痤疮皮肤镜表现具有一定典型的模式与结构特征,在临床诊疗中有一定参考价值,也有助于基于人工智能的痤疮诊断、鉴别及疗效评估等深入开发应用。

Objective To collect images of acne vulgaris with different forms of skin lesions and severity by dermoscopy.The consistent relationship between dermoscopic findings and histopathology of different forms of skin lesions was analyzed in combination with histopathology,and summarize the dermoscopic features of acne with different severity levels and forms.Methods According to Pillsbury classification,120 patients meeting the diagnostic criteria were divided into gradeⅠ~Ⅳ,and the images of comedones,papules,pustules and scars were collected.Control group:normal healthy people without acne matched for age and sex.Results①Comparison of dermatoscopic manifestations of acne with different severity levels(mild,moderate and severe):There was no significant difference in vessel morphology and increased vellus hair in acne severity(P>0.05).Mild acne visible:light red background,vascular focal distribution,thick pores,yellowish halo around hair follicles,granulation tissue-like structure.Moderate acne visible:red/yellow red background,focal vascular distribution,thick pores,yellowish halo around hair follicles,granulation tissue-like structure.Severe acne visible:yellow-red background,diffuse vascular distribution,thick pores,yellowish halo around hair follicles,granulation tissue-like structure.Among the above categories,the differences were statistically significant,respectively(P<0.05).②Comparison of dermoscopic manifestations of different forms of acne skin lesions:comedones:light red background,dot-like vessels,focal distribution has statistical significance;pustules:red background,annular vessels,diffuse distribution,"red dot sign"around hair follicles;Papules:yellow-red background,flower ring-like vessels,focal distribution,perihairy"red dot sign";Scars:yellow-red background,atypical vessels,diffuse distribution;in the above categories,the differences were statistically significant,respectively(P<0.05).Conclusion Dermoscopy has certain overlap in the observation of acne vulgaris,but each has typical patterns and structural characteristics,which has certain reference value in clinical practice.