摘要
目的：探讨反射式共聚焦显微镜（RCM）在儿童常见丘疹性疾病（光泽苔藓、扁平疣、线状苔藓、粟丘疹、传染性软疣、毛发苔藓）中的临床应用价值。方法收集579例以丘疹为临床表现的门诊儿童病例，利用RCM分别观察皮损处及皮损周边正常皮肤的镜下结构，分析总结6种丘疹性疾病RCM图像的基本特征及鉴别要点。结果经RCM检测后确诊光泽苔藓236例，扁平疣70例，线状苔藓123例，粟丘疹40例，传染性软疣53例，毛发苔藓57例。6种疾病均具有典型RCM特征，光泽苔藓可见扩大的真皮乳头，内有致密炎细胞及噬色素细胞浸润；扁平疣的颗粒层及棘层细胞呈同心圆状排列，似玫瑰花团样；线状苔藓棘层灶性水肿，基底细胞无或局灶性液化变性，真皮浅层中等量炎细胞呈簇状分布；粟丘疹在真皮可见境界清晰的圆形或椭圆形结构，内含高折光物质，且内容物折光不均匀；传染性软疣在RCM下可见完整的囊腔样结构，内有较高折光的软疣小体；毛发苔藓的毛囊漏斗部扩张，可见中低折光的近似角质样物质。6种疾病RCM下鉴别要点在于连续纵扫下皮损部位的结构特征（模式、折光度）。结论 RCM在儿童丘疹性疾病的诊断中具有较高临床应用价值。
Objective To evaluate the clinical application value of reflectance confocal microscopy（RCM） in the diagnosis of several common diseases manifesting as papules in children, including lichen nitidus, verruca planae, lichen striatus, milium, molluscum contagiosum and lichen pilaris. Methods A total of 579 children clinically characterized by papules were recruited into this study. RCM was used to observe lesions and perilesional normal skin. The RCM features of 6 diseases manifesting as papules were analyzed and compared. Results Based on RCM images, 236 patients were diagnosed with lichen nitidus, 70 with verruca planae, 123 with lichen striatus, 40 with milium, 53 with molluscum contagiosum and 57 with lichen pilaris. All the 6 diseases had typical RCM features. Concretely speaking, RCM images of lichen nitidus lesions showed infiltration of dense inflammatory cells and melanophages in enlarged dermal papillae. In RCM images of verruca planae lesions, cells in the granular and spinous layers were arranged in concentric circles, giving a rose cluster-like appearance. RCM images of lichen striatus lesions revealed focal swelling of stratum spinosum, absent or local liquifaction degeneration of basal cells, and clustering of a moderate number of inflammatory cells in the superficial dermis. In RCM images of milium lesions, well-circumscribed round or oval structures containing highly but nonuniformly refractive materials could be seen in the dermis. RCM images of molluscum contagiosum lesions showed intact cystoid structures containing highly refractive molluscum bodies. Lowly to moderately refractive cutin - like materials were observed along with the dilation of hair follicle infundibula in RCM images of lichen pilaris lesions. In RCM images, the 6 diseases were distinguished mainly based on structural features（patterns and refractivity）of skin lesions shown by continuous vertical scanning. Conclusion RCM is of great value to the diagnosis of diseases manifesting as papules in children.
作者
陈立新
苏海辉
王莹
王蓟
宫泽琨
管志伟
廉佳
冯小燕
林杨杨
高西波
刘欣欣
毕田田
李钦峰
Chen Lixin Su Haihui Wang Ying Wang Ji Gong Zekun Guan Zhiwei Lian Jia Feng Xiaoyan Lin Yangyang Gao Xibo Liu Xinxin Bi Tiantian Li Qinfeng(Department of Dermatology, Tianjin Children＇s Hospital, Tianjin 300074, Chin)
出处
《中华皮肤科杂志》
CAS
CSCD
北大核心
2016年第11期817-820,共4页
Chinese Journal of Dermatology
关键词
显微镜检查
共焦
皮肤疾病
丘疹鳞屑性
儿童
诊断
鉴别
Microscopy,confocal
Skin diseases,papulosquamous
Child
Diagnosis,differential
