目的:研究日光性角化病的皮肤镜表现及组织病理变化.方法:对入院患者皮损部位进行组织病理检测,并通过单反相机及皮肤镜对患者皮损部位进行取像观察.结果:56例临床诊断疑似日光性角化病患者,其中46例皮肤镜与病理结果一致均为日光性角化,10例皮肤镜诊断日光性角化,而组织病理结果为:2例基底细胞癌,7例脂溢性角化症,1例湿疹,皮肤镜与病理诊断符合率为82.14%.其中,女性患者22例(47.83%),男性患者24例(52.17%).患者发病年龄在40~82岁,其中40~50岁发病患者5例(10.87%),51~60岁发病患者6例(13.04%),61~70岁发病患者24例(52.17%),71~82岁发病患者11例(23.92%).患者多为老年男性,发病年龄集中在60~80岁,占本次研究人数的74.23%.病程最长患者为20余年.患者在职业上有明显差异,农民患者最多,有38例(82.61%).日光性角化病大多发病于暴露部位,颈部发病患者6例(13.04%),手背部发病患者3例(6.53%).主诉患病部位有疼痛感患者6例(13.04%),有瘙痒感患者32例(69.57%),无明显不适感患者8例(17.39%).患者皮损大小0.4~3.3cm,表现为红色或黄棕色斑片或丘疹,皮损部位较干燥,损害呈鳞屑性,且常出现过度角化及疣状特征.部分患者皮损部位出现溃烂结痂症状.同时,皮损部位周围皮肤出现日光损伤特点,如皮肤萎缩、色素改变及血管明显扩张等.病理诊断结果统计发现,肥厚型患者8例(17.39%),萎缩型患者13例(28.26%),色素型患者4例(8.70%),指样型患者5例(10.87%),鲍温样型患者13例(28.26%),棘刺松解型患者3例(6.52%).皮肤镜表现中,红斑背景下假网格结构33例(71.74%),毛囊口角质栓围绕白圈28例(60.87%),毛囊口周围点状结构25例(54.35%),表现有鳞屑者39例(84.78%),表现有红斑者34例(73.91%),草莓样结构者36例(78.26%),有卷曲的血管者37例(80.43%).结论:皮肤镜检查对日光性角化病的诊断与病理组织检查结果存在较好的一致性.日光性角化病皮肤镜表现及组织病理变化具有明显的特征性,可通过相关检查确诊疾病,及早进行治疗,降低患者病情恶化、癌变的风险,检测方法值得临床推广.%Objective: To study the skin microscopy and histopathological changes of solar keratosis. Methods:The lesion was examined by histopathological examination, and the skin lesions were observed by SLR camera and skin mirror. Results:56 cases were diagnosed with suspected kyphotic keratosis patients, of which 46 cases of skin and pathology consistent with the results of solarization keratosis, 10 cases of dermatolo-gy diagnosis of solarization keratosis, and histopathological results:2 cases of basal cell carcinoma, 7 cases of seborrheic keratosis, 1 case of eczema, dermoscopy and pathology coincidence rate was 82. 14%. Among them, female patients in 22 cases ( 47. 83%) , male patients in 24 cases ( 52. 17%) . 6 patients ( 13. 04%) from 51 to 60 years old, 24 patients (52.17%) from 61 to 70 years old, 71~ 82 years old patients in 11 cases ( 23.92%) . Most of the elderly patients, the age of onset concentrated in the 60 to 80 years old, accounting for 74.23% of the number of this study. The longest course of the disease for more than 20 years. There were sig-nificant differences in the occupation of the patients, the largest number of farmers, 38 cases ( 82. 61%) . There were 6 cases (13.04%) of cervical disease and 3 cases (6.53%) of patients with dorsal disease. There were 6 patients (13.04%) with pain in the affected area, 32 patients (69.57%) with itching, 8 patients (17. 39%) without obvious discomfort. Patients with 0. 4cm ~ 3. 3cm lesions, the performance of red or yellow brown patches or pimples, lesions more dry parts, damage was scaly, and often appear excessive keratosis and verrucous features. Some patients with ulceration of crust injury site symptoms. At the same time, skin lesions around the skin days of sun damage characteristics, such as skin atrophy, pigment changes and significant ex-pansion of blood vessels. Histopathological findings showed that there were 8 cases (17.39%) of hypertrophic patients, 13 cases (28.26%) of atrophic patients and 4 cases (8.70%) of pigment patients, 5 cases of digitat-ed patients (10.87%), Type of bowenoid patients in 13 cases (28.26%), acantholytic type in 3 cases (6. 52%). Dermoscopic erythema, under the background of false grid structure in 33 cases (71.74%), hair folli-cle hornplug surrounded by white circles in 28 cases (60.87%), 25 cases of punctate structures around the hair follicle orifice (54.35%), performance scales in 39 cases (84.78%), showing erythema in 34 cases (73. 91%), 36 cases of strawberry the structure of (78.26%), 37 cases had curled vessels (80.43%). Conclu-sion:There is a good consistency of dermoscopy on the diagnosis of solar keratosis and pathological findings of the results. Sunshine keratosis skin mirror performance and histopathological changes have obvious characteris-tics, through the relevant examination to diagnose the disease, early treatment, reduce the patient's condition deterioration, the risk of cancer, the detection method worthy of clinical promotion.
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