Application of reflectance confocal microscopy and dermoscopy in the efficacy evaluation of comprehensive treatment of melanosis

Objective To investigate the role of reflectance confocal microscopy (RCM) , dermoscopy and VISIA skin detector in the efficacy evaluation of comprehensive treatment of melanosis. Methods Six patients with melanosis were treated with comprehensive therapy, which included avoiding sunlight exposure, sunscreen, moisturizing, intravenous drips of compound glycyrrhizin injection at a single-dose of 40 ml once every 3 days for 8 sessions, oral tranexamic acid at a dose of 0.25 g twice a day, oral vitamin E at a dose of 60 mg/d, oral vitamin C at a dose of 0.1 g/d, self-made traditional Chinese medicine in the hospital, topical hydroquinone cream, asiaticoside ointment and levorotatory vitamin C serum. All patients were followed up once every 2 months for 12 months. RCM, dermoscopy and VISIA skin detector were performed in these patients before the treatment and during the follow-up. Statistical analysis was carried out to assess differences in VISIA indices before and after treatment using t test with the SPSS 19.0 software. Results After 12-month treatment, the skin lesions became ligher in color and and smaller in size. Before the treatment, RCM imaging showed disappearance of normal structure at the dermo-epidermal junction and lots of highly refractive cells of various shapes, which were consistent with histopathological liquefaction degeneration in the basal layers. There were many mildly to moderately refractive round or oval cells in the superficial dermis, which were consistent with melanophages and lymphocytes in histopathology. After 12-month treatment, liquefaction degeneration and infiltration of inflammatory cells were both markedly improved. Before the treatment, dermoscopy showed gray-brown dots or small balls with a grid-like appearance, and indistinct blood vessel shadows. After 2- to 4-month treatment, the number of gray-brown dots or small balls obviously decreased, and linear, branched or reticular blood vessels can be observed. After 12-month treatment, there were no obvious dark brown dots/small balls or blood vessels by dermoscopy. The VISIA brown spot index and erythema index before the treatment were both significantly decreased compared with those after 12-month treatment (brown spot index: 47.7 ± 0.9 vs. 42.3 ± 0.4, t= 6.740, P= 0.001; erythema index: 36.2 ± 2.1 vs. 32.8 ± 1.4, t= 6.69, P= 0.001) . Conclusion The comprehensive therapy of melanosis is effective. RCM, dermoscopy and VISIA skin detector can assist in the evaluation of curative effect on melanosis. Key words: Melanosis; Dermoscopy; Microscopy, confocal; Treatment outcome