摘要目的 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.

abstractsObjective To investigate the microscopic features of common hypopigmentation disorders using confocal laser scanning microscopy (CLSM).Methods Totally,1915 child patients with hypopigmentation disorders were enrolled in this study,including 181 cases of vitiligo,38 idiopathic guttate hypomelanosis,370 amelanotic nevus,304 lichen striatus,712 pityriasis alba,and 310 postinflammatory hypopigrnentation.C LSM was performed to observe all layers of depigmented lesions,their borders,and normal-appearing perilesional skin in these patients.Statistical analysis was done by chi-square test and Fisher's exact test.Results Grade 1 and 2 hypopigmentation was observed in 984 (51.4％) and 684 (35.7％) out of the 1915 patients,respectively.The proportion of patients with grade 3 hypopigrnentation was 77.9％ (141/181) in patients with vitiligo,significantly higher than that in those with the other diseases (0-10.3％).Among the 1915 patients,815 showed mild epidermal hyperkeratosis,1060 focal edema of stratum spinosum,79 changes in dermal papillary rings,and 1133 sparse inflammatory cells or dendritic cells in the superficial dermis.There were significant differences in the degree of hypopigmentation and frequencies of pathologic changes in different skin layers on CLSM images among the six hypopigmentation disorders (all P ＜ 0.05).As CLSM showed,idiopathic guttate hypomelanosis was characterized by complete absence of dermal papillary rings;lichen striatus,pityriasis alba and postinflammatory hypopigmentation were all characterized by nonspecific inflammatory changes;lichen striatus manifested as punctiform or focal liquifaction degeneration of basal cells,and amelanotic nevus as only hypopigmentation and refractive attenuation;vitiligo was characterized by complete depigmentation and lack of integrity of dermal papillary rings in white patches.Conclusions CLSM images obviously differ between vitiligo,idiopathic guttate hypomelanosis,amelanotic nevus,lichen striatus,pityriasis alba and postinflammatoryhypopigmentation,and can serve as a basis for their differential diagnosis.