皮肤共聚焦激光扫描显微镜在儿童色素减退性疾病诊断中的应用

目的 探讨儿童常见色素减退性疾病皮肤共聚焦激光扫描显微镜(CLSM)图像的基本特征.方法 分别观察1 915例色素减退性疾病(包括白癜风、特发性滴状色素减少症、无色素痣、线状苔藓、白色糠疹及炎症后色素减退)患者的皮损,用CLSM观察皮损处、交界处及白斑周边正常皮肤的各层镜下特征.应用卡方检验和Fisher精确检验进行统计学分析.结果 1级和2级色素减少占总病例数的51.4％(984/1 915)和35.7％(684/1 915),白癜风3级色素减少的比例为77.9％(141/181),明显高于其他疾病(0～ 10.3％);815例角质层轻度角化过度,1 060例棘层灶性水肿,79例基底细胞环出现改变,1 133例真皮浅层可见稀疏炎症细胞或树枝状细胞.6种色素减退性皮肤病CLSM扫描图像色素减少程度及各层CLSM图像变化均有统计学差异(P＜0.05).CLSM特征:特发性滴状色素减少症可见色素环完全缺失;线状苔藓、白色糠疹、炎症后色素减退可见非特异性炎症改变,线状苔藓可见点灶状基底细胞液化变性;无色素痣仅为色素减少及折光变弱,白癜风白斑区色素完全缺失,且皮肤色素环缺乏完整性.结论 白癜风、特发性滴状色素减少症、无色素痣、线状苔藓、白色糠疹及炎症后色素减退皮损CLSM图像有差异,可以作为鉴别诊断的依据之一.     

皮肤镜对常见色素减退性疾病的临床图像特征分析技术的建立

目的:建立皮肤镜对白癜风、白色糠疹、无色素痣、炎症后色素减少症、进行性斑状色素减少症、老年性白斑和贫血痣的临床图像特征分析技术。方法:分别观察1439例色素减退性疾病患者的皮损,用皮肤镜观察肉眼不可见的细微结构,如背景颜色、血管形态、边界情况、毛发及毛囊是否异常等。应用卡方检验和Fisher精确检验方法进行统计学分析。结果:瓷白色、花斑色和浅白色背景色度分别为白癜风稳定期、无色素痣和进行性斑状色素减少症的较特异性皮肤镜图像特征。灰白色糠状鳞屑是白色糠疹的特异性皮肤镜图像特征,可区别于其他疾病。进展期白癜风特征为乳白色背景,边界模糊,毛囊周围色素残留,周边点状、不规则状色素减退斑,斑片状色素残留。稳定期白癜风特征为瓷白色背景,边界清晰,毛囊周围色素残留,皮损周围色素加深。恢复期白癜风特征为边界清晰,毛囊周围色素残留,皮损周围色素加深,易见色素岛。白色糠疹特征为淡黄白色背景,表面细小或片状灰白色糠状鳞屑,边界模糊。无色素痣:花斑样背景,边界模糊,斑片状色素残留。炎症后色素减少症特征为黄白色背景,边界模糊。进行性斑片状色素减少症特征为浅白色背景,边界模糊。老年性白斑特征为乳白色背景,边界清晰。贫血痣特征为黄白色背景,边界模糊,摩擦后周边呈现网格状血管分布。结论:皮肤镜临床图像特征分析技术可作为诊断和鉴别诊断白癜风、白色糠疹、无色素痣、炎症后色素减少症、进行性斑状色素减少症、老年性白斑和贫血痣的一种辅助方法。     

色素障碍性皮肤病

20111668几种色素减退性皮肤病的共聚焦激光扫描显微镜图像特点/赖来桂(浙江中医大),许爱娥∥中华皮肤科杂志.-2011,44(4).-273～274运用激光共聚焦显微镜(GLSM)观察白癜风、无色素痣、进行性斑状色素减少症和贫血痣的特征。结果:进展期白癜风白斑区部分区域色素完全缺失,     

临床特征和皮肤CT特征判定白癜风分期

目的 采用临床特征和皮肤CT特征来判定白癜风分期。 方法 200例白癜风患者按照临床特征问卷和皮肤CT特征进行分期： ＞ 2分为快速进展期,1 ~ 2分为缓慢进展期, < 1分为稳定期。选择进展期和稳定期白癜风患者各5例,在皮肤CT检测的区域进行HE染色分析。 结果 用临床特征和皮肤CT特征判定200例白癜风患者的分期,差异无统计学意义。临床特征：进展期为白斑边缘隆起或与周围正常皮肤边界不清,三色白癜风,皮损颜色呈灰白色或浅白色;稳定期为白斑区与正常皮肤边界清晰,皮损颜色呈乳白色或瓷白色,可见色素岛。皮肤CT：进展期为表真皮交界处色素环失去完整性,与周边正常皮肤边界不清,在表真皮交界、边缘处可以看到高折光性细胞。稳定期为表真皮交界处色素环完全缺失,与周边正常皮肤边界清,有树突状高折射光的黑素细胞存在。HE染色结果显示,进展期在真皮乳头层内的病灶的边缘可见大量的CD8T淋巴细胞。稳定期在真皮乳头层内的病灶边缘未见CD8T淋巴细胞。 结论 临床特征和皮肤CT特征可以用来判定白癜风的分期,结果与进展期组织病理学基本一致。     

黄褐斑和白癜风的诊疗标准(2010年版)

一、白癜风 (一)诊断标准:①通常在儿童期或青年期发病,表现为大小和形状各异的脱色性白斑,周围颜色正常或有色素增加.②皮损好发于面部、颈部、手背和躯干;腔口黏膜及周围皮肤也易受侵犯,如眼、鼻、口、耳、乳头、脐、阴茎、女阴和肛门;亦常见于外伤部位;白斑部位的毛发通常也变白.③排除炎症后色素减退斑、斑驳病、特发性色素减退斑、白色糠疹、无色素痣和贫血痣等皮肤病.④或者Wood灯下白斑区见亮白色荧光.     

雀斑样痣共聚焦激光扫描显微镜图像特征分析北大核心CSCD

目的通过在体共聚焦激光扫描显微镜（CLSM）采集雀斑样痣的图像,研究其影像学特征。方法30例临床诊断为日光性雀斑样痣、10例单纯性雀斑样痣患者,用CLSM观察皮损及皮损周边正常皮肤,并与组织病理学表现相比较。结果CLSM下所有雀斑样痣的主要表现在真表皮交界处,表现为表皮突延长,数目增多且基底层色素显著增加,形成几种不同的图像特征如形状不规则的真皮乳头环扩大,周围环绕折光度较高的细胞等。真皮浅层可见少许噬黑素细胞及淋巴细胞浸润。讨论雀斑样痣的CLSM图像与常规组织病理表现相符合。     

黄褐斑和白癜风的诊疗标准(2010年版)

一、白癜风 (一)诊断标准:①通常在儿童期或青年期发病,表现为大小和形状各异的脱色性白斑,周围颜色正常或有色素增加.②皮损好发于面部、颈部、手背和躯干;腔口黏膜及周围皮肤也易受侵犯,如眼、鼻、口、耳、乳头、脐、阴茎、女阴和肛门;亦常见于外伤部位;白斑部位的毛发通常也变白.③排除炎症后色素减退斑、斑驳病、特发性色素减退斑、白色糠疹、无色素痣和贫血痣等皮肤病.④或者Wood灯下白斑区见亮白色荧光.     

黄褐斑和白癜风的诊疗标准(2010年版)

一、白癜风 (一)诊断标准:①通常在儿童期或青年期发病,表现为大小和形状各异的脱色性白斑,周围颜色正常或有色素增加.②皮损好发于面部、颈部、手背和躯干;腔口黏膜及周围皮肤也易受侵犯,如眼、鼻、口、耳、乳头、脐、阴茎、女阴和肛门;亦常见于外伤部位;白斑部位的毛发通常也变白.③排除炎症后色素减退斑、斑驳病、特发性色素减退斑、白色糠疹、无色素痣和贫血痣等皮肤病.④或者Wood灯下白斑区见亮白色荧光.     

偏振光皮肤镜在白癜风早期诊断及与其他色素减退斑鉴别中的应用

目的 探讨偏振光皮肤镜图像分析技术在白癜风早期诊断中的应用及与其他色素减退斑的鉴别.方法 收集局限性色素减退斑患者,采用偏振光皮肤镜观察皮损微观形态、特征和颜色;所选病例除花斑糠疹经临床与实验室检查确诊外,其余病例均经病理活检确诊.结果 176例患者中,白癜风97例,进展期毛周色素残留发生率达91.94%,显著高于稳定期(62.86%),两者之间差异有统计学意义(P<0.05);毛细血管扩张、早期色素岛形成和皮周色素加深等与病程和近期有无治疗有关.79例色素减退斑,包括花斑糠疹、炎症后色素减退、白色糠疹、老年性白斑、无色素痣、贫血痣和特发性滴状色素减退症,未见毛周色素残留.结论 偏振光皮肤镜有效地排除了白癜风皮损中的反射光干扰,是一种可直接观察到肉眼不可见微细结构与特征的影像技术;对白癜风的早期诊断及与其他色素减退斑相鉴别提供了参考依据.     

几种色素减退性疾病的研究进展

色素减退性疾病是皮肤科常见的疾病,严重影响美观.白癜风、无色素痣和进行性斑状色素减少症等色素减退性疾病的发病机制、组织病理和治疗不尽相同,但均以色素脱火斑为主要特征,临床鉴别有时较为困难.概述这几种色素减退性疾病的发病机制、临床表现、组织病理及治疗等方面的最近研究进展,以提高对色素减退性疾病的认识,帮助临床诊断与治疗.     

In vivo reflectance confocal microscopy imaging of vitiligo,nevus depigmentosus and nevus anemicus

Background/purpose: Hypopigmentary skin disorders such as vitiligo, nevus depigmentosus and nevus anemicus are common diseases in clinic. The lesions of these diseases could be similar to some extent, although each of them has its own characteristic clinical appearance and histological features. Clinically, the atypical lesions are often difficult to be differentiated. In vivo reflectance confocal microscopy (RCM) is a non‐invasive, repetitive imaging tool that provides real‐time images at a nearly cellular histological resolution. Our aim was to investigate the RCM features of vitiligo, nevus depigmentosus and nevus anemicus. Subjects and Methods: A total of 135 patients with a clinical diagnosis of the aforementioned diseases were included in this study. The RCM images from depigmented skin, border of the white macules, adjacent normal‐appearing skin and distant normal skin for all patients at the dermo‐epidermal junction (DEJ) level were investigated. Results: In the active phase of vitiligo (AVP), the RCM demonstrated a complete loss of melanin in lesional skin in eight (53; 15.1%) patients. In 45 patients (53; 84.9%) of the AVP, part of the bright dermal papillary rings normally seen at the DEJ level disappeared or part of the rings lost their integrity and the content of melanin decreased obviously. In 20 patients (53; 37.7%) of the AVP, highly refractile inflammatory cells could be seen within the papillary dermis in the lesional and adjacent normal‐appearing skin, which may indicate the lesion progresses. In addition, part of the dermal papillary rings showed lack of integrity or their brightness decreased in adjacent normal‐appearing skin in all the patients of the AVP. It is important to know that the RCM demonstrated an ill‐defined border. In the stable phase of vitiligo (SPV), the RCM demonstrates a complete loss of melanin in lesional skin and a clear border in 31 (41; 75.6%) patients; the content of melanin and dermal papillary rings in adjacent normal‐appearing skin show no changes. In 10 (41; 24.4%) patients, the dendritic and highly refractile melanocytes arose in the recovery phase of vitiligo, which may indicate the repigmentation of vitiligo. There are three kinds of repigmentation patterns under RCM: marginal, perifollicular and diffuse. Distant normal skin showed no difference from controls in both the active and the SPV. In all the patients with nevus depigmentosus, the content of melanin decreases obviously but the dermal papillary rings are intact. The dermal papillary rings show no differences between lesional skin and adjacent normal‐appearing skin of nevus anemicus. Conclusion: Considering our results, RCM may be useful to non‐invasively discriminate vitiligo, nevus depigmentosus and nevus anemicus in vivo.     

Histopathologic features in vitiligo

Nevus depigmentosus is a congenital disorder characterized by a nonprogressive hypopigmented lesion, which may not be apparent at birth. Thus, it is sometimes difficult to differentiate vitiligo from nevus depigmentosus only by clinical features. We postulated that the histologic changes in lesional and perilesional skin might be different in the 2 conditions. We took biopsies from both lesional and perilesional skin of 100 cases of vitiligo to assess the number of melanocytes, the amount of melanin, dermal inflammatory infiltrate, and other changes. We compared them with 30 cases of nevus depigmentosus. Histologically, lesions of vitiligo showed more basal hypopigmentation and dermal inflammation than perilesional normal skin. With Fontana-Masson staining, 16% of cases of vitiligo showed the presence of melanin. The ratio of pigmented area to epidermal area was 0.06% in vitiligo, whereas 17% in perilesional normal skin and 8.9% in nevus depigmentosus. In NKI/beteb staining, 12% of vitiligo showed the presence of melanocytes, and their average number was 7.68 per square millimeter. The number of melanocytes was also decreased in nevus depigmentosus but not as much as in vitiligo. We also confirmed the presence of melanocytes in 1 of 3 cases of vitiligo by electron microscopy. In conclusion, there are a few melanocytes and melanin in some cases of vitiligo. Therefore, the diagnosis of vitiligo should be made considering these points.     

Nevus depigmentosus: review of a mark of distinction

Nevus depigmentosus (ND), also known as nevus achromicus or achromic nevus, is an uncommon congenital hypomelanosis of the skin that is often characterized as being nonprogressive and having serrated borders. It needs to be distinguished from other hypopigmented skin conditions such as nevus anemicus, hypomelanosis of Ito, Fitzpatrick patches (ash leaf spots) of tuberous sclerosis, vitiligo, indeterminate leprosy, and pigment demarcation lines. Treatment may be desired for aesthetic and possible psychosocial considerations. We review and update knowledge about ND and its simulants.     

Lichen striatus-like leukoderma

A particular pigmentary disorder develops on the skin of Chinese children. The lesions are composed of whitish macules and patches arranged in linear bands on the extremities unilaterally. Histologically these lesions are hypopigmented chronic dermatitis. Although the lesions are arranged in a lichen striatus pattern, they differ clinically from lichen striatus by the absence of papules and plaques. These cases may represent a new entity. The differential diagnosis includes lichen striatus, vitiligo, piebaldism, nevus depigmentosus, and hypomelanosis of Ito. The differences between the disorder presented here and those of different diagnosis are discussed.     

Epidermal changes in active vitiligo.

Light and electron-microscopic studies were performed on the vitiligo and adjacent, normal appearing skin from 97 patients with actively spreading vitiligo and 19 patients with stable vitiligo. The vitiliginous skin revealed complete loss of pigment and melanocytes. In addition to degenerative changes in melanocytes, vacuolar changes of basal cells, epidermal infiltration of lymphocytes, dermal infiltration of lymphocytes, and melanophages in the upper dermis were also seen in the normal appearing skin adjacent to vitiliginous skin. These epidermal and dermal changes are more prominent in the skin of actively spreading vitiligo than in stable vitiligo. These findings suggest that the adjacent, normal appearing skin of actively spreading vitiligo shows some characteristic histopathologic findings, especially in the epidermis, indicating that cellular immunity could be involved in the pathogenesis of vitiligo.     

Behavior of pigment cells on lesions of the pigmented venus with vitiligo.

When vitiligo occurred on lesions of the pigmented nevus, the behavior of pigment cells in this nevus was investigated. Three cases of giant hairy nevi, seven cases of moles, three cases of Mongolian spots and eleven specimens in nine cases of halo nevi were used. Giant hairy nevi combining with vitiligo showed intensive decreases in nevus cells, particularly superficial A and B-type nevus cells. The epidermal dopa-positive melanocytes and melanin granules in the epidermis decreased, but still remained. On the other hand, moles in vitiligo showed an almost complete disappearance of epidermal dopa-positive melanocytes and melanin granules in the epidermis; nevus cells in the dermis decreased only slightly. Mongolian spots with vitiligo showed an epidermis similar to vitiligo, but the dermal melanocytes were hardly changed. Halo nevi exhibited an intensive decrease and degeneration of nevus cells and marked lymphocytic infiltration. Some of them showed disappearance of epidermal dopa-positive melanocytes and melanin granules in the epidermis. The characteristic findings of vitiliginous skin are mostly restricted to epidermis. In contrast, however, it is interesting to note that, on the lesions of nevocellular nevi with vitiligo, the dermis also exhibited some decrease and degeneration of nevus cells and lymphocytic infiltration.     

Kallin syndrome associated with vitiligo

Kallin syndrome (KS) is a variant of epidermolysis bullosa simplex (EBS), which, in addition to the classic features of EBS, also presents with deafness, alopecia, hypodontia and nail dystrophy. We report the case of a 17‐year‐old boy who presented to our clinic with trauma‐induced skin blistering, alopecia, deafness, dental caries, nail dystrophy and vitiliginous areas. The skin blisters had been appearing since birth, and healed without scarring. The vitiliginous areas were unrelated to the sites of the blisters. Electron microscopy of the skin blisters was diagnostic of EBS, and the depigmented lesions were similar to those of vitiligo. An association of vitiligo with EBS has not been reported previously. Multiple genetic findings have confirmed a role for keratin in regulating skin pigmentation. Apoptosis of melanosome‐bearing keratinocytes may participate in the reduction of melanin density and result in depigmentation. Further studies on the defective proteins in KS may clarify the mechanism underlying the association with vitiligo.     

Application of a pigment measuring device – Mexameter®– for the differential diagnosis of vitiligo and nevus depigmentosus

Background/purpose: Vitiligo and nevus depigmentosus (ND) present similar hypopigmented macules with significantly different prognoses. Although the distinction between the two diseases is important, differential diagnosis relies on medical history and physical examination, which is far from decisive in some cases. The Mexameter^® is an objective skin color-measuring device, and has been reported to provide a reproducible and sensitive means of quantifying small skin color differences. In this study, we investigated the usefulness of a Mexameter^® for discriminating these diseases.
Methods: A selection of 202 hypopigmented skin lesions (182 from vitiligo and 20 from ND) were the objects of this study. Using a Mexameter, MIs were obtained from lesions and symmetrically located control skin. RMIs, ratios of the MIs of lesional skins to control skins, were calculated.
Results: The mean MIs and RMIs were significantly different for vitiligo and ND. The mean RMI of ND lesions was 74±13, which was significantly higher than that of vitiligo lesions (50±24). No ND lesion had an RMI of <50%.
Conclusion: This study shows that the Mexameter^®, an objective pigment-measuring device, can be used to achieve a more accurate diagnosis of hypopigmentary disorders, and that the relative melanin index (RMI), which represents the relative pigment levels, might be a more effective parameter than the melanin index (MI) itself for comparing pigmentation differences.