| Objective: Through the clinical application of dermoscopy and high-frequency ultrasound in laser therapy for PWS,this paper discusses the value of dermoscopy and high-frequency ultrasound in the evaluation and prediction of the curative effect of PWS.Methods : According to the inclusion criteria,exclusion criteria and exclusion criteria,PWS patients who were treated with laser for three times in the dermatology clinic of the Affiliated Hospital of Guilin Medical College from October 2020 to October 2021 were selected.Laser treatment,once a month.Before the first,second and third laser treatment and one month after the third laser treatment,the general images of the patient’s skin lesions were collected by digital camera;the dermoscopic images of the same part of skin lesions were collected by dermoscopy,recording the vessel features and pattern: superficial vessel pattern(dotted or spherical vessels,sausage vessels),deep vessel pattern(linear and reticular vessels)and mixed vessel pattern(with the characteristics of shallow vessel pattern and deep vessel pattern),and recording whether there are non vascular features: white veil,white circle and brown area;22MHz high-frequency ultrasound was used to collect the high-frequency ultrasound images of the patient’s skin lesions and contralateral normal parts,and the linear hypoechoic signal,the dermal thickness and density of the skin lesions and normal parts,the dermal thickness difference between the skin lesions and normal parts(Δthickness),and the dermal density difference between the skin lesions and normal parts(Δdensity)were recorded.One month after completing three laser treatments,the digital photo evaluation method was used,according to the change of area,the skin lesions are evaluated as: significantly effective,effective and ineffective,and the total effective rate =(significantly effective + effective)/ total number of skin lesions×100%,the skin lesions were divided into significantly effective group,effective group and ineffective group.SPSS 25.0 software was used for statistical analysis,nonparametric rank sum test was used to analyze the differences of significant effective group,effective group and ineffective group in gender,age,lesion distribution,lesion type,lesion area,vessel pattern and non vascular features under dermoscopy,and linear hypoechoic signal under high frequency ultrasound;Paired sample t-test was used to compare the thickness and density of dermis between normal and lesion parts,the thickness and density of dermis before treatment,after different times treatment and between different times treatment;Nonparametric rank sum test was used to compare the differences of dermal thickness,density,Δthickness and Δdensity among the groups.Results:(1)49 PWS patients(51 skin lesions in total)meeting the standards with complete data were included in this study.After three times of laser treatment,the digital image evaluation method was used.Significantly effective group: 8 skin lesions,effective group: 19 skin lesions,ineffective group: 24 skin lesions,the total effective rate was 52.94%.There was no significant difference in gender(P > 0.05),but there were significant differences in age,lesion distribution,lesion type and lesion area(P < 0.05).(2)Under dermoscopy,superficial vessel pattern:11 skin lesions,deep vessel pattern: 31 skin lesions,mixed vessel pattern: 9 skin lesions,the curative effect of PWS with superficial vessel pattern was better than that with deep vessel pattern and mixed vessel pattern(P < 0.05).There was no significant difference between deep vessel pattern and mixed vessel pattern(P >0.05).(3)Non vascular structure of skin lesions under dermoscopy,9 skin lesions with white veil,1 skin lesion rated as effective,8 ineffective,42 skin lesions without white veil,8 skin lesion rated as significantly effective,18 effective,16 ineffective,there was significant difference between two groups(P < 0.05);5 skin lesions with white circles,all rated as ineffective,46 skin lesions without white circles,8 skin lesions rated as significantly effective,19 effective,19 ineffective,there was significant difference between two groups(P < 0.05);5 skin lesions with brown area,2 skin lesions rated as significantly effective,3 effective,46 skin lesions without brown area,6 skin lesions rated as significantly effective,16 effective,24ineffective,there was significant difference between two groups(P< 0.05).(4)The changes of vascular morphology,non vascular structure and background color before and after laser treatment of PWS skin lesions can be observed through dermoscopy.Due to the variety of vessel patterns,the presence or absence of background color and the change of background color,it is difficult to form a quantitative standard for efficacy evaluation.(5)Under 22 MHz high-frequency ultrasound,17 skin lesions with linear hypoechoic signal,the effective rate was 23.53%,34 skin lesions without linear hypoechoic signal,the effective rate was 67.65%,there was significant difference between two groups(P< 0.05).(6)Under the measurement of 22 MHz high-frequency ultrasound,the dermal thickness of skin lesion(1098.13±280.51)was greater than that of normal part(940.56±232.21),and the difference was statistically significant(P < 0.05).The dermal density of skin lesion part(19.37±2.90)was less than that of normal part(28.03±2.29),and the difference was statistically significant(P < 0.05).(7)Under the measurement of 22 MHz high-frequency ultrasound,the dermal thickness of skin lesion: significantly effective group(771.13±40.09),effective group(997.11±197.63),ineffective group(1287.11±238.99),the difference among the three groups was statistically significant(P < 0.05).The dermal density of skin lesion: significantly effective group(22.55±0.83),effective group(20.72±2.61),ineffective group(17.25±1.75),the difference among the three groups was statistically significant(P < 0.05).(8)Under the measurement of 22 MHz high-frequency ultrasound,the difference of dermal thickness between skin lesion and normal part(Δthickness): the significantly effective group(79.88±10.58),the effective group(130.73±38.33)and the ineffective group(204.73±44.91),the difference among the three groups was statistically significant(P < 0.05).The difference of dermal density between skin lesion and normal part(Δdensity): the significantly effective group(5.95±1.16),the effective group(7.45±1.09)and the ineffective group(10.53±2.11),the difference among the three groups was statistically significant(P < 0.05).(9)Under the measurement of 22 MHz high-frequency ultrasound,the dermal thickness of skin lesion before and after laser treatment,before laser treatment(1098.13±280.51),after 1 laser treatment(1067.11±278.46),after 2 laser treatments(1037.78±263.31)and after 3 laser treatments(1011.75±257.17),the difference was statistically significant through the paired sample t-test(P < 0.05).The dermal density of skin lesion before and after laser treatment,before laser treatment(19.37±2.90),after 1 laser treatment(21.78±3.54),after 2 laser treatments(23.34±3.42)and after 3 laser treatments(24.46±3.65),the difference was statistically significant through the paired sample t-test(P < 0.05).Conclusions:(1)The curative effect of laser treatment is related to age,lesion location,lesion type and lesion area.(2)It is suggested that the vessel pattern and some non vascular structures(white veil,white circle and brown area)of skin lesions under dermoscopy can be used as reference indexes for predicting the efficacy of laser treatment for PWS.(3)It is suggested that dermoscopy has limited value in dynamically evaluating the efficacy in laser treatment of PWS.(4)It is suggested that the linear hypoechoic signal,dermal thickness,dermal density,Δthickness and Δdensity under 22 MHz high-frequency ultrasound can be used as reference indexes for predicting the efficacy of laser treatment for PWS.(5)It is suggested that 22 MHz high-frequency ultrasound can be used to dynamically evaluate the efficacy of laser treatment for PWS by measuring the dermal thickness and density of skin lesion. |
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