| Objective:Acne is a chronic inflammatory skin disease of hair follicles and sebaceous units,which can be caused by androgen-induced sebaceous gland hypersecretion,abnormal keratinization of pilosebaceous ducts,microbe-induced inflammatory response,environmental factors and genetic factors.At present,the molecular biology,microbiology and cytology studies in the pathogenesis of acne are sufficient,but the studies on different lesion morphology(microcomedones,comedones,inflammatory papules,etc.)and different severity of acne micromorphology(hair follicle opening,hair follicle and surrounding inflammatory characteristics,etc.)are lacking.Histopathology is the main means of microscopic morphology research,but because acne is mostly located on the face,histopathology is invasive,the operation is relatively complex,and it is not suitable for multiple tests and other defects,it is not easy to carry out microscopic morphology research of acne,which brings obstacles to the basic research such as pathophysiological mechanism of acne pathogenesis and the evaluation of clinical drugs and therapy effects.Dermoscopy has the characteristics of non-invasive,real-time,dynamic,with the function of optical amplification and elimination of reflected light on the skin surface,which can display the subtle structure of invisible epidermis and superficial dermis to the naked eye.It has the application prospect of dynamic and submicroscopic detection of microscopic morphological changes of acne.Therefore,we use dermoscopy to collect the images of acne vulgaris with different morphological lesions and severity,and analyze the consistency relationship between the dermoscopic findings of different morphological lesions and histopathology in combination with histopathology,and summarize the dermoscopic characteristics of acne with different severity and different morphological forms.Do some basic work for the study of the microscopic morphology and imaging of acne.Methods:A total of 120 acne patients who meet the diagnostic criteria for acne are selected from the Department of Dermatology of the First Affiliated Hospital of Kunming Medical University from October 2018 to February 2019.The name,gender,age,clinical diagnosis,treatment and severity classification were recorded and the skin lesions of the patients were not treated within 3 weeks(including oral,external,and photoelectric).According to Pillsbury grading criteria,the patients were divided into grade Ⅰ～Ⅳ,56 patients with mild acne,41 patients with moderate acne and 23 patients with severe acne;In addition,25,30,30,and 25 acne patients with comedones,papules,pustules,and scars,respectively,were selected for dermoscopic image acquisition.(A total of three lesions were selected from each patient,and one of the most typical lesions was acquired),dermoscopic characteristics(background,pores,hair follicle horn plugs,vascular morphology,vascular distribution,additional features,etc.)are recorded,and some patients underwent histopathological biopsy;control group:age and sex-matched normal healthy individuals without acneSPSS 17.0 software was used for statistical analysis.Enumeration data were expressed as rate(%).Chi-square test was used.Measurement data were analyzed by mean ± standard deviation(x ± s).Analysis of variance was used.P<0.05 was considered statistically significant.Dermoscopy frequency comparisons were calculated for mild,moderate to severe acne and each lesion feature.Results:1、Dermoscopic features of acne with different severity:Fifty-six patients with mild acne had a reddish background in 28 cases(50.00%);rosette vessels in 31 cases(55.36%);focal vascular distribution in 35 cases(62.50%);additional features:enlarged pores were seen in 30 cases(53.57%)and increased hairs were seen in 40 cases(71.43%).In 41 patients with moderate acne,yellow-red background was found in 16 cases(39.02%),red background in 16 cases(39.02%),rosette-shaped blood vessels in 20 cases(48.78%),focal vascular distribution in 20 cases(48.78%),granulation tissue-like structure in 23 cases(56.10%),and increased hairs in 22 cases(53.66%).In 23 patients with severe acne,yellow-red background was found in 16 cases(69.56%),atypical blood vessels in 12 cases(52.17%),vascular diffuse distribution in 15 cases(65.21),yellowish halo around hair follicles in 17 cases(73.91%),granulation tissue-like structure in 13 cases(56.52%).Chi-square test:mild,moderate and severe acne vulgaris:there was no significant difference in vascular morphology and increased vellus hair(P>0.05),background,vascularity,thick pores,yellowish halo around hair follicles and granulation tissue-like structure were statistically significant(P<0.05);2、Different types of skin lesions:There were 25 cases of comedo lesions,17 cases(68.00%)of reddish background,13 cases(52.00%)of punctate vessels,and 19 cases(76.00%)of local distribution;30 cases of pustules,12 cases(40.00%)of red background,14 cases(46.67%)of floral ring vessels,12 cases(40.00%)of diffuse distribution,and 20 cases(66.67%)of perifollicular "red spot sign";30 cases of papular lesions,11 cases(36.67%)of yellow-red background,14 cases(46.67%)of floral ring vessels,19 cases(63.33%)of local distribution,and 22 cases(73.33%)of perifollicular "red spot sign";25 cases of scars,15 cases(60.00%)of yellow-red background,14 cases(56.00%)of atypical vessels,and 18 cases(72.00%)of diffuse distribution;Chi-square test:comedones,pustules,papules and scars:background,vascular morphology,vascular distribution and perifollicular red spot signs were statistically significant(P<0.05);3、Perifollicular "oil drop-like halo" was more frequent in dermoscopic lesions of moderate to severe acne(58.54%,73.91%),and most of them were distributed around hair follicles and sebaceous glands;4、"Granulation tissue" structure,with a higher frequency in patients with moderate,severe acne(56.10%,56.52%);"granulation tissue" structure reflects recurrent acne attacks,occurring around hair follicles and sebaceous glands in the early stage,breaking through hair follicles in the later stage,and chronic inflammation of the whole dermis,but still centered on hair follicles;5、In patients with mild acne,we can observe the phenomenon of enlarged pores(53.57%),corresponding to the pathological follicular angular plug;6、The "red dot sign" around the hair follicles:the frequency of inflammatory papules was higher(73.33%),followed by pustules(66.67%),which indirectly confirmed that the pathogenesis of acne was always centered on inflammation.Conclusion:1、In acne vulgaris,the dermoscopic manifestations of acne lesions with different severity and forms of skin lesions overlap to a certain extent,but each has typical patterns and structural characteristics,which has a certain reference value in clinical practice.2、In patients with mild and moderate acne,the vascular morphology and vascular distribution are mainly flower ring and local distribution,and the phenomenon of increased vellus hair can be observe;Some microscopic morphologies are stacked,which may be related to insufficient sample size,inherent subjective observation characteristics of dermoscopy,and cannot be one-to-one with histopathology. |
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