中华皮肤科杂志 ›› 2019, Vol. 52 ›› Issue (6): 425-428.doi: 10.3760/cma.j.issn.0412-4030.2019.06.010

• 研究报道 • 上一篇    下一篇

皮肤镜在白癜风诊断及鉴别诊断中的应用

陈旭光    马锦媛    张宇伟    郭艳阳    刘玲    李春英   

  1. 第四军医大学西京皮肤医院，西安  710032
  • 收稿日期:2019-01-02 修回日期:2019-02-17 发布日期:2019-06-03
  • 通讯作者: 李春英 E-mail:lichying@fmmu.edu.cn
  • 基金资助:
    国家自然科学基金（81703128）；陕西省重点研发计划项目（2019SF-09）

Application of dermoscopy in the diagnosis and differential diagnosis of vitiligo

Chen Xuguang, Ma Jinyuan, Zhang Yuwei, Guo Yanyang, Liu Ling, Li Chunying   

  1. Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi′an 710032, China
  • Received:2019-01-02 Revised:2019-02-17 Published:2019-06-03
  • Contact: Li Chunying E-mail:lichying@fmmu.edu.cn
  • Supported by:
    National Natural Science Foundation of China （81703128）; Key Research and Development Program of Shaanxi Province （2019SF-09）

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摘要： 【摘要】 目的 探讨偏振光皮肤镜在白癜风诊断及其与常见色素减退性皮肤病鉴别诊断中的应用价值。方法 回顾性分析2018年1 - 6月在西京皮肤医院235例确诊的白癜风患者皮损的皮肤镜图像，包括进展期患者130例，稳定期患者105例。同时与151例无色素痣、113例白色糠疹和54例特发性点状色素减少症患者的皮肤镜图像进行比较。组间率比较采用χ2检验。 结果 毛囊周围色素残留、网状色素减退、星爆现象、Tapioca sago征、微小Koebner征在进展期白癜风患者中的比例明显高于稳定期（χ2 = 36.5、151.2、13.0、14.9、8.4，均P < 0.05）；毛囊周围色素脱失、皮损周围色素增多、毛囊周围毛细血管扩张、白发在稳定期患者中的比例显著高于进展期（χ2 = 91.2、166.0、54.3、41.1，均P < 0.05）。毛囊周围色素残留在进展期（89.2%，116/130）和稳定期白癜风（54.3%，57/105）中的比例均明显高于无色素痣（20.5%，31/151）、白色糠疹（12.4%，14/113）和特发性点状色素减少症（9.3%，5/54），差异有统计学意义（均P < 0.05）。结论 毛囊周围色素残留可作为白癜风与无色素痣、白色糠疹及特发性点状色素减少症的重要鉴别特征，偏振光皮肤镜对于白癜风和某些色素减退性皮肤病的鉴别具有较好的辅助诊断和临床应用价值。

关键词: 白癜风； 皮肤镜检查； 诊断, 鉴别； 色素减退性皮肤病

Abstract: 【Abstract】    Objective    To evaluate the application value of polarized light dermoscopy in the diagnosis of vitiligo and differential diagnosis between vitiligo and other common hypopigmented diseases. Methods    Dermoscopic images of lesions of 235 patients with confirmed vitiligo （130 with active vitiligo and 105 with stable vitiligo） were collected from the database in the Department of Dermatology, Xijing Hospital from January 2018 to July 2018, and retrospectively analyzed. Meanwhile, dermoscopic images of amelanotic nevus （151 cases）, pityriasis alba （113 cases） and idiopathic guttate hypomelanosis （54 cases） were compared with the dermoscopic images of vitiligo. Chi-square test was used for comparison of rates among groups. Results    The prevalence of perifollicular pigmentation, reticular pigmentation, starburst, Tapioca sago and micro-Koebner phenomenon was significantly higher in the patients with active vitiligo than in those with stable vitiligo （χ2 = 36.5, 151.2, 13.0, 14.9, 8.4 respectively, all P < 0.05）. The prevalence of perifollicular pigmentation, perilesional hyperpigmentation, perifollicular telangiectasia, leukotrichia was significantly higher in patients with stable vitiligo than in those with active vitiligo （χ2 = 91.2, 166.0, 54.3, 41.1 respectively, all P < 0.05）. The prevalence of residual perifollicular pigmentation was significantly higher in patients with active （89.2%, 116/130） or stable vitiligo （54.3%, 57/105） than in those with amelanotic nevus （20.5%, 31/151, P < 0.05）, pityriasis alba （12.4%, 15/113, P < 0.05）or idiopathic guttate hypomelanosis （9.3%, 5/54, P < 0.05）. Conclusion    Residual perifollicular pigmentation could serve as an important feature for distinguishing vitiligo from achromic nevus, pityriasis alba and idiopathic guttate hypomelanosis, and polarized light dermoscopy shows good value in the differential diagnosis between vitiligo and some hypopigmented diseases.

Key words: Vitiligo, Dermoscopy, Diagnosis, differential, Hypopigmented diseases

引用本文

陈旭光 马锦媛 张宇伟 郭艳阳 刘玲 李春英. 皮肤镜在白癜风诊断及鉴别诊断中的应用[J]. 中华皮肤科杂志, 2019,52(6):425-428. doi:10.3760/cma.j.issn.0412-4030.2019.06.010

Chen Xuguang, Ma Jinyuan, Zhang Yuwei, Guo Yanyang, Liu Ling, Li Chunying. Application of dermoscopy in the diagnosis and differential diagnosis of vitiligo[J]. Chinese Journal of Dermatology, 2019, 52(6): 425-428.doi:10.3760/cma.j.issn.0412-4030.2019.06.010