皮肤镜辅助诊断难辨认汗孔角化症12例  

Dermatoscopy Assist in the Diagnosis of 12 Cases of Unrecognizable Porokeratosis

作　　者：王安宁 马玉航 于涓[1] 宋雅欣 杨海琼[1] WANG Anning;MA Yuhang;YU Juan;SONG Yaxin;YANG Haiqiong(Department of Skin Image Center,Dalian Dermatosis Hospital,Dalian 116021,China)

机构地区：[1]大连市皮肤病医院影像中心,辽宁大连116021

出　　处：《皮肤科学通报》2024年第2期179-184,共6页Dermatology Bulletin

基　　金：仁爱天使健康皮肤/毛发研究项目。

摘　　要：目的 分析难辨认汗孔角化症(porokeratosis, PK)首诊误诊情况及皮肤镜特征,探讨皮肤镜检查在难辨认PK诊断中的应用价值。方法 收集我院2021年4月—2024年1月首诊误诊但皮肤镜下可见典型汗孔角化症特征的12例患者临床资料,观察其临床表现、皮肤镜特点。结果 12例PK患者中斑块型5例(41.67%)、疣状斑块型1例(8.33%)、炎症性浅表播散型4例(33.33%)、炎症角化型2例(16.67%)。首诊被误诊为银屑病5例、扁平苔藓3例、湿疹2例、环状肉芽肿2例。上述病例皮肤镜下均可见汗孔角化症的特异性结构“双轨征”,最常见的血管结构是点状血管,其他相对常见的皮肤镜检查结果如下:鳞屑、边缘灰褐色点及边缘内浅棕色色素沉着。结论 PK分型的临床病程、形态和分布各不相同,需与多种皮肤疾病相鉴别,包括扁平苔藓、银屑病、脂溢性角化病、红斑狼疮等,皮肤镜可用于辅助诊断难辨认汗孔角化症,进一步明确诊断,降低误诊率。Objective To analyse the initial misdiagnosis and dermoscopic features of difficult-to-identify porokeratosis(PK),and to explore the application value of dermoscopy in the diagnosis of difficult-to-identify PK.Methods The clinical data of 12 patients who were initially misdiagnosed but with typical features of porokeratosis visible in dermoscopy were collected from April 2021 to January 2024 in our hospital,and their clinical manifestations and dermoscopic features were observed.Results Among the 12 patients with PK,5(41.67%)were plaque type,1(8.33%)was verrucous plaque type,4(33.33%)were inflammatory superficial disseminated type,and 2(16.67%)were inflammatory keratosis.The initial diagnosis was misdiagnosed as psoriasis in 5 cases,lichen planus in 3 cases,eczema in 2 cases and granuloma annulare in 2 cases.In all the cases,dermoscopy revealed the“double-track sign”,a structure specific to porokeratosis,with the most common vascular structures being punctate vessels,and other relatively common dermatoscopic findings were as follows:scaling,grey-brown dots at the margins,and light-brown hyperpigmentation within the margins.Conclusion The clinical course,morphology and distribution of PK subtypes vary and need to be differentiated from a variety of skin diseases,including lichen planus,psoriasis,seborrheic keratosis,lupus erythematosus,etc.Dermoscopy can be used to assist in the diagnosis of difficult-to-identify porokeratosis to further clarify the diagnosis and reduce the misdiagnosis rate.

关 键 词：汗孔角化症 临床表现 皮肤镜 

分 类 号：R758.5[医药卫生—皮肤病学与性病学]