儿童线状苔藓57例临床资料分析

Clinical features of 57 cases of lichen striatus in children

目的探讨儿童线状苔藓的临床特征,以助儿童线状苔藓的早期诊断及治疗。方法对2020年11月至2021年11月首次就诊于首都儿科研究所附属儿童医院皮肤科门诊并平均随访1.5年的57例线状苔藓患儿进行临床回顾性分析,总结其临床特点、皮肤反射式共聚焦显微镜等检查特点、治疗情况及预后。结果57例患儿男29例,女28例,患儿就诊中位(IQ1~IQ3)年龄为5岁(2~7岁),中位(IQ1~IQ3)病程为13.0个月(11.0~15.5个月)。53例患儿皮损为单发,4例患儿有2处皮损。57例患儿共61处皮损,发病部位依次为下肢23处,上肢17处,躯干14处,甲5处,面部2处。根据病灶的形态,主要分为3种临床模式:经典型(47处),色素减退型(8处),甲受累型(6处)。3种类型间整体病程存在差异(H=11.801,P=0.003),甲受累型比经典型、色素减退型中位病程长。3种类型活动期病程存在差异(H=12.537,P=0.000),甲受累型比经典型中位活动期长。61处皮损,48处外用0.03%他克莫司软膏或0.1%糠酸莫米松乳膏加0.03%他克莫司软膏外用治疗1~3个月,13处皮损未治疗或未坚持规律用药治疗。结论儿童线状苔藓的临床表现及皮肤反射式共聚焦显微镜下表现具有典型特征,可辅助诊断。儿童线状苔藓主要分为3种临床模式:经典型、色素减退型、甲受累型。疾病进展期外用糖皮质激素和(或)钙调磷酸酶抑制剂有助于对症缓解瘙痒,缩短进展期病程,但并不缩短总病程。该病有自限性,不治疗经过数月亦可自行消退,且不留瘢痕。

Objective To investigate the clinical features of lichen striatus in children,so as to assist the early diagnosis and treatment of lichen striatus in children.Methods A retrospective analysis was performed on 57 children with lichen striatus,who initially sought medical care at the the department of dermatology,Children's Hospital Affiliated to the Capital Institute of Pediatrics between November2020 and November 2021 and were followed up for an average of 1.5 years.The multiple clinical data were collected for further analysis,including general manifestation of skin lesions,results of skin reflectance confocal microscopy examination,treatment results and prognosis.Results Among the 57 pediatric patients,there were 29 males and 28 females.The median age of the patients(IQ1~IQ3)was 5 years old(2~7 years old),and the median duration of disease was 13.0 months(11.0~15.5 months).A total of 61 skin lesions were detected in 57pediatric patients,with single lesions observed in 53 children and dual lesions present in 4 children.The skin lesions were mainly distributed in the lower limbs(23 lesions),followed by the upper limbs(17 lesions),trunk(14 lesions),nails(5 lesions),and face(2 lesions).According to the morphology,the lesions were mainly divided into three clinical modes,including classic type(47 lesions),hypopigmentation type(8 lesions)and nail involvement type(6 lesions).There were significant differences in the overall course of disease among the three types(H=11.801,P=0.003),with the longest median course of disease in nail involvement type.There were significant differences in the duration of disease activity among the three types(H=12.537,P=0.000),and nail involvement type had a longer median course of disease activity compared to classic type.Out of 61 skin lesions,48 lesions received treatment with external application of 0.03%tacrolimus ointment(or combination with 0.1%mometasone furoate cream)for 1-3 months,and 13 lesions were left untreated or lacked regular medication.Conclusions The clinical manifestations of lichen striatus and its skin manifestations observed through reflectance confocal microscopy exhibit typical characteristics,which can be utilized as diagnostic aids for lichen striatus.The lichen striatus is mainly divided into three clinical modes,including classic type,hypopigmentation type,and nail involvement type.Topical glucocorticoids and(or)calcineurin inhibitors administered during the active phase of the disease can effectively alleviate symptomatic pruritus and reduce the duration of disease activity,without impacting the overall course of the disease.The lichen striatus is a self-limiting disease,resolving spontaneously within a few months without treatment,and exhibiting a favorable prognosis with no scar formation.