唐磊 周汛,2 王淑美

(1.重庆医科大学中医药学院，重庆 401331；2.重庆市中医院皮肤美容科，重庆 400021)

1 临床资料

1.1 病历资料

患儿，女，2岁6个月。因头皮鳞屑、黑点10个月于2021年1月11日到我院门诊就诊。患儿10个月前因头皮鳞屑、黑点伴瘙痒就诊于当地医院，诊断“脂溢性皮炎”，予吡硫翁锌洗剂外洗后无效，黑点逐渐增多；8个月前就诊于当地上级医院，真菌镜检找见可疑真菌孢子，诊断为“头癣？”，予采乐洗剂外洗2个月后无明显好转，患儿黑点进一步增多，出现黑点状断发，密集黑点处无正常毛发生长。为进一步治疗就诊于我院门诊。既往史无特殊，家中养猫，小区理发。家人中无类似疾病病史。体格检查：一般情况可，各系统检查无特殊。皮肤科检查：头皮鳞屑、多个毛囊密集黑点，密集黑点处头发在发根处折断，散在红斑，无丘疹、脓疱，拉发试验阴性(见图1a)。

图1 a.治疗前：头皮多个毛囊密集分布黑点；b.治疗4周后：头皮黑点消失 图2 a.治疗前：皮肤镜下表现为黑点征、螺旋状发、逗号发(×50)；b.治疗4周后：皮肤镜下黑点征、螺旋状发、逗号发消失 图3 a.直接荧光显微镜镜检头皮屑中大量孢子聚集(×400)；b.直接荧光显微镜镜检头皮屑中未找见真菌孢子及菌丝 图4 a.SDA培养25℃，培养10 d，可见菌落生长缓慢、湿润、呈紫红色，表面皱褶不规则，高出培养基表面；b. DTM培养28℃，培养7 d，培养基变红 图5 BCP-MSG培养基培养28℃，培养10 d，菌落深红色，可见宽度约3 mm的水解晕 图6 PDA铜圈小培养10 d，镜下可见大量厚壁孢子和粗短、分隔菌丝(10% KOH，×400)Fig.1 a. Before treatment: multiple hair follicles with black spots on the scalp; b. After 4 weeks of treatment: the scalp black dots disappear Fig.2 a. Before treatment: Dermoscopy showed black dots, spiral hair, and comma hair (×50); b. After 4 weeks of treatment: Black dots, spiral hair, and comma hair disappeared Fig.3 a. Direct fluorescence microscopy showed large number of spores in dandruff (×400); b. Direct fluorescence microscopy showed no fungal spores and hyphae in dandruff Fig.4 a. SDA cultured at 25℃ for 10 days, the colonies grew slowly with moist, purplish red, irregular surface wrinkles; b. DTM cultured at 28℃, after 7 days of culture, the medium turned red Fig.5 BCP-MSG culture medium cultured at 28℃ for 10 days, the dark red colony with a width about 3 mm wasshowed a hydrolysis halo Fig.6 The PDA copper ring was cultured for 10 days, and a large number of thick-walled spores and thick and short, separated hyphae (10% KOH, ×400) were visible under the microscope

1.2 实验室检查

①伍德灯检查：阴性。②皮肤镜检查：毛囊口可见大量黑点状的发根、螺旋状发、逗号发少量黄棕色鳞屑痂皮(见图2a)。……