趾甲银屑病与指甲银屑病的皮肤镜特征比较  

Comparison of dermoscopic features of toenail psoriasis and fingernail psoriasis

作　　者：王诗琪 王爱平[1] 李航[1] 李若瑜[1] Wang Shiqi;Wang Aiping;Li Hang;Li Ruoyu(Department of Dermatology,Peking University First Hospital,National Clinical Research Center for Skin and Immune Diseases,Research Center for Medical Mycology,Peking University,Beijing Key Laboratory of Molecular Diagnosis of Dermatoses,NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics,Beijing 100034,China;Department of Dermatology,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]北京大学第一医院皮肤性病科、国家皮肤与免疫疾病临床医学研究中心、北京大学真菌和真菌病研究中心、皮肤病分子诊断北京市重点实验室、国家药品监督管理局化妆品质量控制与评价重点实验室,北京100034 [2]首都医科大学附属北京朝阳医院皮肤科,北京100029

出　　处：《中华皮肤科杂志》2024年第2期161-165,共5页Chinese Journal of Dermatology

基　　金：国家重点研发计划项目(2023YFC2508100)。

摘　　要：目的分析并比较趾甲银屑病和指甲银屑病的皮肤镜特征。方法收集2020年6月至2022年1月于北京大学第一医院皮肤科确诊为趾甲银屑病(61例)和指甲银屑病(80例)的患者,对受累的139处趾甲和158处指甲行皮肤镜检查。采用卡方检验比较两组间皮肤镜特征差异。结果甲银屑病中最常见的皮肤镜特征为点状凹陷(223/297,75.08%),其次为裂片状出血(164/297,55.22%)、甲下角化过度(133/297,44.78%)、油滴征(126/297,42.42%)、甲完全分离(121/297,40.74%)、甲分离近端的线状边缘(107/297,36.03%)和甲分离边缘的线状红斑(77/297,25.93%)。两组间相比,趾甲银屑病中甲下角化过度[81处(58.27%)比52处(32.91%),P<0.001]、点状或块状出血[22处(15.83%)比11处(6.96%),P<0.05]、纵向条纹[34处(24.46%)比10处(6.33%),P<0.001]、甲纵裂[24处(17.27%)比9处(5.70%),P<0.01]、褐色改变[14处(10.07%)比2处(1.27%),P<0.01]、甲横沟[17处(12.23%)比1处(0.63%),P<0.001]和白甲[10处(7.19%)比1处(0.63%),P<0.01]的出现频率显著较高;指甲银屑病中裂片状出血[100处(63.29%)比64处(46.04%),P<0.01]、油滴征[81处(51.27%)比45处(32.37%),P<0.01]、甲分离边缘的线状红斑[55处(34.81%)比22处(15.83%),P<0.001]、甲部分分离[50处(31.65%)比19处(13.67%),P<0.001]和甲半月红点[36处(22.78%)比12处(8.63%),P<0.01]的出现频率显著较高。结论趾甲银屑病与指甲银屑病的皮肤镜特征显著不同,甲下角化过度、纵向条纹、褐色改变等特征在趾甲银屑病中显著增多。Objective To evaluate and compare dermoscopic features of toenail psoriasis and fingernail psoriasis.Methods Between June 2020 and January 2022,61 patients with confirmed toenail psoriasis and 80 with confirmed fingernail psoriasis were enrolled from the Department of Dermatology of Peking University First Hospital.Dermoscopy was performed on 139 affected toenails and 158 affected fingernails among the psoriasis patients,and dermoscopic characteristics were analyzed between the two groups by using the chi-square test.Results The most common dermoscopic feature of nail psoriasis was pitting(223/297,75.08%),followed by splinter haemorrhages(164/297,55.22%),subungual hyperkeratosis(133/297,44.78%),oil drop sign(126/297,42.42%),complete onycholysis(121/297,40.74%),linear margin of the proximal onycholysis(107/297,36.03%)and linear erythema at the margin of the onycholysis(77/297,25.93%).Compared with the patients with fingernail psoriasis,those with toenail psoriasis more commonly presented with subungual hyperkeratosis(81[58.27%]vs.52[32.91%],P<0.001),punctate/blocky haemorrhages(22[15.83%]vs.11[6.96%],P<0.05),longitudinal striae(34[24.46%]vs.10[6.33%],P<0.001),longitudinal nail splitting(24[17.27%]vs.9[5.70%],P<0.01),brown discoloration(14[10.07%]vs.2[1.27%],P<0.01),transverse grooves(17[12.23%]vs.1[0.63%],P<0.001)and leukonychia(10[7.19%]vs.1[0.63%],P<0.01);compared with the patients with toenail psoriasis,those with fingernail psoriasis more commonly presented with splinter haemorrhages(100[63.29%]vs.64[46.04%],P<0.01),oil drop sign(81[51.27%]vs.45[32.37%],P<0.01),linear erythema at the margin of the onycholysis(55[34.81%]vs.22[15.83%],P<0.001),partial onycholysis(50[31.65%]vs.19[13.67%],P<0.001)and red spots in the lunula(36[22.78%]vs.12[8.63%],P<0.01).Conclusion The dermoscopic features of toenail psoriasis were quite different from those of fingernail psoriasis,and features such as subungual hyperkeratosis,longitudinal streaks,and brown discoloration were more commonly presented in patients with toenail psoria

关 键 词：银屑病 指(趾)甲 甲银屑病 皮肤镜特征 诊断 

分 类 号：R758.63[医药卫生—皮肤病学与性病学]