| 李腊梅,张思平,龙宾曼,尉玮,王捷敏,张苑菁,谢佳佳.皮肤镜在不同类型真菌所致甲真菌病诊断及治疗中的应用[J].中国临床保健杂志,2022,25(3):328-333. |
| 皮肤镜在不同类型真菌所致甲真菌病诊断及治疗中的应用 |
| Application of dermatoscopy in the diagnosis and treatment of onychomycosis caused by different types of fungi |
| 投稿时间：2022-02-25 |
| DOI：10.3969/J.issn.1672-6790.2022.03.008 |
| 中文关键词: 甲癣 皮肤镜检查 诊断技术和方法 |
| 英文关键词: Onychomycosis Dermoscopy Diagnostic techniques and procedures 〖FL |
| 基金项目:安徽省自然科学基金项目(1808085MH259) |
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| 中文摘要: |
| 目的 比较不同属真菌感染甲真菌病患者皮肤镜特征及模式,以及观察系统性抗真菌治疗前后皮肤镜下的改变,以探索皮肤镜是否可以作为甲真菌病疗效判定新的手段。方法 选取2020年11月至2022年2月在安徽医科大学附属省立医院皮肤科门诊确诊的112例甲真菌病患者,并对其临床资料及皮肤镜表现及模式进行前瞻性研究。结果 ①锯齿状边缘、甲板增厚、甲变色、甲下角蛋白及碎屑沉积、甲周皮肤干燥脱屑、无光泽甲板、锥形甲角化、大理石样浑浊这些特征,有助于诊断甲真菌病。②锯齿状边缘是远端外侧甲下型的特征性表现。甲板增厚、甲下角蛋白及碎屑沉积呈废墟样外观、甲周皮肤干燥脱屑有力地支持了全甲损毁型的临床诊断。③短刺状模式是远端外侧甲下型的特征性模式,线状边缘模式可能是白色浅表型的特征性模式,远端不规则中断模式是全甲损毁型的特征性模式。④真菌种属在远端外侧甲下型和全甲损毁型组之间差异无统计学意义(P>0.05),而且它们在2组中出现的频率基本相同。⑤经系统性抗真菌治疗,皮肤镜下发现病甲的甲板增厚、甲下角蛋白碎屑最先发生好转,锯齿状边缘最后好转。结论 不同类型真菌所致的甲真菌病的皮肤镜下表现具有特征性。皮肤镜可以作为临床甲真菌病的辅助诊断方法,并可用于评估抗真菌治疗效果。 |
| 英文摘要: |
| Objective To explore whether dermatoscopy can be used as a new method to determine the efficacy of onychomycosis.Methods A total of 112 patients with onychomycosis diagnosed in our outpatient department from November 2020 to February 2022 were selected and their clinical data,dermatoscopic manifestations and patterns were reviewed.Results ①Serrated edges,thickening of the deck,nail discoloration,subnail keratin and detritus deposition,dry and desquamated skin around the nail,dull deck,conical nail keratosis,and marbling are helpful for the diagnosis of onychomycosis.②Serrated margin is characteristic of distal lateral subturniform.The thickening of the deck,the ruins appearance of subnail keratin and detritus deposition,and the desquamination of perinail skin strongly support the clinical diagnosis of total nail lesions.③The short spines pattern is the characteristic pattern of distal lateral subnail type,the linear edge pattern may be the characteristic pattern of white superficial type,and the irregular break pattern of distal end is the characteristic pattern of total nail damage.④There was no statistical difference in fungal species between the distal lateral subarmored type and the total armored damage group (P>0.05),and their frequency was almost the same in both groups.⑤After systemic antifungal treatment,dermoscopy showed that the keratin fragments under the thickened plate of the diseased nail were the first to improve,and the serrated edge was the last to improve.Conclusions The dermatoscopic manifestations of onychomycosis caused by different types of fungi are characteristic,which can be used as an auxiliary diagnostic method for clinical onychomycosis,and evaluate the effect of antifungal treatment. |
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