皮肤影像技术辅助诊断成人头癣1例

Skin Imaging Technique Assisted in the Diagnosis of Tinea Capitis in Adults:A Case Report

患者女,23岁。头皮脱屑伴红色丘疹1个月余,伴瘙痒。反射式共聚焦显微镜检查示:头皮鳞屑可见高折光的疑似菌丝状结构,发鞘受损明显,发丝内可见高折光疑似串珠样菌丝状结构。皮肤镜下可见红色背景,不均匀分布的点状、线状、环状、发夹样血管,可见头癣样块状发,毛发折断,有营养不良发,毛发根部周围包裹黄白色鳞屑,伍德灯下为亮绿色荧光。真菌涂片检查:找见菌丝孢子;真菌培养15 d,鉴定为犬小孢子菌。诊断:成人头癣。

A 23-years-old female patient presented with scalp desquamation,red papules and itching for over a month.Reflective confocal microscopy revealed a highly refractive structure suspected to be filamentous in the scalp scales.It also showed significant damage to the hair sheath and a suspected beaded filamentous structure in the hair.Further dermoscopy examination found a red background,unevenly distributed punctate,linear,annular,hairpin-like vessels,tinea captis-induced patches of hair loss,broken and dystrophic hairs,and yellow and white scales around the hair roots.The bright green fluorescence could be seen under the Wood lamp.A smear examination revealed mycelial spores.A fungal culture done for 15 days,identifying the infection as Microsporum canis.The diagnosis was tinea capitis in adults.