甲真菌病和甲银屑病的皮肤镜特征分析

doi:10.3760/cma.j.issn.0412-4030.2019.02.008

中华皮肤科杂志 ›› 2019, Vol. 52 ›› Issue (2): 106-110.doi: 10.3760/cma.j.issn.0412-4030.2019.02.008

甲真菌病和甲银屑病的皮肤镜特征分析

熊娟娟¹ 毕健平² 孙德祥³ 李念⁴ 鲁巧云¹

¹襄阳市中心医院湖北文理学院附属医院皮肤科，441000；²青岛市立医院皮肤科，266000；³青岛市胶州中心医院皮肤科，266000；⁴襄阳市第一人民医院皮肤科，441000

收稿日期:2018-03-26 修回日期:2018-09-17 出版日期:2019-02-15 发布日期:2019-01-29
通讯作者: 鲁巧云 E-mail:xyluqiaoyun@163.com

Dermoscopic features of onychomycosis and nail psoriasis

Xiong Juanjuan¹, Bi Jianping², Sun Dexiang³, Li Nian⁴, Lu Qiaoyun¹

¹Department of Dermatology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, Hubei, China; ²Department of Dermatology, Qingdao Municipal Hospital, Qingdao 266000, China; ³Department of Dermatology, Jiaozhou Central Hospital of Qingdao, Jiaozhou 266000, Shandong, China; ⁴Department of Dermatology, Xiangyang No.1 People′s Hospital, Xiangyang 441000, Hubei, China

Received:2018-03-26 Revised:2018-09-17 Online:2019-02-15 Published:2019-01-29
Contact: Lu Qiaoyun E-mail:xyluqiaoyun@163.com

摘要/Abstract

摘要： 【摘要】目的分析甲真菌病和甲银屑病的皮肤镜特征。方法 2017年3月至2018年3月在湖北襄阳市中心医院皮肤科收集就诊的甲真菌病和甲银屑病患者各128例，对病甲皮肤镜图像进行比较。计数资料比较采用χ2检验和Fisher精确检验分析。结果甲真菌病出现7种皮肤镜模式，分别为锯齿状边缘69例（53.91%）、纵行条纹72例（56.25%）、锥形甲角化30例（23.44%）、甲板增厚21例（16.41%）、甲黑点5例（3.91%）、甲剥离26例（20.31%）和甲变色23例（17.97%）。其中，锯齿状边缘和纵行条纹在远端侧位甲下型甲真菌病中出现的频率明显高于其他3种亚型，差异有统计学意义（均P＜0.001），锥形甲角化在全甲毁损型甲真菌病中出现的频率明显高于其他3种亚型，差异有统计学意义（χ2 = 42.020，P＜0.001），甲板增厚、甲黑点、甲剥离和甲变色在4种甲真菌病临床亚型中的分布差异无统计学意义（均P＞0.05）。甲银屑病出现7种皮肤镜模式，分别为点蚀征61例（47.66%）、油滴征41例（32.03%）、裂片形出血41例（32.03%）、甲床毛细血管扩张23例（17.97%）、甲板增厚20例（15.63%）、甲剥离20例（15.63%）和甲变色13例（10.16%），其中油滴征在寻常性和关节病性银屑病中出现的频率明显高于其他两种亚型（P = 0.019），甲床毛细血管扩张在脓疱性银屑病中出现的频率明显高于其他3种亚型（P = 0.047），点蚀征、裂片形出血、甲板增厚、甲剥离和甲变色在4种银屑病临床亚型中的分布差异无统计学意义（均P＞0.05）。结论甲真菌病皮肤镜下特征包括锯齿状边缘、纵行条纹、锥形甲角化和甲黑点，银屑病甲皮肤镜下特征包括点蚀征、油滴征、裂片形出血和甲床毛细血管扩张，二者同时出现的镜下表现包括甲板增厚、甲剥离和甲变色。

关键词: 甲癣, 银屑病, 指（趾）甲, 皮肤镜检查

Abstract: 【Abstract】 Objective To investigate dermoscopic features of onychomycosis and nail psoriasis. Methods From March 2017 to March 2018, 128 patients with onychomycosis and 128 with nail psoriasis were enrolled from Department of Dermatology, Xiangyang Central Hospital. Dermoscopic images of the lesional nails were compared. Enumeration data were analyzed by chi-square test and Fisher′s exact test. Results There were 7 kinds of dermoscopic patterns in onychomycosis, including jagged edge （69/128, 53.91%）, longitudinal striae （72/128, 56.25%）, cone-shaped keratosis （30/128, 23.44%）, nail plate thickening （21/128, 16.41%）, black dots （5/128, 3.91%）, onycholysis （26/128, 20.31%）, and nail discoloration （23/128, 17.97%）. The jagged edge and longitudinal striae occurred more frequently in distal/lateral subungual onychomycosis （DLSO） than in the other 3 clinical subtypes of onychomycosis （all P < 0.001）, and cone-shaped keratosis occurred more frequently in total dystrophic onychomycosis （TDO） than in the other 3 clinical subtypes of onychomycosis （χ2 = 42.020, P < 0.001）. There were no significant differences in the prevalance of nail plate thickening, black dots, onycholysis and nail discoloration among the 4 clinical subtypes of onychomycosis （all P > 0.05）. There were 7 kinds of dermoscopic patterns in nail psoriasis, including pitting corrosion （61/128, 47.66%）, oil drop sign （41/128, 32.03%）, splinter hemorrhage （41/128, 32.03%）, dilated hyponychial capillaries （23/128, 17.97%）, nail plate thickening （20/128, 15.63%）, onycholysis （20/128, 15.63%）, and nail discoloration （13/128, 10.16%）. The oil drop sign occurred more frequently in psoriasis vulgaris and psoriasis arthropathica than in the other 2 clinical subtypes of psoriasis （P = 0.019）. The dilated hyponychial capillaries occurred more frequently in pustular psoriasis than in the other 3 clinical subtypes of psoriasis （P = 0.047）. There were no significant differences in the prevalance of pitting corrosion, splinter haemorrhage, nail plate thickening and nail discoloration among the 4 clinical subtypes of psoriasis （all P > 0.05）. Conclusions The dermoscopic features of onychomycosis include jagged edge, longitudinal striae, cone-shaped keratosis and black dots, and the dermoscopic features of nail psoriasis include pitting corrosion, oil drop sign, splinter haemorrhage and dilated hyponychial capillaries. Their common dermoscopic features include nail plate thickening, onycholysis and nail discoloration.

Key words: Onychomycosis, Psoriasis, Nails, Dermoscopy

中图分类号:

R751

熊娟娟毕健平孙德祥李念鲁巧云. 甲真菌病和甲银屑病的皮肤镜特征分析[J]. 中华皮肤科杂志, 2019, 52(2): 106-110.

Xiong Juanjuan, Bi Jianping, Sun Dexiang, Li Nian, Lu Qiaoyun. Dermoscopic features of onychomycosis and nail psoriasis[J]. Chinese Journal of Dermatology, 2019, 52(2): 106-110.

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甲真菌病和甲银屑病的皮肤镜特征分析

Dermoscopic features of onychomycosis and nail psoriasis

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