| Objective The objective of this study was to summarize the clinical,RCM features and TCM syndrome type`s distribution of vitiligo patients with trichrome sign and investigate the relationship between the trichrome sign and vitiligo activity.Methods1.We collected clinical data of 272 patients with a clinical diagnosed of vitiligo in the Department of Dermatology,Wuhan No.1 Hospital from January 2019 to January 2020.The clinical data was including gender,age of onset,age,duration of disease,stage of vitiligo,vitiligo type,size of lesion,region of lesion,halo nevi,Koebner`s phenomenon,trichrome vitiligo,family history,TCM syndrome type and vitiligo disease activity score.2.On the basis of trichrome vitiligo,the patients were dividedinto the trichrome sign-positive group（n=48 cases）andnegative group（n=224 cases）.The clinical data of positivegroup were analyzed separately and compared with negativegroup.3.We reviewed the RCM images of trichrome lesions,including vitiliginous skin,light brown skin and normal skin.We summarized the RCM features and selected the melanocytes as a quantitative parameter to evaluate the stability of lesions.4.We recorded all data in EXCEL software and used SPSS 26.0 software for statistical processing.Univariate analysis methods included T test,analysis of variance,chi-square test,etc.The significance test level of the statistical results was P=0.05,and P<0.05 was statistically significant.Results1.There were 48 vitiligo patients in the trichrome sign-positive group,including 26 males（54.2%）and 22 females（45.8%）with a ratio of 1.18:1.The average age of onset was（35.16±12.432）years old and concentrated in 30~39 years old.The average disease duration was（50.73±83.346）months and concentrated in less than 12 months.2.The patients in trichrome sign-positive group were mainly of limited type（27 cases,56.3%）.22 cases（45.8%）were in the rapidly progressive stage,19 cases（39.6%）in the progressive stage,and 4 cases（14.6%）in the stable stage.3.The trichrome sign lesions were mostly involved in the trunk,and the abdomen and back are mainly involved in the trunk.The lesions area was usually less than 1% BSA.Trichrome sign lesions could be involved in multiple parts at the same time,mainly in the abdomen and back.When there were two or more involved parts,the incidence of neck and back is significantly increased（χ2valueswere 3.868 and 5.530,P<0.05）.4.Compared with the trichrome sign-negative group,the proportion of rapidly progressive vitiligo patients in the trichrome sign-positive group,the rate of involvement of the trunk,the proportion of BSA associated with isomorphic reaction,and the area of skin lesions ≥1% were signifi cantly higher（χ2values were 7.184,20.56,6.726,6.116,P<0.05）5.In the trichrome sign-positive group,the syndrome differentiation was included 19 cases of liver stagnation and qi stagnation type,18 cases of qi and blood disharmony type,5 cases of spleen and stomach deficiency type,5 cases of liver and kidney deficiency type,and 1 case of meridian block type.In the trichrome sign-negative group,the syndrome differentiation was included 86 cases of qi and blood disharmony,69 cases of liver stagnation and qi stagnation,32 cases of spleen and stomach deficiency,30 cases of liver and kidney deficiency,and 7 cases of meridian block type.6.The average disease duration of patients with liver stagnation and qi stagnation in the trichrome sign-positive group was significantly higher than that in the trichrome sign-negative group（t=2.197,P=0.002）,and the proportion of patients with skin lesions ≥1%BSA in the positive group was significant higher than the negative group（χ2=14.386,P<0.001）.7.In the light brown skin of trichrome sign,the basal layer of pigment was reduced or lost under RCM.The dermal papillary layer and superficial layer were infiltrated by inflammatory cells and melanocytes.The average number of melanocytes in the light brown skin area was significantly higher than that in the vitiligous skin area（P<0.05）.ConclusionTrichrome sign in vitiligo could be considered as a marker of disease activity.Trichrome sign-positive patients could be in the progressive stage.The appearance of trichrome sign might be related to region of lesion,size of lesion and Koebner`s phenomenon.There was no significant association with gender,age of onset,duration of disease,vitiligo type,family history and sunburn history.TCM syndrome types of vitiligo patients with trichrome sign were mainly the syndrome of liver stagnation and qi stagnation,qi and blood disharmony,of which the patients with liver stagnation and qi stagnation had the features of longer disease duration and larger size of lesion.Trichrome sign could be hard to detected in the early stage.Reflection confocal microscope could be an effective method for diagnosis and disease activity assessment. |
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