非生殖器部位硬化性苔藓57例皮肤镜与反射式共聚焦显微镜影像特征分析

Analysis of dermoscopic and reflectance confocal microscopic characteristics of 57 cases of extragenital lichen sclerosus

目的分析非生殖器部位硬化性苔藓皮肤镜与反射式共聚焦激光扫描显微镜(RCM)的影像特征及与组织病理表现的关联。方法回顾性分析2010年10月至2024年4月于武汉市第一医院皮肤科门诊经组织病理学确诊的硬化性苔藓患者,选取非生殖器部位典型皮损,分别采集皮肤镜、RCM图像,对比两者图像特征与组织病理学特征的一致性。结果57例非生殖器部位硬化性苔藓患者,男15例,女42例,年龄5~60岁,病变持续时间5~28个月,皮损主要位于面颈部(23例,40.4%)和背部(11例,19.3%)。组织病理特征为角化过度,伴毛囊角栓,基底细胞空泡变性,真皮乳头及浅层水肿,伴胶原均质化改变;真皮浅层不等量噬黑素细胞及淋巴细胞为主的炎症细胞浸润。皮肤镜下可见黄白色无结构区57例(100%),黄白色圆圈状结构55例(毛囊角栓,96.5%),特征性血管结构54例(94.7%),灰褐色点状色素沉着56例(98.3%),黄棕色斑片状色素沉着20例(35.1%),白色鳞屑54例(94.7%),白色瘢痕样色素减退43例(75.4%),出血性瘀斑2例(3.5%)。RCM下可见毛囊漏斗部扩张,其内包裹高折光角化性物质,即毛囊角栓44例(77.2%);基底细胞环液化变性57例(100%),基底细胞环缺失,真表皮界面模糊,真皮浅层可见不等量噬黑素细胞及炎症细胞浸润;真皮浅层血管扩张46例(80.7%);经测量表皮厚度较周围正常皮肤减少,表皮萎缩变薄,皮突变平57例(100%);角化过度57例(100%);真皮浅层纤维增粗增厚,折光增高39例(68.4%)。皮肤镜下毛囊角栓、斑片状色素沉着和白色瘢痕样色素减退的检出率与组织病理检查存在差异(均P<0.05),RCM下真皮浅层胶原增厚和血管扩张的检出率也与组织病理检查存在差异(均P<0.05)。结论非生殖器部位硬化性苔藓皮肤镜与RCM影像均具有特征性改变,并与组织病理表现具有高度一致性,两者可对非生殖器部位硬化性苔藓的诊断及鉴别诊断提供有力支持。

Objective To analyze the dermoscopic and reflectance confocal microscopic(RCM)features of extragenital lichen sclerosus,and to identify their associations with histopathological manifestations.Methods A total of 57 patients with histopathologically confirmed lichen sclerosus were retrospectively collected from the Department of Dermatology,Wuhan No.1 Hospital from October 2010 to April 2024.Dermoscopic and RCM images were collected from typical skin lesions in extragenital areas,and the consistency between dermoscopic or RCM characteristics and histopathological features was analyzed.Results Among the 57 patients with extragenital lichen sclerosus,there were 15 males and 42 females,with ages ranging from 5 to 60 years and disease duration from 5 to 28 months.The skin lesions were mainly located on the face and neck(23 cases,40.4%)and back(11 cases,19.3%).Histopathological features included hyperkeratosis with follicular plugging,vacuolar degeneration of basal cells,edematous papillary and superficial dermis,collagen homogenization,and predominant infiltration of variable amounts of melanophages and lymphocytes in the superficial dermis.Dermoscopy showed yellowish-white structureless areas in 57 cases(100%),yellowish-white circular structures in 55(corresponding to follicular keratotic plugs,96.5%),characteristic vascular structures in 54(94.7%),gray-brown punctate pigmentation in 56(98.3%),xanthochromic patchy pigmentation in 20(35.1%),white scales in 54(94.7%),white scar-like hypopigmentation in 43(75.4%),and hemorrhagic spots in 2(3.5%).RCM images showed follicular plugging in 44 cases(77.19%),manifesting as dilated follicular infundibula containing highly refractive keratotic materials;liquefaction degeneration of the basal cell ring was observed in 57 cases(100%),manifesting as loss of the basal cell ring,blurred epidermal-dermal junction,and infiltration of variable amounts of melanophages and inflammatory cells in the superficial dermis;dilatation of superficial dermal blood vessels was seen in 46(80.7%);all 57 cases(100%)showed reduced epidermal thickness compared to surrounding normal skin,epidermal atrophy and thinning,and rete ridge flattening;hyperkeratosis was observed in 57 cases(100%);39 cases(68.42%)showed thickened fibers with increased refractivity in the superficial dermis.The detection rates of follicular keratotic plugs,patchy pigmentation,and white scar-like hypopigmentation by dermoscopy significantly differed from those by histopathological examinations(all P<0.05),so did the detection rates of superficial dermal collagen thickening and vascular dilatation by RCM(both P<0.05).Conclusions Extragenital lichen sclerosus has characteristic dermoscopic and RCM manifestations,which were highly consistent with its histopathological findings.Dermoscopy combined with RCM technology can provide effective support for the diagnosis and differential diagnosis of extragenital lichen sclerosus.