中华皮肤科杂志 ›› 2018, Vol. 51 ›› Issue (11): 812-814.doi: 10.3760/cma.j.issn.0412-4030.2018.11.008

• 研究报道 • 上一篇    下一篇

甲真菌病皮肤镜表现及模式分析

孙振燕    张思平    章婧    周奥    郑建峰   

  1. 安徽省宣城市人民医院皮肤科(孙振燕、章婧、周奥、郑建峰);安徽省立医院皮肤科(张思平)

  • 收稿日期:2017-12-29 修回日期:2018-07-26 出版日期:2018-11-16 发布日期:2018-10-31
  • 通讯作者: 张思平 E-mail:zsp3285@163.com

Dermoscopic features and patterns of onychomycosis

Sun Zhenyan, Zhang Siping, Zhang Jing, Zhou Ao, Zheng Jianfeng   

  1. Department of Dermatology, The People′s Hospital of Xuancheng City, Xuancheng 242000, Anhui, China (Sun ZY, Zhang J, Zhou A, Zheng JF); Department of Dermatology, Anhui Provincial Hospital, Hefei 230001, China (Zhang SP)
  • Received:2017-12-29 Revised:2018-07-26 Online:2018-11-16 Published:2018-10-31
  • Contact: Zhang Siping E-mail:zsp3285@163.com

摘要: 目的 探讨皮肤镜下甲真菌病的特征性表现及模式。方法 对2017年2 - 7月在安徽宣城市人民医院内分泌皮肤科病区住院的患者进行甲真菌直接镜检,阳性者诊断为甲真菌病,对病甲拍摄皮肤镜照片,分析甲真菌病的皮肤镜下特征及皮肤镜模式。结果 共调查205例患者634个病甲。甲板特征中大理石样浑浊区300个(47.3%)、色素沉着196个(30.9%)、出血碎片116个(18.3%)、甲剥离84个(13.2%)。远端侧位型和全甲毁损型病甲大理石样浑浊区、色素沉着、甲剥离的出现频率差异均有统计学意义(χ2值分别为42.09、31.23、18.19,均P < 0.01)。210个(33.1%)甲增厚,168个(26.5%)甲下角蛋白及碎屑沉积。全甲毁损型病甲甲增厚和甲下角蛋白及碎屑沉积的比例均显著高于远端侧位型病甲(χ2值分别为44.3和18.52,均P < 0.01)。甲周皮肤干燥脱屑在全甲毁损型病甲中的比例高于远端侧位型(χ2 = 16.07,P < 0.01)。634个病甲中,短刺状模式141个(22.2%)、纵向条纹模式210个(33.1%)、线状边缘模式202个(31.9%)、远端不规则中断模式193个(30.4%)。结论 大理石样混浊区、甲下角蛋白及碎屑沉积、甲周皮肤干燥脱屑是甲真菌病皮肤镜下主要特征性表现,短刺状模式、纵向条纹模式、线状边缘模式、远端不规则中断模式是甲真菌病皮肤镜下特征性模式。

关键词: 甲癣, 皮肤镜检查, 模式分析

Abstract: Sun Zhenyan, Zhang Siping, Zhang Jing, Zhou Ao, Zheng Jianfeng Department of Dermatology, The People′s Hospital of Xuancheng City, Xuancheng 242000, Anhui, China (Sun ZY, Zhang J, Zhou A, Zheng JF); Department of Dermatology, Anhui Provincial Hospital, Hefei 230001, China (Zhang SP) Corresponding author: Zhang Siping, Email: zsp3285@163.com 【Abstract】 Objective To analyze the dermoscopic features and patterns of onychomycosis. Methods From February to July in 2017, hospitalized patients from the Department of Endocrine Dermatology of the People′s Hospital of Xuancheng City was enrolled and subjected to direct microscopic examination of fungi in nails, and the patients with positive results for fungi were diagnosed with onychomycosis. And then, dermoscopic photographs of infected nails were taken to analyze the dermoscopic characteristics and patterns of onychomycosis. Results A total of 205 patients with 634 infected nails were investigated. The dermoscopic characteristics on the nail plates included marble-like turbid areas (47.3%, 300/634), pigmentation (30.9%, 196/634), splinter hemorrhages (18.3%, 116/634) and onycholysis (13.2%, 84/634). The prevalence rates of marble-like turbid areas, pigmentation and onycholysis all significantly differed between distal and lateral subungual onychomycosis (DLSO) group and total dystrophic onychomycosis (TDO) group (χ2 = 42.09, 31.23, 18.19, respectively, all P < 0.01). The dermoscopic characteristics at the free edge of the nails included nail thickening (33.1%, 210/634) and subungual deposition of keratin and debris (26.5%, 168/634). The TDO group showed significantly higher prevalence rates of nail thickening and subungual deposition of keratin and detritus compared with the DLSO group (χ2 = 44.3, 18.52, respectively, both P < 0.01). Periungual skin dryness and desquamation occurred more frequently in the TDO group than in the DLSO group (χ2 = 16.07, P < 0.01). Of the 634 lesional nails, 141 (22.2%) showed a short spiked pattern, 210 (33.1%) showed a longitudinal striated pattern, 202 (31.9%) showed a linear edge pattern, and 193 (30.4%) showed a distal irregular termination pattern. Conclusion The main characteristic dermoscopic manifestations of onychomycosis are marble-like turbid areas, subungual deposition of keratin and debris, periungual skin dryness and desquamation, and characteristic dermoscopic patterns of onychomycosis are short spiked pattern, longitudinal striated pattern, linear edge pattern and distal irregular termination pattern.

Key words: Onychomycosis, Dermoscopy, Pattern analysis