里爾氏Riehl's 黑色素沉著症：在三級醫療中心進行多模態皮膚影像研究，結合細胞分辨率光學相干斷層成像和先進皮膚診斷系統

摘 要：

**背景：** 里爾氏黑色素沉著症是一種對心理造成極大影響的色素沉著障礙，通常發生在面部和頸部。由於其罕見性、形態多變以及缺乏非侵入性診斷工具，對里爾氏黑色素沉著症的研究非常有限。最近在皮膚影像分析和診斷系統方面的進展提高了診斷準確性，並使色素性疾病的非侵入性、實時評估成為可能。然而，尚未有綜合利用多模態和活體皮膚影像系統來研究里爾氏黑色素沉著症臨床形態的報導。
**目的：** 調查里爾氏黑色素沉著症的臨床特徵及其活體先進皮膚影像結果。
**方法：** 我們回顧性地研究了里爾氏黑色素沉著症的臨床特徵、皮膚鏡檢和組織病理特徵。我們進一步利用多模態皮膚影像分析系統，包括細胞分辨率光學相干斷層成像（OCT）和新的皮膚診斷系統，來研究里爾氏黑色素沉著症的特徵。此外，我們將OCT發現與組織病理特徵和臨床評估進行了比較。
**結果：** 我們評估了2010年至2022年在一所三級醫療中心的30例里爾氏黑色素沉著症患者，平均年齡為47.7 ± 12.3歲（平均值 ± 標準差），主要為女性患者（女性：n = 23；男性：n = 7）。病變皮膚的細胞分辨率OCT影像顯示黑素細胞帽增多、基底膜破壞、毛細血管擴張及真皮中的黑素吞噬細胞。先進的皮膚診斷系統捕捉到皮膚的亞臨床紅斑，強調了該病的炎症性質。結果與組織病理學發現良好吻合。
**局限性：** 這是一項單中心的橫斷面研究。 **結論：** 我們通過新穎的細胞分辨率OCT和攝影皮膚診斷系統突出了里爾氏黑色素沉著症的特徵。多模態皮膚診斷系統可以作為評估色素性疾病的實時、活體、非侵入性方法。

Background: Riehl’s melanosis is a psychologically devastating hyperpigmentary disorder that typically occurs on the face and neck. The study of Riehl’s melanosis is limited due to its rarity, variable morphology, and lack of noninvasive diagnostic tools. Recent advances in skin imaging analysis and diagnostic systems improve diagnostic accuracy and enable the noninvasive, real-time evaluation of pigmentary disease. A comprehensive study of Riehl’s melanosis clinical morphology with multimodality and in vivo skin imaging systems has yet to be reported. Objectives: To investigate the clinical features and in vivo advanced skin imaging findings of Riehl’s melanosis. Methods: We retrospectively investigated the clinical characteristics, dermoscopic, and histopathological features of Riehl’s melanosis. We further utilized multimodality skin imaging analysis systems, including a cellular resolution optical coherence tomography (OCT) and new skin diagnosis system, to investigate the features of Riehl’s melanosis. In addition, we compared OCT findings with histopathological features and clinical assessment. Results: We evaluated 30 patients with Riehl’s melanosis at a tertiary medical center from 2010 to 2022. The average age was 47.7 ± 12.3 (mean ± SD) years, predominantly female patients (female: n = 23; male: n = 7). Cellular resolution OCT imaging from lesion skin shows increased melanocyte capping, disrupted basement membrane, telangiectatic blood vessels, and melanophages in the dermis. The advanced skin diagnosis system captured subclinical erythema of the skin, highlighting the inflammatory nature of the disease. The results correlated well with histopathological findings. Limitations: This is a single-center, cross-sectional study. Conclusions: We highlight the features of Riehl’s melanosis through a novel cellular resolution OCT and photographic skin diagnosis system. A multimodality skin diagnosis system can serve as a real-time, in vivo, noninvasive method for evaluating pigmentary disorders.