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Objective To evaluate the clinical application value of reflectance confocal microscopy(RCM) in the diagnosis of several common diseases manifesting as papules in children, including lichen nitidus, verruca planae, lichen striatus, milium, molluscum contagiosum and lichen pilaris. Methods A total of 579 children clinically characterized by papules were recruited into this study. RCM was used to observe lesions and perilesional normal skin. The RCM features of 6 diseases manifesting as papules were analyzed and compared. Results Based on RCM images, 236 patients were diagnosed with lichen nitidus, 70 with verruca planae, 123 with lichen striatus, 40 with milium, 53 with molluscum contagiosum and 57 with lichen pilaris. All the 6 diseases had typical RCM features. Concretely speaking, RCM images of lichen nitidus lesions showed infiltration of dense inflammatory cells and melanophages in enlarged dermal papillae. In RCM images of verruca planae lesions, cells in the granular and spinous layers were arranged in concentric circles, giving a rose cluster?like appearance. RCM images of lichen striatus lesions revealed focal swelling of stratum spinosum, absent or local liquifaction degeneration of basal cells, and clustering of a moderate number of inflammatory cells in the superficial dermis. In RCM images of milium lesions, well?circumscribed round or oval structures containing highly but nonuniformly refractive materials could be seen in the dermis. RCM images of molluscum contagiosum lesions showed intact cystoid structures containing highly refractive molluscum bodies. Lowly to moderately refractive cutin ? like materials were observed along with the dilation of hair follicle infundibula in RCM images of lichen pilaris lesions. In RCM images, the 6 diseases were distinguished mainly based on structural features(patterns and refractivity)of skin lesions shown by continuous vertical scanning. Conclusion RCM is of great value to the diagnosis of diseases manifesting as papules in children.
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Objective To assess the reflectance confocal microscopic features of childhood lichen planus (LP),and to evaluate the performance of reflectance confocal microscopy (RCM) in the diagnosis of childhood LP.Methods RCM was performed for imaging of lesions in 35 children with LP.Then,biopsies were carried out at the same sites followed by histopathological examination.A comparison was conducted between confocal microscopic and histopathological findings.All the 35 cases were diagnosed based on clinical manifestations and histopathological findings.Results RCM imaging of lesions in the 35 cases showed cellular edema forming lowly reflective areas in the epidermis,sharp transition between the granular and spinous layers,and infiltration of moderately reflective inflammatory cells,which corresponded to wedge-shaped thickening of the granular layer on pathological examination.The dermo-epidermal junction was unclear,and dermal papillary rings were obscure or absent with infiltration of inflammatory cells arranged in lamelliform structures around the dermo-epidermal junction,which corresponded to interface dermatitis on histopathological examination.A band-like infiltration of inflammatory cells,including big,highly reflective oval or stelliform pigmentophages and small,moderately reflective round lymphocytes,was observed in the dermis,and the thickness of infiltration was measurable.Dilated blood vessels were longitudinally distributed in the papillary dermis with perivascular infiltration of inflammatory cells and pigmentophages.RCM images were highly consistent with histopathological findings in these patients.Conclusion RCM,as a real-time non-invasive imaging technique,can serve as an auxiliary examination method for the diagnosis of childhood LP.