Feasibility Study Of Dermoscopy In Evaluating The Severity Of Chronic Eczema

Background and Objective:Dermoscope is a non-invasive auxiliary diagnostic tool in dermatology,which can observe the microscopic changes of the skin epidermis,the junction of the dermis and the papillary layer of the dermis,especially the visualization of blood vessels.By observing the shape and distribution of blood vessels,it has been widely used in the diagnosis and differential diagnosis of inflammatory skin diseases in recent years.Chronic eczema is a chronic and inflammatory skin disease caused by internal and external factors.Its recurrent and delayed characteristics have a serious impact on the patients’ quality of life.Due to the atypical manifestations of chronic eczema,how to evaluate the severity of chronic eczema and monitor the follow-up curative effect is the focus of chronic eczema research field.At present,there are few domestic and foreign researches to evaluate the curative effect according to the changes of the characteristic structure of eczema under dermoscope.Therefore,in this study,dermoscopy technique was used to dynamically observe the changes of skin lesions before and after effective treatment of eczema,and to compare the correlation between dermoscope score,blood vessel diameter and naked eye observation index.to explore the feasibility and accuracy of dermoscopy in monitoring the efficacy of eczema.Methods:Thirty-seven patients with chronic eczema were selected from the dermatology clinic of the first affiliated Hospital of Henan University from August 2021 to June 2022.All patients were treated with mucopolysaccharide polysulfonate cream,evenly smeared and fully massaged for 2-5 min,followed by fluticasone propionate cream,twice a day for 4 weeks.The patients were followed up at 0,1,2,3 and 4weeks.The clinical indexes were as follows: Eczema Area and Severity Index(EASI),Dermatology Life Quality Index(DLQI),Investigator’s Global Assessment(IGA),Visual Analogue Scale(VAS).At the same time,each patient selected a lesion with a typical manifestation of chronic eczema as the target lesion,collected dermoscopic images,scored the dermatoscopic images,and measured the diameter of blood vessels.Pearson correlation analysis was performed between dermoscope score,vessel diameter and clinical observation index,and the correlation between dermoscope score decline rate,blood vessel diameter decrease rate and EASI score decline rate was calculated.The descending index of EASI was used as the criterion to evaluate the severity of eczema.The sensitivity,specificity and accuracy of dermoscopy score and vascular diameter to evaluate the improvement of chronic eczema by calculating dermoscope score,blood vessel diameter,the Receiver Operator Characteristic Curve(ROC curve)and Area Under Curve(AUC).Results:The clinical indexes(EASI score,DLQI score,IGA score,VAS score)and microscopic indexes(dermoscope score,vessel diameter)of 37 patients after 4 weeks treatment were significantly lower than those before treatment,and the difference was statistically significant.There was a positive correlation between dermoscope score and EASI score in the first 4 weeks,in which there was a strong correlation in the third week(r = 0.748),and there was also a certain correlation between dermoscope score and DLQI score,IGA score and VAS score,which was statistically significant.There was a positive correlation between vascular diameter and EASI score in the first 4 weeks,and there was a moderate correlation between vascular diameter and DLQI score and IGA score,which was statistically significant,while the correlation between vascular diameter and VAS score was poor.There was a certain correlation between the dermoscope score decline rate and the EASI score decline rate in the first 4 weeks,which was statistically significant.The correlation between the vessel diameter decline rate and the EASI score decline rate in the first 4 weeks was poor.For the accuracy evaluation of the improvement of eczema,the dermoscope score has higher sensitivity and specificity for the severity of chronic eczema,suggesting that the diagnostic accuracy of dermoscope score is higher(AUC=0.851),while the diameter of blood vessels was less accurate in evaluating severity of chronic eczema(AUC=0.512).Conclusion:Dermoscope score can be used as an effective index to evaluate the severity of chronic eczema.Dermoscopy can dynamically monitor the changes of skin lesions and blood vessels in the treatment of chronic eczema,which plays a good auxiliary role in evaluating the severity of chronic eczema,and tracks the curative effect more accurately and objectively from a microscopic point of view.