| Objective:To evaluate the value of Reflectance confocal microscopy(RCM),dermoscope and Wood lamp used in the treatment of stable vitiligo lesions by microscopy,and to explore the effects of vitiligo on quality of life and sleep.Methods:78 patients with stable vitiligo who were diagnosed in our outpatient department from June 2021 to August 2022 and met the requirements of the study were collected.The treatment was given by oral administration of 308nm excimer light combined with vitiligo capsule and external use of tacrolimus ointment.The total course of treatment was 12 weeks.RCM,dermoscope and Wood lamp were used to observe the same target lesions before treatment,at the 4th,8th and 12th week of treatment,and the images in the process of white patch recolor were recorded.Meanwhile,the results of the primary physician’s determination of vitiligo recolor by naked eye were recorded.78 patients with vitiligo and 78 healthy people were investigated by using Dermatology Life Quality Index(DLQI)and Pittsburgh Sleep Quality Index(PSQI),and the results were recorded.Statistical methods were used to analyze the above data.Results:1.At the 4th,8th,and 12th week,49 cases,75 cases,and 77 cases were observed in the basal cell layer of vitiligo skin lesions.At the 4th,8th,and 12th week,35 cases,61 cases,and 76 cases were observed by dermoscopy as early pigment island formation.In the 4th,8th and 12th week,23 cases,48 cases and 76 cases were observed with Wood lamp,while in the 4th,8th and 12th week,19 cases,47 cases and 76 cases were observed with naked eye.2.Results of RCM in the evaluation of multiple color in the treatment of vitiligo:Compared with dermoscopy,the number of effective cases was significantly increased at the4th and 8th weeks,the difference was statistically significant(χ~2=5.06,P<0.05;χ~2=11.24,P<0.01);Compared with Wood lamp,the number of effective cases increased significantly at week 4 and week 8,with statistical significance(χ~2=17.44,28.02,P<0.01).Compared with the naked eye,the number of effective cases was significantly increased at the 4th and8th week,with statistical significance(χ~2=23.46,29.49,P<0.01).3.The results of dermoscopy in the evaluation of multiple colors in the treatment of vitiligo:compared with Wood lamp,the number of effective cases was significantly increased at week 4 and week 8,with statistical significance(χ~2=3.95,5.15,P<0.05).Compared with the naked eye,the number of effective treatment cases was significantly increased at the 4th and 8th week,the difference was statistically significant(χ~2=7.25,P<0.01;χ~2=5.90,P<0.05).4.The results of Wood lamp in the evaluation of multiple colors in the treatment of vitiligo:compared with the naked eye,there was no statistical significance in the number of effective cases observed at week 4,week 8 and week 12(χ~2=0.52,0.03,0.00,P>0.05).5.The formation time of melanocyte or high-refraction granules in RCM was5.65±1.31 weeks.The onset time of early pigment island formation was 7.10±2.20 weeks under dermoscopy.The onset time of pigment island formation under Wood lamp was8.41±3.27 weeks.The onset time of recolor was 8.67±3.33 weeks.The onset time of recolor in RCM was significantly earlier than that of dermoscope,Wood lamp and naked eye,and the difference was statistically significant(t=5.00,6.92,7.45,P<0.01).The onset time of recolor under dermoscopy was significantly earlier than that under Wood lamp and naked eye,and the difference was statistically significant(t=2.94,3.47,P<0.01).6.At the 12th week of treatment,22 cases of bright"ring"structure at the dermal junction were observed under RCM,while 38 cases,41 cases and 45 cases were cured under dermoscopy,Wood lamp and naked eye,respectively.At the 12th week,the number of cases cured by dermoscopy,Wood lamp and naked eye was higher than that of RCM,the difference was statistically significant(χ~2=6.93,9.61,13.84,P<0.01).7.The average DLQI score of 78 patients with vitiligo was 6.25±1.46 points,which was significantly higher than the normal scale range(0～1 points).The average PSQI score was 7.43±1.17 points,higher than that of the healthy control group(5.47±1.86 points),and the difference was statistically significant(t=7.88,P<0.01).Conclusion:1.In the observation of the recolor process of stable vitiligo treatment,melanocytes or high refraction particles in the basal cell layer could be observed by RCM,and the evidence of recolor was objective,which was significantly better than dermoscope,Wood lamp and naked eye observation at 4 weeks and 8 weeks.2.Early pigment island formation can be observed by dermoscopy during the treatment of stable vitiligo skin lesions and recolor,which is better than Wood lamp and naked eye observation at 4 weeks and 8 weeks.3.At the 12th week,it is more scientific and objective to select the RCM observation index as the basis for determining the cure and withdrawal time of stable vitiligo treatment,while there is no obvious advantage to select the dermoscopic observation index as the basis for judgment.4.Vitiligo significantly affected patients’quality of life and sleep. |
PDF Full Text Request