Accuracy of standard dermoscopy for diagnosing scabies
Accuracy of standard dermoscopy for diagnosing scabies
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DOI：
10.1016/j.jaad.2006.07.025
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发表时间：
2007-01-01
影响因子：
13.8
通讯作者：
Petit, Antoine
中科院分区：
文献类型：
--
作者：
Dupuy, Alain;Dehen, Laure;Petit, Antoine
背景：疥疮是由人类疥螨 Sarcoptes scabiei 引起的传染性皮肤感染。明确诊断的常用参考方法是通过皮肤刮屑的显微镜检查来体外鉴定螨虫。我们比较了使用袖珍手持式低倍率 DS 进行体内皮肤镜 (DS) 螨识别的诊断准确性与参考方法。方法：我们进行了一项前瞻性、非随机、评估者盲法、非劣效性研究，以比较 DS 的敏感性（主要结果）和其他诊断特性以及皮肤刮屑的显微镜检查。在一个中心咨询的 756 名假定诊断为疥疮的患者中，有 238 名患者依次接受了两种诊断程序。三名皮肤科医生（一名专家，两名缺乏经验）参与其中。比较仅使用临床技能、DS 结果以及两者组合的诊断策略。结果：DS 的敏感性为 91%（95% 置信区间：86-96），皮肤刮片显微镜检查的敏感性为 90%（95% 置信区间：85-96）（非劣效性 P = 0.005）。 DS 的特异性为 86%（95% 置信区间：80-92），皮肤刮片显微镜检查的特异性为 100%（根据定义）。专家和缺乏经验的皮肤科医生的 DS 敏感性相似，但在特异性方面存在差异。然而，在研究期间，缺乏经验的皮肤科医生的诊断准确性稳步提高。与基于临床的治疗决策规则相比，基于DS的治疗决策规则最大限度地减少了假阳性和假阴性结果的数量，而基于临床推定和DS结果相结合的治疗决策规则则大大减少了未经治疗的疥疮患者的数量。 局限性：没有明确的标准来排除疥疮的诊断。结论：带有手持式DS的标准DS是诊断疥疮的有用工具，灵敏度很高，即使对于缺乏经验的人来说也是如此。它极大地提高了做出治疗决策的临床技能。
Background: Scabies is a contagious skin infestation caused by the human mite Sarcoptes scabiei. The usual reference method for definitive diagnosis is ex vivo identification of the mite with microscopic examination of skin scrapings. We compared diagnostic accuracy of in vivo dermoscopic (DS) mite identification using a pocket handheld low-magnification DS with the reference method,Methods: We conducted a prospective, nonrandomized, evaluator-blinded, noninferiority study to compare sensitivities (main outcome) and other diagnostic properties of DS and microscopic examination of skin scrapings. Among 756 patients witha presumptive diagnosis of scabies consulting in one center, 238 were sequentially submitted to the two diagnostic procedures. Three dermoscopists (one expert, two inexperienced) were involved. Diagnostic strategies using clinical skills only, DS results, and a combination of both were compared.Results: Sensitivities, were 91% (95% confidence interval: 86-96) for DS and 90% (95% confidence interval: 85-96) for microscopic examination of skin scrapings (P =.005 for noninferiority). Specificities were 86% (95% confidence interval: 80-92) for DS and 100% (by definition) for microscopic examination of skin scrapings. DS Sensitivities Were similar for the expert and inexperienced dermoscopists, whereas differences were observed in specificities. However, diagnostic accuracy of inexperienced dermoscopists steadily increased during the study. Compared with clinical-based, DS-based treatment decision rule miminized the number of false-positive and false-negative findings, whereas a treatment decision rule based on combination of clinical presumption and DS result drastically reduced the number of patients with scabies left untreated.Limitations: There is no definitive standard for ruling out the diagnosis of scabies.Conclusions: Standard DS with a handheld DS is a useful tool for diagnosing scabies, with high sensitivity, even in inexperienced hands. It greatly enhances clinical skills for making treatment decisions.