Dermoscopy of discoid lupus erythematosus - a systematic review of the literature

Can Dermoscopy Be a Useful Follow-Up Tool in Patients with Discoid Lupus Treated with Anifrolumab?

This report discusses a female patient with longstanding discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE), refractory to multiple immunosuppressive and biologic treatments. Upon presenting with infiltrated, hypertrophic plaques in facial and décolletage regions, she was started on anifrolumab therapy after the histopathological confirmation of DLE. Following three infusions, significant clinical and dermoscopic improvements were observed, including the resolution of plaques and regression of scarring areas. This case highlights anifrolumab's efficacy in severe lupus skin manifestations, emphasizing its potential to induce dermoscopic and histological remission. Additionally, it suggests that dermoscopy could be a valuable tool for monitoring therapeutic responses in DLE and cutaneous lupus erythematosus, warranting further investigation.

A Three-Step Diagnostic Algorithm for Alopecia: Pattern Analysis in Trichoscopy

Background/Objectives: Alopecia is a common and distressing hair loss condition that poses a major diagnostic challenge. While histopathology is the gold standard, its invasive nature limits its routine use. Trichoscopy, a non-invasive imaging technique, has shown promises in diagnosing and differentiating the various alopecia subtypes. However, existing diagnostic algorithms primarily rely on dermoscopic findings. To address this, we developed a novel, three-step algorithm that integrates clinical and trichoscopic features and employs pattern analysis as a diagnostic tool. Methods: A comprehensive literature review was conducted to identify key trichoscopic features associated with different alopecia types. The gathered data were used as a base for the description of trichoscopic features and patterns for each subtype of alopecia, either scarring or non-scarring. Results: The proposed algorithm is analyzed into three steps. In the first step, alopecia is categorized by distribution into: patchy, patterned, or diffuse. In the second step, it distinguishes between scarring and non-scarring alopecia based on the absence or presence of follicular ostia, respectively. Lastly, in the third step, alopecias are distinguished based on specific trichoscopic clues, allowing for the identification of distinct trichoscopic patterns. Conclusions: The three-step diagnostic algorithm for alopecia, utilizing clinical and dermoscopic findings, performs a pattern analysis in trichoscopy, leading to a dermoscopic diagnosis with great confidence, and minimizing the need for invasive diagnostic procedures.

Application of Ultraviolet-Induced Fluorescence Trichoscopy (UVFT) in Hair and Scalp Diseases

INTRODUCTION

Ultraviolet-induced fluorescence dermoscopy (UVFD) is increasingly utilized in dermatooncology and general dermatology. The objective of the study was to characterize the ultraviolet-induced fluorescence trichoscopy (UVFT) findings in a wide range of hair and scalp conditions.

METHODS

Consecutive patients with non-scarring alopecias (alopecia areata, AA, n = 40; androgenetic alopecia, AGA, n = 40), scarring alopecias (frontal fibrosing alopecia, FFA, n = 20; lichen planopilaris, LPP, n = 20; folliculitis decalvans, FD, n = 14; discoid lupus erythematosus, DLE, n = 23), and inflammatory scalp conditions (psoriasis, n = 30; seborrheic dermatitis, n = 14) were included. Examinations were performed using polarized trichoscopy and UVFT.

RESULTS

The following features were observed under UVFT: white-blue perifollicular fluorescence, white-blue interfollicular fluorescence, irregular confluent dark areas, dark follicular dots, dark perifollicular areas, regular/irregular pink-red follicular fluorescence, regular/irregular green follicular fluorescence, short white hair, black dots, exclamation mark hair, double/triple white follicular dots, pink-red fluorescence of the scales, pink-red fluorescence of the background. Non-scarring alopecias showed more frequently pink-red or green follicular fluorescence (p < 0.001), dark follicular dots (p < 0.001), short white hair (p < 0.001), and double/triple white follicular dots (p < 0.001). In scarring alopecias, white-blue perifollicular fluorescence (p < 0.001), dark perifollicular areas (p < 0.001), and dark confluent areas (p < 0.001) were more commonly observed. Psoriasis showed more frequently pink-red fluorescence of the scales than seborrheic dermatitis (p = 0.019).

CONCLUSION

UVFT supports the differentiation between scarring and non-scarring alopecia, as well as between psoriasis and seborrheic dermatitis. UVFT may hypothetically facilitate the biopsy site selection by highlighting the subclinical perifollicular and interfollicular inflammation.

Clinical and Trichoscopic Patterns of Discoid Lupus Erythematosus of Scalp in Patients with Systemic Lupus Erythematosus: An Observational Study

Background

Discoid lupus erythematosus (DLE) is a specific cutaneous manifestation of systemic lupus erythematosus (SLE), which results in scarring alopecia of the scalp.

Methods

A prospective cross-sectional observational study on scarring alopecia among SLE patients was done between September 2016 and August 2017. The clinical and trichoscopic patterns of scalp DLE among these patients were studied. The DLE lesions were categorised into active and inactive based on clinical features. Trichoscopy was done and photographs were obtained using a non-polarised videodermoscope.

Results

There were 26 patients with scalp DLE, out of which 15 patients (57.69%) had active DLE and 11 (42.30%) had inactive DLE. The trichoscopic findings seen were structureless white areas, loss of follicular units, blue-grey dots and globules, follicular keratotic plugs and telangiectasia. The trichoscopic features seen in active versus inactive DLE were blue-grey dots and globules (93.33% vs 63.63%), structureless white areas (93.33% vs 90.90%), loss of follicular units (86.66% vs 72.72%) and follicular keratotic plugs (80% vs 45.45%), yellow dots with arborising vessels (33.33% vs 72.72%), exaggerated honeycomb pigmentation (46% vs 63.63%) and telangiectasia (66.67% vs 54.54%). Scaling (P = 0.033) and blue-grey dots (P = 0.021) were significantly higher in active and yellow dots with arborising vessels (P = 0.047) in inactive DLE.

Conclusions

On comparing trichoscopic features between active and inactive DLE scaling and blue-grey dots were significantly higher in active and yellow dots with arborising vessels in inactive DLE.

Trichoscopy of Discoid Lupus Erythematosus in Caucasian Scalp: A Review

Background

Scalp discoid lupus erythematosus in Caucasians is still a rare disease with a variable clinical presentation. Its dermoscopic characteristics are poorly described in literature, especially in the white population. The aim of this review was to critically analyze published papers on this topic and summarize relevant features.

Summary

A comprehensive search for eligible articles was conducted in the databases of MEDLINE/PubMed. Results were analyzed following dermoscopic patterns such as follicular openings, hair shafts, perifollicular surface, and vessel pattern.

Key Messages

The most representative features appeared the absence of follicular openings and the presence of follicular keratotic plugs, along with yellow-brown and red dots. In long-lasting lesions with chronic stage, trichoscopy showed the absence of follicular openings, white or milky red cicatricial patches, white and brown structureless areas, and thick arborizing vessels.

Evaluation of hair surface structure and morphology of patients with lichen planopilaris (LPP) by atomic force microscopy (AFM)

BACKGROUND

Lichen planopilaris (LPP) is a chronic lymphocytic skin disease manifested by progressive scarring alopecia. The diagnosis of LPP is made based on histopathological examination, although it is not always definite. The current study evaluates the effectiveness of non-invasive atomic force microscopy (AFM) hair examination in detecting morphological differences between healthy and diseased hair.

MATERIALS AND METHODS

Here, three to five hairs from lesional skin of 10 LPP patients were collected and examined at nine locations using AFM. At least four images were taken at each of the nine sites. Metric measurements were taken and metric (length, width, and scale step height) and morphological features (striated and smooth surface of scales, the presence of endocuticle and cortex, shape of scales edges, scratches, pitting, cracks, globules, and wavy edge) were compared with hair from healthy controls. In addition, areas on diseased hair where the process of pathological, unnatural delamination of the hair fiber occurs are described.

RESULTS

There was a statistically significant difference in the number of scratches in the initial sections of the LPP hair, in the intensity of wavy edges along the entire length of the tested hair, and in the number of scales with pitting in the middle section of the hair. In addition, a statistically significant higher number of scales with striated surface was found in LPP group starting at 3.5 cm from the root continuing towards the free end of the hair. Other morphological changes such as presence of cortex, globules, oval indentations, and rod-like macrofibrillar elements were also assessed, however, detailed results are not presented, as the differences shown in the number of these morphological changes were not significantly different.

CONCLUSION

This publication outlines the differences between virgin, healthy Caucasian hair, and the hair of LPP patients. The results of this study can be used for further research and work related to LPP. This is the first attempt to characterize the hair of LPP patients using AFM.

Trichoscopic Features of Scalp Discoid Lupus Erythematosus versus Lichen Planopilaris: A Systematic Review

Introduction

Lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) are primary scarring alopecias that pose diagnostic challenges clinically, where trichoscopy features may provide benefit in delineating these two cicatricial alopecia, and also helps in assessing the evolution and therapeutic response. To date, there are few reviews on dermoscopic findings in differentiating these two alopecias.

Methods

A systematic literature review was conducted using the PubMed and Google Scholar databases. The search terms included for scalp DLE were 'lupus' OR 'discoid lupus' OR "scalp lupus" and for scalp LPP were "lichen planopilaris" OR "scalp follicular lichen planus" OR "lichen planus follicularis" and were combined with "dermoscopy" OR "dermatoscopy" OR "videodermoscopy" OR "video dermatoscopy" OR "trichoscopy". The differences in the prevalence of dermoscopic features in scalp DLE and LPP were calculated using the Chi-square test.

Results

Of 52 articles, 36 (17 LPP, 19 DLE) were eligible for quantitative analysis. We found predominant peripilar tubular casts and perifollicular erythema with the presence of arborizing vessels in the vicinity of these changes, indicating early LPP. In contrast, follicular red dots, speckled brown pigmentation, and hair diameter variability indicated active DLE. Shiny white areas were common in both the groups in late stages. The target pattern of distribution of blue-grey dots, milky red areas, and irregular white fibrotic dots were seen in LPP, and pink-white background, follicular plugs, perifollicular and interfollicular scale, rosettes, chrysalides, and red spider on yellow dots were detected in DLE. Features such as yellow dots and blue-grey structureless areas were nonspecific and did not have a major role in differentiating DLE from LPP.

Conclusion

This article provides a comprehensive review of the literature and delineates the trichoscopic differences and peculiarities of scalp DLE and LPP, including the correlation of dermoscopic features with histopathological findings.

Dermoscopy for the Differentiation of Subacute Cutaneous Lupus Erythematosus from Other Erythematous Desquamative Dermatoses-Psoriasis, Nummular Eczema, Mycosis Fungoides and Pityriasis Rosea

Subacute cutaneous lupus erythematosus (SCLE) is a condition that might pose a diagnostic challenge. The aim of this study was to assess the usefulness of videodermoscopy in the differentiation of SCLE from other erythematous-desquamative dermatoses. Consecutive patients with SCLE (n = 27), psoriasis (n = 36), nummular eczema (n = 30), mycosis fungoides (n = 26), and pityriasis rosea (n = 20) referred to our Department of Dermatology were recruited for this study. A representative lesion was visualized using a Canfield D200EVO Videodermatoscope (Canfield Scientific GmbH, Bielefeld, Germany) and evaluated for the following parameters: vessels (morphology and distribution), scales (color and distribution), follicular findings, colors and morphologies, and presence of specific clues. SCLE was predominantly characterized by a polymorphous vascular pattern (92.6%) of unspecific distribution (92.6%) over a pink-red background (74.1%). Gray-brown dots were present in 10 (37.0%) cases, and pigmentation was noted in 15 (55.6%) patients, including peripheral pigmentation in 7 (25.9%) patients. Videodermoscopic evaluation showed significant differences between SCLE and psoriasis, which was characterized by regularly distributed dotted vessels. Although some common dermoscopic features with MF were noted, the presence of yellow structureless areas and red dots/globules favored the diagnosis of MF. In conclusion, a polymorphic vascular pattern, especially in association with gray-brown dots and/or peripheral pigmentation, is a valuable clue for the differentiation of SCLE from other erythematous-desquamative dermatoses.

Dermoscopic Characteristics of Cutaneous Lupus Erythematosus According to Subtype, Lesion Location, Lesion Duration, and CLASI Score

INTRODUCTION

Dermoscopic findings are used to diagnose and evaluate disease activity in patients with cutaneous lupus erythematosus (CLE).

OBJECTIVES

This study aimed to characterize the dermoscopic features of discoid LE (DLE) and LE tumidus (LET) by lesion duration and CLE Disease Area and Severity Index (CLASI) scores and to examine the dermoscopic findings of lesions in different locations in DLE patients.

METHODS

Dermoscopic findings (follicular features, perifollicular surface, interfollicular features, and vessel pattern) were assessed and lesion duration (≤12 and >12 months) and CLASI scores (grouped as mild or moderate) were calculated. DLE lesion locations were categorized as, non-scalp, scalp and lip.

RESULTS

Forty-eight dermoscopic images from 35 DLE and 4 LET patients were analyzed. The most common dermoscopic findings in non-scalp DLE were follicular keratotic plugs (82.8%) and white scales (69%). In scalp DLE (n=9), the most common findings were absent follicular openings (77.8%), white structureless areas (77.8%), and perifollicular scaling (66.7%). All LET patients had pink-white background and linear vessels. Follicular plugs, peripheral pigmentation, and polymorphous vessels were lower in patients with mild CLASI activity than moderate activity (P = 0.036, 0.039, and 0.019, respectively). Fibrotic white dots, honeycomb pigment pattern, and blue-gray dots/globules were lower in those with mild CLASI damage scores than moderate damage (P = 0.010, 0.010, and 0.020, respectively). Peripheral pigmentation was more common in patients with lesion duration ≤12 months, while blue-gray dots/globules were more common with lesion durations >12 months.

CONCLUSIONS

Certain dermoscopic features may facilitate the differential diagnosis of DLE and LET.

The dermatoscope in the hair clinic: Trichoscopy of scarring and nonscarring alopecia

Trichoscopy is currently regarded as an essential part of the hair loss consultation. It allows visualization of morphologic structures that are not obvious to the naked eye, including peri- and interfollicular skin surface abnormalities and changes to hair shaft thickness and shape. In this paper, we aim to discuss current knowledge on trichoscopy of the most common forms of scarring and nonscarring alopecias.

Halting the Progression of Cicatricial Alopecia with Injectable Platelet-Rich Fibrin

Discoid lupus erythematosus (DLE) is a chronic variant of cutaneous lupus erythematosus characterized by well-defined erythematous plaques with adherent scales and follicular plugging. The affected scalp shows erythema, edema, atrophy, alopecia, and telangiectasia. Trichoscopy of DLE shows branching capillaries, white patches, keratin plugs, reduced follicular ostia, and white dots and blue-gray dots arranged in speckles pattern. Prompt diagnosis and aggressive, early multimodal therapy helps in preventing disfiguring hair loss and psychosocial sequelae. Hereby, we present a case of reversal of hair loss in DLE with newer modalities of treatment such as injectable platelet-rich fibrin.

Recent Advances in Understanding of the Etiopathogenesis, Diagnosis, and Management of Hair Loss Diseases

Hair-loss diseases comprise heterogenous conditions with respective pathophysiology and clinicopathological characteristics. Major breakthroughs in hair follicle biology and immunology have led to the elucidation of etiopathogenesis of non-scarring alopecia (e.g., alopecia areata, AA) and cicatricial alopecia (e.g., lichen planopilaris, LPP). High-throughput genetic analyses revealed molecular mechanism underlying the disease susceptibility of hair loss conditions, such as androgenetic alopecia (AGA) and female pattern hair loss (FPHL). Hair loss attracted public interest during the COVID-19 pandemic. The knowledge of hair loss diseases is robustly expanding and thus requires timely updates. In this review, the diagnostic and measurement methodologies applied to hair loss diseases are updated. Of note, novel criteria and classification/scoring systems published in the last decade are reviewed, highlighting their advantages over conventional ones. Emerging diagnostic techniques are itemized with clinical pearls enabling efficient utilization. Recent advances in understanding the etiopathogenesis and management for representative hair diseases, namely AGA, FPHL, AA, and major primary cicatricial alopecia, including LPP, are comprehensively summarized, focusing on causative factors, genetic predisposition, new disease entity, and novel therapeutic options. Lastly, the association between COVID-19 and hair loss is discussed to delineate telogen effluvium as the predominating pathomechanism accounting for this sequela.

[Dermoscopy of granulomatous and autoimmune skin diseases]

Dermoscopy is an easily accessible, noninvasive diagnostic tool, originally used in the differentiation of benign and malignant skin tumors. Other structures beside pigment content observed by dermoscopy, e.g., scaling, follicles, or vessels, may present in a specific pattern in different dermatoses. Recognition of these patterns may aid the diagnosis of inflammatory and infectious dermatological conditions. The aim of this article is to review the distinct dermoscopic features of granulomatous and autoimmune skin diseases. Diagnosis of granulomatous skin disorders is based on the histopathological examination. The dermoscopic picture of these diseases (cutaneous sarcoidosis, granuloma annulare, necrobiosis lipoidica, and granulomatous rosacea) show many similarities; however, there are some differences to note between the dermatoses, mainly in granuloma annulare. The cornerstones of the diagnostic process of autoimmune skin diseases (morphea, systemic sclerosis, dermatomyositis, cutaneous lupus erythematosus) include the clinical picture, immunoserology, and histology; however, dermoscopy may aid the diagnostic process and follow-up of the patients. For those diseases, where vascular abnormalities play an important role in the pathogenesis, videocapillaroscopy is used for examination of the microcirculation at the nailfold capillaries. Dermoscopy can be an easy-to-use everyday diagnostic tool in clinical practice regarding granulomatous and autoimmune skin diseases. Although punch biopsy is inevitable in many cases, the distinct dermoscopic structures can aid the diagnostic process.

Clinical aspects of cutaneous lupus erythematosus

Lupus erythematosus (LE) is an autoimmune inflammatory disease with a wide clinical spectrum from life-threatening multi-organ inflammation in systemic lupus erythematosus (SLE) to limited skin disease in cutaneous LE (CLE). The etiology of CLE is still not fully understood but a multifactorial genesis with genetic predisposition and certain environmental factors as triggers for the development are generally accepted features. Lesions can be induced and aggravated by UV-irradiation and smoking is linked to more severe forms of skin disease and to co-morbidity. Drugs, including many common medicines like antihypertensives, are known to induce subacute CLE (SCLE). The mechanisms involved have recently been shown to be part of the IFN-I pathway and new, specific treatments are currently in clinical trials. CLE is currently classified in subtypes based on clinical presentation and duration into acute CLE (ACLE), SCLE, and chronic CLE (CCLE). Distinct subtypes can be seen in individual patients or coexist within the same patient. Because of the confluent and overlapping picture between these subsets, serology, and histopathology constitute an important role guiding towards correct diagnose and there is ongoing work to update the classification. The Cutaneous Lupus Area Severity Index (CLASI) is a validated tool to measure activity and damage both in clinical trials but also for the clinician to evaluate treatment and follow the course of the disease among patients. CLE is known to have substantial impact on the life of those affected. Several tools have been proposed to measure QoL in these patients, currently Skindex-29 is probably the most used. Patient education is an important part of prevention of flares, including UV-protection and smoking cessation. First-line treatment includes topical corticosteroids as well as topical calcineurin inhibitors with the addition of systemic treatment with antimalarials in more severe or therapy resistant cases. Treatment specifically targeting CLE has been lacking, however novel potential therapies are in later phase clinical trials. In this review we aim to describe the different subsets of the cutaneous form in LE with focus on clinical aspects.

Dermoscopic Findings of Discoid Lupus Erythematosus Involving the Eyelids

Introduction

Although facial involvement in discoid lupus erythematosus (DLE) is common, eyelid involvement is atypical. Identifying this condition is challenging due to misdiagnosis, and it is essential to avoid potential deformities of the eyelid margin.

Case Presentation

We, herein, report the dermoscopic findings in 2 female patients with a confirmed diagnosis of DLE who presented eyelids involvement.

Discussion/Conclusion

This study highlights the importance of performing a dermoscopy examination to help physicians obtain an early diagnosis of DLE.

Chronic Cutaneous Lupus Erythematosus in a White Population: Dermoscopic Characteristics by Clinical Subtype, Lesion Location and Disease Duration

INTRODUCTION

Chronic cutaneous lupus erythematosus (CCLE) comprises three major clinical variants: discoid lupus erythematosus (DLE), chilblain lupus erythematosus (CHLE), and lupus erythematosus profundus, also referred to as lupus erythematosus panniculitis (LEP). The aim of the current study was to systematically describe the dermoscopic features of CCLE in Polish patients with Fitzpatrick skin phototypes I-III.

METHODS

The videodermoscopic images from patients with various clinical variants of CCLE (DLE, CHLE and LEP) were reviewed. Predefined parameters for dermoscopic evaluation in general dermatology were used to describe the findings in lesions located beyond the scalp. In the analysis of trichoscopic findings in lesions located on the scalp, dermoscopic features of follicular openings, hair shafts, the perifollicular surface, the interfollicular surface and vessel morphology were considered. Based on personal experience, several additional dermoscopic and trichoscopic characteristics were included in the analysis.

RESULTS

A total of 85 lesions from 26 patients (16 women and 10 men; mean age 40.8 ± 11.2 years) were assessed. DLE on glabrous skin showed polymorphous vessels (89.1%), pink-red background (70.9%), follicular plugs (67.3%) and white scaling (58.2%), while scalp DLE was characterized by polymorphous vessels (83.3%), yellow dots (66.7%), follicular plugs (55.6%) and a reduced number of follicles (55.6%). Labial DLE (n = 2) showed linear branched and linear curved vessels, white structureless areas, red structureless (hemorrhagic) areas and red dots/globules. White scaling (61.1% vs. 34.1%; p = 0.042), gray-brown dots/globules (44.4% vs. 12.2%; p = 0.015) and peripheral pigmentation (100.0% vs. 46.2%; p = 0.036) were significantly more common in long-lasting (> 1 year) DLE lesions. CHLE (n = 5) presented with polymorphous vessels, white scales, pink-red background, red structureless areas and red dots/globules. LEP showed polymorphous vessels, white-yellow scales, follicular plugs, white structureless areas and red hemorrhagic areas.

CONCLUSIONS

Dermoscopy might be useful in the preliminary diagnosis of DLE, and its role in the diagnosis of CHLE and LEP needs further elucidation.

Dermoscopic Features of Acute, Subacute, Chronic and Intermittent Subtypes of Cutaneous Lupus Erythematosus in Caucasians

Cutaneous lupus erythematosus (CLE) is divided into the following four clinical subtypes: acute CLE (ACLE), subacute (SCLE), chronic CLE (CCLE) and lupus erythematosus tumidus (LET). The aim of this study was to describe the dermoscopic patterns of CLE by clinical variant. A total of 54 Caucasian patients from Poland (ACLE = 10; SCLE = 11; CCLE = 26; LET = 7) were included. The predefined parameters for dermoscopic assessment in inflammatory dermatoses were analyzed separately by two dermatologists. Under dermoscopy, all the variants of CLE showed predominantly polymorphous vessels on a pink−red background within the lesional skin. Dotted vessels, in association with other vessel morphologies, were observed more frequently in SCLE than in the other subtypes of CLE, but the difference did not reach statistical significance (p = 0.07). The findings associated with hair follicles, including rosettes (p = 0.02), follicular plugs (p = 0.01), follicular red dots (p < 0.01), perifollicular white halos (p < 0.01) and dermoscopic features corresponding to scarring, including white (p = 0.01) and pink (p < 0.01) structureless areas, were significantly more common in CCLE than in other variants of CLE. A lack of scaling, pigmentation, erosions and crusting were observed in all the cases of LET. The role of dermoscopy as an auxiliary tool in the differential diagnosis of CLE needs further elucidation.

Dermoscopy of Gottron's papules and other inflammatory dermatoses involving the dorsa of the hands

BACKGROUND

Several inflammatory dermatoses, including dermatomyositis (DM), may present as erythematous papules or plaques on the dorsal aspects of the hands over the joints. Limited skin involvement in these entities may pose a diagnostic challenge. (Video)dermoscopy is being utilized more frequently to aid in differential diagnosis of inflammatory skin conditions.

OBJECTIVE

To describe the dermoscopic findings in Gottron's papules and compare with dermoscopic features of other dermatoses involving the dorsal aspects of the hands.

METHODS

Videodermoscopic images from patients presenting with erythematous papules or plaques on the dorsal surface of the hands were retrospectively analyzed for the presence of standardized dermoscopic parameters.

RESULTS

Dermoscopic images from patients with DM (n=12), psoriasis (n=19), chronic dermatitis (n=16), mycosis fungoides (n=7), lichen planus (n=5) and pityriasis rubra pilaris (n=3) were included. Gottron's papules were characterized by pleomorphic vessels (dotted vessels accompanied by thick or thin linear vessels with branches or linear curved vessels) in 66.7% of cases, arranged in unspecified pattern (91.7%), and accompanied by white or pink structureless areas (75.0%). Psoriatic plaques were characterized by dotted vessels arranged in a uniform pattern (94.7%). Vessels arranged in a ring pattern were nearly exclusively observed in psoriasis, while yellow structureless areas and erosions were more frequently present in chronic dermatitis. White lines, corresponding to Wickham striae, were specific for lichen planus.

CONCLUSIONS

Videodermoscopy might be of value in differentiating Gottron's papules from other dermatoses involving dorsa of the hands.

Horizontal Histopathology Correlation with In Vivo Reflectance Confocal Microscopy in Inflammatory Skin Diseases: A Review

Horizontal histopathological sections (HHSs) have been reported to show a strong correlation with images obtained via in vivo reflectance confocal microscopy (RCM), as both reflect the same horizontal plane of the skin. Although vertical histopathology remains the diagnostic gold standard for most neoplastic and inflammatory skin diseases, HHSs represent a useful tool to validate the RCM features of some inflammatory disorders, including psoriasis, discoid lupus erythematosus, and eczema. The aim of the present review is to summarize the state of the art on the existing correlations between HHS and RCM in this field and to emphasize that RCM may represent a useful diagnostic tool to discriminate between diseases with similar clinical presentations.

Dermoscopy and Trichoscopy in Dermatomyositis-A Cross-Sectional Study

BACKGROUND

(Video)dermoscopy is a non-invasive diagnostic technique that has a well-established role in dermatooncology. In recent years, this method has also been increasingly used in the assessment of inflammatory dermatoses. So far, little is known about the (video)dermoscopic features of dermatomyositis (DM).

METHODS

Consecutive patients with DM were included in the study and videodermoscopic assessments of the nailfolds, scalp, and active skin lesions were performed.

RESULTS

Fifteen patients with DM (10 women and 5 men) were included. Capillaroscopy showed elongated capillaries (90.9%), avascular areas (81.8%), disorganized vessel architecture (81.8%), tortuous capillaries (72.7%), dilated capillaries (72.7%), and hemorrhages (72.7%). The trichoscopic findings included linear branched vessels (80.0%), linear vessels (60.0%), linear curved vessels (53.3%), perifollicular pigmentation (40.0%), perifollicular erythema (33.3%), scaling (20.0%), white (20.0%) or yellow (20%) interfollicular scales, and white (20.0%) or pinkish (13.3%) structureless areas. Polymorphic vessels of an unspecific distribution and white or pink structureless areas were frequently observed under dermoscopy in cutaneous manifestations of DM, including Gottron's papules and Gottron's sign.

CONCLUSIONS

Dermoscopy of the nailfolds (capillaroscopy), scalp (tricoscopy), and active cutaneous lesions may be of value in the preliminary diagnosis of DM.

Fluorescence advanced videodermoscopy: a new method of hairs and scalp evaluation. Comparison with trichoscopy

INTRODUCTION

Non-invasive diagnostic methods in clinical dermatology are widely used to reduce the need for invasive techniques, with great advantages in terms of cost and time. Dermoscopy is the reference test for the in vivo diagnosis of cutaneous lesions, and when it is performed on the scalp region it is named trichoscopy. Fluorescence advanced videodermoscopy (FAV) has been lately proposed as a new non-invasive method for the in vivo skin examination at high magnification, with cell-level resolution. So far, it has shown promising results for the assessment of melanocytic and vascular lesions and for the in vivo diagnosis of parasitosis.

OBJECTIVES

This observational study aims to perform, for the first time, a morphologic study of healthy scalp and scalp elementary lesions using FAV and to compare it with trichoscopy.

METHODS

We enrolled 90 healthy individuals for the evaluation of the scalp using FAV. Then, we recruited 53 patients with alopecia and collected images of the elementary lesions using FAV and trichoscopy.

RESULTS

Three hundred healthy scalp FAV images of different epidermal layers, papillary dermis, follicular ostia and healthy hair shafts were collected. Three hundred and eighty FAV and trichoscopic images of alopecic scalp elementary lesions were collected, showing that FAV provided a more detailed observation than trichoscopy, with higher magnification and cellular resolution.

CONCLUSION

Fluorescence advanced videodermoscopy may represent a new valid technique of support to trichoscopy, adding further information, increasing chances of diagnosis and decreasing the need of invasive procedures.