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. 2025 Mar 28;50(3):358-365.
doi: 10.11817/j.issn.1672-7347.2025.240708.

Characteristics and differential diagnosis of common verrucous proliferative skin diseases under dermoscopy and reflectance confocal microscopy

[Article in English, Chinese]
Lu Zhou  1 , Yule Fu  2 , Jian Huang  3 , Zhen Tang  3 , Jianyun Lu  3 , Lina Tan  3 , Dan Wang  3 , Jinrong Zeng  3 , Jia Wang  4 , Lihua Gao  5
Affiliations
Free article

Characteristics and differential diagnosis of common verrucous proliferative skin diseases under dermoscopy and reflectance confocal microscopy

[Article in English, Chinese]
Lu Zhou et al. Zhong Nan Da Xue Xue Bao Yi Xue Ban. .
Free article

Abstract
in English, Chinese

Objectives: Verrucous epidermal nevus (VEN), seborrheic keratosis (SK), verruca plana (VP), verruca vulgaris (VV), and nevus sebaceous (NS) are common verrucous proliferative skin diseases with similar clinical appearances, often posing diagnostic challenges. Dermoscopy and reflectance confocal microscopy (RCM) can aid in their differentiation, yet their specific features under these tools have not been systematically described. This study aims to summarize and analyze the dermoscopic and RCM features of VEN, SK, VP, VV, and NS.

Methods: A total of 121 patients with histopathologically confirmed verrucous proliferative skin diseases were enrolled. Dermoscopy and RCM imaging was used to observe and analyze the microscopic features of these conditions.

Results: Under dermoscopy, the 5 diseases displayed distinct characteristics: VEN typically showed gyriform structures; SK was characterized by gyriform structures, comedo-like openings, and milia-like cysts; VP and VV featured dotted vessels and frogspawn-like structures; NS presented as brownish-yellow globules. RCM revealed shared features such as hyperkeratosis and acanthosis across all 5 diseases. Specific features included gyriform structures and elongated rete ridges in VEN; pseudocysts and gyriform structures in SK; evenly distributed ring-like structures in VP; vacuolated cells and papillomatous proliferation in VV; and frogspawn-like structures in NS.

Conclusions: These 5 verrucous proliferative skin conditions exhibit distinguishable features under both dermoscopy and RCM. The combination of these 2 noninvasive imaging modalities holds significant clinical value for the differential diagnosis of verrucous proliferative skin diseases.

目的: 疣状表皮痣(verrucous epidermal nevus，VEN)、脂溢性角化病(seborrheic keratosis，SK)、扁平疣(verruca plana，VP)、寻常疣(verruca vulgaris，VV)和皮脂腺痣(nevus sebaceous，NS)是常见的疣状增生性皮肤病，它们外观相似，有时难以鉴别。借助皮肤镜、反射式共聚焦显微镜(reflectance confocal microscopy，RCM)有助于鉴别上述疣状增生性皮肤病，但目前尚无上述疾病在皮肤镜和RCM下特征的报道。本研究旨在总结和分析 VEN、SK、VP、VV和NS在皮肤镜和 RCM 下的特征及鉴别要点。方法: 招募121例经病理检查确诊为疣状增生性皮肤病的患者，通过皮肤镜和RCM观察并分析上述疾病的镜下特征。结果: 在皮肤镜下5种疣状增生性皮肤病特征不一，VEN常表现为脑回样结构，SK典型特征为脑回样结构、粉刺样开口和粟粒样囊肿，VP和VV的特征为点状血管结构和蛙卵样结构，NS 特征为棕黄色球状体。在RCM下，这5种疣状增生性皮肤病的共同特征包括角化过度和棘层肥厚，VEN特征为脑回样结构和表皮突延长，SK的典型特征为假性角囊肿和脑回样结构，VP特征为均匀分布的花环状结构，VV的特征为空泡细胞和乳头状瘤样增生，NS主要特征为蛙卵样结构。结论: 5种疣状增生性皮肤病在皮肤镜和RCM下具有不同的特征。皮肤镜和RCM在这5种疣状增生性皮肤病的鉴别诊断中具有较好的临床应用价值。.

Keywords: dermoscopy; nevus sebaceous; reflectance confocal microscopy; seborrheic keratosis; verruca plana; verruca vulgaris; verrucous epidermal nevus; verrucous proliferation.

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