| Background and Objective Psoriasis is a chronic,inflammatory skin disease with complex etiology.According to clinical manifestations,psoriasis can be divided into vulgaris,arthropathica,pustulosa and erythroderma,among which the vulgaris accounts for more than 99%.According to the development of the disease,psoriasis vulgare can be divided into unstable stage,stable stage and regressive stage.And in different stages the treatment of psoriasis is different.Reflective confocal microscopy can provide three-dimensional images of skin tissues and images of subcellular structures,and scans depth up to 300 nm(dermis).Reflective confocal microscopes are non-invasive,real-time and dynamic.It has been widely used to diagnose skin diseases such as skin tumors,inflammatory skin diseases,pigmented skin diseases.It is also possible to dynamically assess the effectiveness of treatments for certain diseases,such as psoriasis vulgaris.Therefore,the purpose of this study is to determine the stage and treatment monitor the treatment of psoriasis vulgaris by analyzing the reflective confocal microscope image characteristics of psoriasis vulgaris and to provide guidance for the clinical treatment of psoriasis vulgaris.Materials and methods A total of 116 patients with psoriasis vulgaris diagnosed by pathologically or clinically in the department of dermatology from October 2018 to October 2019 were collected.The clinical data of the patients were recorded,and the patients were divided into three stages: unstable stage,stable stage and regressive stage according to the skin lesions and medical history of the patients.Then 27 patients with psoriasis vulgaris who were treated with MTX and capotriol ointment were selected,and the same lesion was evaluated using RCM at baseline,after 4 and 8 weeks of treatment.Statistical analysis the incidence of RCM features for 116 psoriasis vulgaris,and the differences of the distribution of RCM features in the three stages were compared using the chi-square test.And the differences of the distribution of RCM features at baseline and after 4 weeks of treatment for 27 psoriasis vulgaris were also compared using the chi-square test.Results 1.Characteristic analysis of reflectance confocal microscopy in determining stability of psoriasis vulgaris 1)Basic information: 116 patients with psoriasis vulgaris,including 78 males(67.24%)and 38 females(32.76%).The male to female ratio was 2.05: 1,and the average age was 43.55(18-80)years.Of the 116 patients,48 patients were in the unstable stage(36.21%),32 patients were in the stable stage(31.03%),and 36 patients were in the regressive stage(32.76%).2)RCM characteristics of unstable psoriasis vulgaris: parakeratosis,munro microabscess in stratum corneum,loss of the stratum granulosum,kogoj microabscess in stratum spinosum,dark dermal papillae not surrounded by a demarcating bright rim of basal cels,enlarged dermal papillae,dilated vessels inside dermal papillae,inflammatory cels in the dermis.RCM characteristics of stable psoriasis vulgaris: progressive reduce of parakeratosis and inflammatory cels in the epidermis and dermis,dark dermal papillae,enlarged dermal papillae,dilated vessels inside dermal papillae.RCM characteristics of regressive psoriasis vulgaris: parakeratosis is reduced or absent,presence of stratum granulosum,inflammatory cels in the epidermis and dermis is disappear,rimmed dermal papillae,progressive reduction in the diameter of the dermal papillae.3)During the development of psoriasis vulgaris lesions from unstable stage to regressive stage and in treatment monitoring,the parakeratosis,loss of the stratum granulosum,inflammatory cels in the epidermis and dermis,and enlarged dermal papillae decreased gradually,while the rimmed dermal papillae increased gradually.4)The incidence of 6 RCM features was compared between 3 stages: There were statistically significant differences in the distribution of parakeratosis,epidermal inflammatory cels and expanded dermal papilla between unstable and stable stages(P<0.0167),and its incidence was higher in unstable stages than in stable stages.There was no statistically significant difference in the distribution of inflammatory cells in the dermis between the unstable stages and the stable period(P>0.0167).There were statistically significant differences in the distribution of parakeratosis,inflammatory cels in dermis and rimmed dermal papillae between stable and regressive period(P<0.0167),and the incidence of rimmed dermal papillae in regressive period was higher than in regressive period.There were no statistically significant differences in the loss of the stratum granulosum,epidermal inflammatory cels and enlarged dermal papillae between stable stage and regressive stage(P>0.0167).2.Characteristic analysis of reflectance confocal microscopy in monitoring treatment of psoriasis vulgaris 1)27 patients with psoriasis vulgaris were treated continuously,including 19 males(70.37%)and 8 females(29.63%),aged 20-65 years.2)Compared with the T0,the incidence of parakeratosis and inflammatory cels in the dermis at T1 was significantly decreased(P < 0.05),while the incidence of inflammatory cels in the epidermis and dilated dermal papillae was not significantly decreased(P > 0.05),and the incidence of rimmed dermal papillae was significantly increased(P < 0.05).Conclusion 1.The reflection confocal microscope has certain guiding significance in distinguishing the unstable,stable and regressive stages of psoriasis vulgaris lesions.2.Inflammatory cell infiltration in epidermis and dermis are good features to distinguish the unstable and stable stages of psoriasis vulgaris lesions.3.The disappearance of parakeratosis and the rimmed dermal papillae are typical features of the regressive stage for psoriasis vulgare lesions.4.RCM features were present or absent(such as parakeratosis,inflammatory cel s in the dermis,rimmed dermal papillae)can be used as microscopic observation indicator to observe the recovery of psoriasis lesions after different treatments. |
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