| Goal:As a unique method of dermatology,skin lesion differentiation lacks norms and standards.By means of macroscopic observation and high frequency ultrasound technology,this study explores the morphological differences of acne nodules in different syndromes and the differences in performance under high frequency ultrasound,in order to provide the basis for acne nodular lesion of syndrome differentiation,and through the sonographic findings explain the connotation of traditional Chinese medicine,a more objective diagnostic differentiation model.Methods:From November 2020 to January 2021,the Dermatology Clinic of Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University visited 40 cases of acne patients diagnosed by the outpatient dermatologist.The dermatologist and the sonographer jointly selected the nodule lesions that were in line with the diagnosis of nodular lesions and the lesions were suitable for ultrasound examination,and a total of 69 acne nodule lesions were collected.Observe the morphological characteristics and ultrasound performance of the skin lesions by naked eyes and high-frequency ultrasound,record the data,and perform statistical analysis.Results:(1)Among the 40 patients collected,there were 15 females and 25 males,ranging from 14 years old to 40 years old.(2)The syndrome differentiation of acne nodules involves five syndromes:heat,poison,dampness,phlegm and blood stasis.The occurrence of stasis and phlegm is the most frequent.A total of 22 card type,phlegm and blood stasis syndrome,wet poison stasis,phlegm and blood stasis syndrome,blood stasis,wet poison and blood stasis syndrome and phlegm syndrome and phlegm dampness syndrome,wet poison,toxic heat wet and humid poison,toxic heat and blood stasis syndrome,heat and blood stasis,hot and damp stasis,toxic heat syndrome,deficiency of phlegm and blood stasis,phlegm heat syndrome,phlegm damp and hot,toxic heat,phlegm dampness syndromes,phlegmy wet stasis,poison and blood stasis syndrome,toxic heat and blood stasis,The most frequent syndrome type was phlegm and blood stasis syndrome(15 cases),followed by dampness and blood stasis syndrome(7 cases)and phlegm and blood stasis toxin syndrome(5 cases).(3)The proportion of bright red lesions in heat was higher than that in total.The proportion of dark red and purple dark skin lesions in sputum and blood stasis was higher than that in total.The proportion of red and yellow lesions in poison was higher than that in total.(4)The proportion of hemispherical skin lesions in heat was higher than that in total,the proportion of creep skin lesions in phlegm and moisture was higher than that in total,and the proportion of apical skin lesions in poison was higher than that in total.(5)Soft skin lesions accounted for a higher proportion in sputum and dampness,tough skin lesions accounted for a higher proportion in heat and dampness,and hard skin lesions accounted for a higher proportion in sputum and blood stasis.(6)The boundary of acne nodules is usually clear by naked eye observation.(7)Nodules with pain and pus head accounted for a high proportion in heat and toxicity,and most of them had no conscious symptoms.(8)Under ultrasound,acne nodules are mostly hypoechoic or mixed echoic lesions,with heterogeneous echoes.(9)The skin lesions with clear boundary had a higher proportion in humidity,while the skin lesions with ill-defined boundary had a higher proportion in heat,toxin,phlegm and blood stasis,and heat and toxin had the highest proportion.(10)The lesions confined to the dermis were more common in heat,dampness and sputum.The proportion of the lesions invaded to the adipose layer in poison and stasis.(11)The proportion of the lesions with fistula-like echo in heat and humidity was significantly higher than that in the general population.Focal calcification with strong echo lesions accounted for a higher proportion in dampness and stasis.A few lesions showed cyst-like echo and line-like moderate strong echo on ultrasound.(12)With the increase of CDFI rating of lesions,the proportion of phlegm of syndromes decreased gradually,and the proportion of heat,toxicity and dampness of syndromes increased gradually.(13)Syndrome differentiation included heat,toxicity and dampness of nodular lesions.Under ultrasound,PSV of blood flow in the lesions was higher than that of sputum,and dampness was the highest.The RI value of blood flow was the highest in wet skin lesions,but there was no significant difference among different syndromes.(14)There was little difference in the elasticity value measured by the tracing method among the syndrome elements.The elasticity of acne nodules ranges from 2.7m/s to 4.2m/s for most acne nodules,from 1.5-3.5 for Emin and from 3-5m/s for Emax.In conclusion:(1)Among the 40 patients with facial acne nodules investigated in this study,the proportion of male patients was significantly higher than that of female patients.The age of the patients ranged from 14 to 40 years old,and the age was mainly between 14 and 30 years old.(2)Distribution sites of acne nodules The distribution sites of acne nodules include T area,neck,perioral area,cheek and mandible,in which skin lesions are mainly distributed in cheek and mandible.(3)Syndrome differentiation of acne nodular lesions includes five syndromes:heat,poison,dampness,phlegm and blood stasis.The most frequent syndromes are phlegm and blood stasis,followed by dampness and phlegm and blood stasis.(4)The morphological manifestations of acne nodules in different syndromes are as follows:acne nodules with heat and toxic syndrome are bright red in color,tough in quality,and most of the lesions are accompanied by pain.Heat syndrome is mostly hemispherical,while toxic syndrome is mostly with pus head and sharp apex.Acne nodules with sputum and dampness syndrome are pale red,soft in texture,with clear boundaries and no conscious symptoms.Most of them are hemispherical in wetness syndrome,and most of them are prostrate in sputum syndrome.Phlegm,stasis syndrome of acne nodules for dark red or dark purple color,mostly creeping shape,hard quality,no conscious symptoms.(5)Performance of acne nodules under high-frequency ultrasound:Part mostly low echo,echo to mix,occasional hypoechoic lesions,even or uneven echo,the boundary is clear or not clear,multiple levels of attack to fat layer,a few limitations in the dermis,also have invaded to muscularis nodules,the other part of the skin can also be observed sample fistula echo,echo of cyst liquefied line sample strong echo,punctate calcification strong echo in the kitchen.(6)Under high-frequency ultrasound,acne nodules with heat and toxic syndrome were mostly manifested as mixed echo,unclear boundary,uneven echo,increased blood flow,heat syndrome was mostly confined to the dermis,and toxic syndrome could attack the fat layer.Ultrasound manifestations of sputum and dampness syndrome were mostly low-echo lesions confined to the dermis.The boundary of sputum syndrome lesions was not clear,cyst-like echo was often seen.The boundary of wet syndrome lesions was clear,fistula-like echo,line-like moderate strong echo and spotty calcification strong echo were often seen.Stasis syndrome is mostly hypoechoic lesions with uneven echoes within the lesions and unclear boundaries.It invades into the fat layer,showing fistula-like echo,cyst-like echo and spotty calcification like strong echo.(7)Under high-frequency ultrasound,the blood flow in the acne nodules with phlegm syndrome was less,while the blood flow in the lesions with acne nodules containing heat,poison and humidity was usually more abundant and the flow rate was high.Dampness will lead to the increase of PSV and RI values.There was no significant difference in the elasticity value among the syndromes.(8)To sum up,there are differences in the morphology of nodules observed by naked eyes and high-frequency ultrasound.High-frequency ultrasound can often observe deeper lesions and some subtle changes,and it is more accurate to evaluate the severity of acne nodules.There are also differences in the high-frequency ultrasonographic manifestations of acne nodule lesions with different syndromes,which should be further explored by enlarging the sample size. |
PDF Full Text Request