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Bakay OSK, Kacar N, Gonulal M, Demirkan NC, Cenk H, Goksin S, Gural Y. Dermoscopic Features of Cutaneous Vasculitis. Dermatol Pract Concept 2024; 14:dpc.1401a51. [PMID: 38364381 PMCID: PMC10868889 DOI: 10.5826/dpc.1401a51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Dermoscopy has become widespread in the diagnosis of inflammatory skin diseases. Cutaneous vasculitis (CV) is characterized by inflammation of vessels, and a rapid and reliable technique is required for the diagnosis. OBJECTIVES We aimed to define CV dermoscopic features and increase the diagnostic accuracy of dermoscopy with machine learning (ML) methods. METHODS Eighty-nine patients with clinically suspected CV were included in the study. Dermoscopic images were obtained before biopsy using a polarized dermoscopy. Dermoscopic images were independently evaluated, and interobserver variability was calculated. Decision Tree, Random Forest, and K-Nearest Neighbors were used as ML classification models. RESULTS The histopathological diagnosis of 58 patients was CV. Three patterns were observed: homogeneous pattern, mottled pattern, and meshy pattern. There was a significant difference in background color between the CV and non-CV groups (P = 0.001). The milky red and livedoid background color were specific markers in the differential diagnosis of CV (sensitivity 56.7%, specificity 96.3%, sensitivity 29.4%, specificity 99.2%, respectively). Red blotches were significantly more common in CV lesions (P = 0.038). Red dots, comma vessels, and scales were more common in the non-CV group (P = 0.002, P = 0.002, P = 0.003, respectively). Interobserver agreement was very good for both pattern (κ = 0.869) and background color analysis (κ = 0.846) (P < 0.001). According to ML classifiers, the background color and lack of scales were the most significant dermoscopic aspects of CV. CONCLUSIONS Dermoscopy may guide as a rapid and reliable technique in CV diagnosis. High accuracy rates obtained with ML methods may increase the success of dermoscopy.
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Affiliation(s)
| | - Nida Kacar
- Pamukkale University Faculty of Medicine, Department of Dermatology, Denizli, Turkey
| | - Melis Gonulal
- Tepecik Education and Research Hospital Department of Dermatology, University of Health Sciences Turkey, İzmir, Turkey
| | - Nese Calli Demirkan
- Department of Pathology, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - Hülya Cenk
- Pamukkale University Faculty of Medicine, Department of Dermatology, Denizli, Turkey
| | - Sule Goksin
- Pamukkale University Faculty of Medicine, Department of Dermatology, Denizli, Turkey
| | - Yunus Gural
- Firat University Faculty of Science, Division of Statistics, Elazig, Turkey
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Sławińska M, Żółkiewicz J, Behera B, Ding DD, Lallas A, Chauhan P, Khare S, Enechukwu NA, Akay BN, Ankad BS, Bhat YJ, Jha AK, Kaliyadan F, Kelati A, Neema S, Parmar NV, Stein J, Usatine RP, Vinay K, Sobjanek M, Errichetti E. Dermoscopy of Inflammatory Dermatoses ( Inflammoscopy) in Skin of Color - A Systematic Review by the International Dermoscopy Society "Imaging in Skin of Color" Task Force. Dermatol Pract Concept 2023; 13:dpc.1304S1a297S. [PMID: 37874994 PMCID: PMC10824322 DOI: 10.5826/dpc.1304s1a297s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 10/26/2023] Open
Abstract
Dermoscopic patterns of inflammatory dermatoses (inflammoscopy) have been extensively studied in the recent years, though data on patients with darker phototypes (IV-VI) are sparse. The aims of this systematic review were to summarize the current state of knowledge on inflammoscopy applied to skin of color and provide a standardized nomenclature of reported findings. Besides dermoscopic features, type of setting and magnification, number of cases, and histopathological correlation were analyzed. Eighty-five papers addressing 78 different dermatoses (25 papulosquamous dermatoses, 19 hyperpigmented dermatoses, eight hypopigmented dermatoses, four granulomatous dermatoses, two sclerotic dermatoses, five facial inflammatory dermatoses, and 15 miscellaneous conditions) for a total of 2073 instances were retrieved. Only one study showed a level of evidence of III (cross-sectional study), whereas 10 and 74 displayed a level of evidence of IV (case-control studies) and V (case-series and case-reports), respectively. Moreover, our analysis also highlighted that most of papers focalized on a limited number of dermatoses, with several conditions having only single dermoscopic descriptions. Additionally, few studies compared findings among phototypes belonging to the "skin of color" spectrum. Further studies designed according to a systematic approach and considering the above-mentioned issues are therefore needed.
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Affiliation(s)
- Martyna Sławińska
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Jakub Żółkiewicz
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Biswanath Behera
- Department of Dermatology and Venereology, AIIMS, Bhubaneswar, India
| | - Delaney D Ding
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Aimilios Lallas
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Payal Chauhan
- Department of Dermatology, All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, India
| | - Soumil Khare
- Department of Dermatology, Venereology and Leprosy, AIIMS, Raipur, India
| | - Nkechi Anne Enechukwu
- Nnamdi Azikiwe University/Nnamdi Azikiwe Teaching Hospital Nnewi, Anambra State, Nigeria
| | - Bengu Nisa Akay
- Department of Dermatology, School of Medicine, Ankara University, Ankara, Turkey
| | - Balachandra S Ankad
- Department of Dermatology, Venereology and Leprosy, SN Medical College, Bagalkot, Karnataka, India
| | - Yasmeen J Bhat
- Department of Dermatology, Venereology and Leprology, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India
| | - Abhijeet Kumar Jha
- Department of Dermatology & STD, Patna Medical College & Hospital, Patna, India
| | - Feroze Kaliyadan
- Department of Dermatology, Sree Narayana Institute of Medical Sciences, Ernakulum, India
| | - Awatef Kelati
- Dermatology Department, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Shekhar Neema
- Department of Dermatology, Venereology and Leprology, Armed Force Medical College, Pune, Maharashtra, India
| | - Nisha V Parmar
- Department of Dermatology, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Jennifer Stein
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Richard P Usatine
- Department of Dermatology and Cutaneous Surgery, Department of Family and Community Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Michał Sobjanek
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Enzo Errichetti
- Institute of Dermatology, “Santa Maria della Misericordia” University Hospital, Udine, Italy
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Sonego B, Sola S, Biondo G, Massone C. Two cases of granuloma faciale showing rosettes. Dermatol Reports 2023; 15:9696. [PMID: 37908606 PMCID: PMC10614554 DOI: 10.4081/dr.2023.9696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 11/02/2023] Open
Abstract
Granuloma faciale (GF) is a rare benign chronic inflammatory dermatosis often difficult to distinguish clinically from other diseases, both inflammatory and neoplastic. Dermoscopy can be a helpful diagnostic tool and indeed several dermoscopic criteria observed in GF have been described in literature. We present two patients affected by GF in which we have observed rosettes.
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Affiliation(s)
- Benedetta Sonego
- Dermatology Unit and Scientific Directorate, Galliera Hospital, Genoa
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste
| | - Simona Sola
- Surgical Pathology, Galliera Hospital, Genoa
| | - Giovanni Biondo
- Istituto Clinico Sant’Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Cesare Massone
- Dermatology Unit and Scientific Directorate, Galliera Hospital, Genoa
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Szykut-Badaczewska A, Sikora M, Rudnicka L, Kittler H. Dermatoscopy of Cutaneous Lichen Planus - Attempt to Translate Metaphoric Terminology Into Descriptive Terminology. Dermatol Pract Concept 2023; 13:e2023174. [PMID: 37557148 PMCID: PMC10412054 DOI: 10.5826/dpc.1303a174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2022] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Dermatoscopy is gaining appreciation in assisting the diagnosis of inflammatory dermatoses (inflammoscopy). Lichen planus (LP) is a common inflammatory skin disease with characteristic dermatoscopic features. Over the last few years, numerous articles were published on the dermatoscopy of LP and a high number of terms have been used to describe the dermatoscopic features of this disease. OBJECTIVES The objective of this study was to review the literature on the dermatoscopy of LP and to re-evaluate the published descriptions in the light of the 2019 expert consensus on the terminology of dermatoscopy for non-neoplastic skin diseases. METHODS We searched the PubMed database using the keywords 'lichen planus and dermatoscopy', 'lichen planus and dermoscopy', 'lichen planus and epiluminescence microscopy', and 'lichen planus and inflammoscopy'. RESULTS Of 408 articles retrieved, we selected 67 articles for full-text review, and finally included 58 articles, mostly case reports or small case series, comprising 572 patients with LP. We identified 118 different terms or short descriptions that were used to characterize the dermatoscopy of LP and redescribed them according to International Dermoscopy Society consensus paper. Frequently, authors applied various terms or descriptions to variants of the same feature. Although reported under different designations, Wickham striae were the most consistent dermatoscopic feature of LP. Other characteristics of LP, such as vascular patterns, pigmented structures and follicular findings were less consistent or depended on skin type, anatomic site, disease stage and applied treatment. CONCLUSIONS While Wickham striae are the single most important clue for the diagnosis, other dermatoscopic characteristics of LP are less consistent. Based on the descriptions published in the literature we established a dictionary of useful terms for the description of LP that is consistent with the terminology suggested by the recent consensus conference.
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Affiliation(s)
- Agata Szykut-Badaczewska
- Department of Dermatology and Venereology, State Hospital Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Mariusz Sikora
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Harald Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Prasanna S, Haridas NS, Kharkar V, Khade P. Extragenital Lichen Sclerosus et Atrophicus-Morphea Overlap Masquerading as Lupus Vulgaris: Histopathology to the Rescue. Dermatol Pract Concept 2023; 13:e2023141. [PMID: 37557133 PMCID: PMC10412083 DOI: 10.5826/dpc.1303a141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 08/11/2023] Open
Affiliation(s)
- Swati Prasanna
- Department of Dermatology, Leprosy and Venereology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Nishigandha S Haridas
- Department of Dermatology, Leprosy and Venereology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Vidya Kharkar
- Department of Dermatology, Leprosy and Venereology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Pandharinath Khade
- Department of Dermatology, Leprosy and Venereology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
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Abstract
Dermatoscopy is a relevant in vivo diagnostic tool for inflammatory diseases of the skin that aids not only in diagnosis, but also in monitoring the response to treatment. The inflammatory diseases show dermoscopic patterns involving the vessels, scales, follicles, background hue, and special clues. This review aims to provide an overview on the use of dermoscopy in inflammatory dermatoses based on the available literature and the deviation from it in the skin of color (SOC) as there is paucity of literature in dermoscopy of inflammatory disorders in SOC. The dermatoscopic patterns in most of the inflammatory diseases in SOC are similar to that of white skin, with pigmentary changes being the prominent dermoscopic findings while vascular patterns and erythema being less evident.
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Affiliation(s)
- Yasmeen J Bhat
- Department of Dermatology, Venereology and Leprosy, Government Medical College, Srinagar, University of Kashmir, Jammu and Kashmir, India
| | - Abhijeet K Jha
- Department of Skin and VD, Patna Medical College, Patna, Bihar, India
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Errichetti E, Ankad BS, Sonthalia S, Jha AK, Keshavamurthy V, Kyrgidis A, Neema S, Chatterjee M, Kaliyadan F, Dogra S, Khare S, Kelati A, Akay BN, Cabo H, Bhat YJ, Bosseila M, Gupta A, Nair P, Gaikwad S, Jayasree P, Sabban ENC, Stinco G, Apalla Z, Zalaudek I, Lallas A. Dermoscopy in general dermatology (non-neoplastic dermatoses) of skin of colour: a comparative retrospective study by the International Dermoscopy Society. Eur J Dermatol 2020; 30:688-98. [PMID: 33319764 DOI: 10.1684/ejd.2020.3928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dermoscopy has been shown to be a useful supportive tool to assist the diagnosis of several non-neoplastic dermatoses (i.e. inflammatory, infiltrative and infectious skin diseases), yet data on skin of colour is still limited. OBJECTIVES To characterize dermoscopic features of non-neoplastic dermatoses in dark-skinned patients in order to identify possible clues that may facilitate the differential diagnosis of clinically similar conditions. MATERIALS & METHODS Members of the International Dermoscopy Society were invited to submit cases of any non-neoplastic dermatosis developing in patients with Fitzpatrick Phototypes V-VI whose diagnosis had been confirmed by the corresponding gold standard diagnostic test. A standardized assessment of the dermoscopic images and a comparative analysis according to clinical presentation were performed. Seven clinical categories were identified: (I) papulosquamous dermatoses; (II) facial hyperpigmented dermatoses; (III) extra-facial hyperpigmented dermatoses; (IV) hypopigmented dermatoses; (V) granulomatous dermatoses; (VI) sclerotic dermatoses; and (VII) facial inflammatory dermatoses. RESULTS A total of 653 patients (541 and 112 with Phototype V and VI, respectively) were recruited for the analysis. Thirty-six statistically significant dermoscopic features were identified for papulosquamous dermatoses, 24 for facial hyperpigmented disorders, 12 for extra-facial hyperpigmented disorders, 17 for hypopigmented disorders, eight for granulomatous dermatoses, four for sclerotic dermatoses and 17 for facial inflammatory diseases. CONCLUSION Our findings suggest that dermoscopy might be a useful tool in assisting the diagnosis of clinically similar non-neoplastic dermatoses in dark phototypes by revealing characteristic clues. Study limitations include the retrospective design, the lack of a direct dermoscopic-histological correlation analysis and the small sample size for less common diseases.
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Abstract
In addition to its use in pigmented and nonpigmented skin tumors, dermoscopy is gaining appreciation in assisting the diagnosis of nonneoplastic diseases, especially inflammatory dermatoses (inflammoscopy). In this field, dermoscopic examination should be considered as the second step of a "2-step procedure," always preceded by the establishment of a differential diagnosis on the basis of clinical examination. In this paper, we sought to provide an up-to-date overview on the use of dermoscopy in common inflammatory dermatoses based on the available literature data. For practical purposes, the analyzed dermatoses are grouped according to the clinical presentation pattern, in line with the 2-step procedure principle: erythematous-desquamative and papulosquamous dermatoses, papulokeratotic dermatoses, erythematous facial dermatoses, sclero-atrophic dermatoses, and miscellaneous.
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Affiliation(s)
- Enzo Errichetti
- Institute of Dermatology, Santa Maria della Misericordia University Hospital, Udine, Italy
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Micali G, Verzì AE, Lacarrubba F. Alternative uses of dermoscopy in daily clinical practice: An update. J Am Acad Dermatol 2018; 79:1117-1132.e1. [PMID: 29920317 DOI: 10.1016/j.jaad.2018.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/30/2018] [Accepted: 06/11/2018] [Indexed: 01/06/2023]
Abstract
Dermoscopy is a noninvasive diagnostic tool that is currently being used for neoplastic skin lesions, several inflammatory and infectious diseases, and skin appendage disorders. As the clinical applications of dermoscopy beyond pigmented lesions are constantly increasing, the aim of this article is to provide an update on this topic. This comprehensive review substantiates how several diseases may show peculiar dermoscopy features so as to enhance the diagnosis and avoid (in selected cases) unnecessary histologic confirmation. In other cases, dermoscopy features may be shared with other conditions, with the advantage of narrowing down the differential diagnosis by ruling out those dermatoses with similar clinical aspect but different dermoscopic presentation.
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Errichetti E, De Francesco V, Pegolo E, Stinco G. Dermoscopy of Grover's disease: Variability according to histological subtype. J Dermatol 2016; 43:937-9. [PMID: 26892381 DOI: 10.1111/1346-8138.13298] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 12/15/2015] [Indexed: 11/30/2022]
Abstract
Distinguishing Grover's disease from other papular dermatoses is often a troublesome task. According to two relatively recent case reports, dermoscopy may be useful in assisting the diagnosis of such a disorder by showing a peculiar pattern. The aim of this study was to evaluate the dermoscopic features of Grover's disease in a larger series of patients and correlate dermoscopy with histopathological findings. Seven patients with histopathologically confirmed Grover's disease were included in the study, with three of them displaying a Darier-like histology and the remaining four cases having a spongiotic histological pattern. The results of our study suggest that Grover's disease may display different features according to the histological subtype, with a central star-shaped/branched polygonal/roundish-oval brownish area surrounded by a whitish halo being characteristic of the Darier-like histological subtype and whitish scales over a reddish-yellowish background being characteristic of the spongiotic histological subtype.
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Affiliation(s)
- Enzo Errichetti
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy
| | - Vincenzo De Francesco
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy
| | - Enrico Pegolo
- Department of Medical and Biological Sciences, Institute of Anatomic Pathology, University of Udine, Udine, Italy
| | - Giuseppe Stinco
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy
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Errichetti E, Stinco G. Dermoscopy in differential diagnosis of palmar psoriasis and chronic hand eczema. J Dermatol 2015; 43:423-5. [PMID: 26460228 DOI: 10.1111/1346-8138.13142] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 08/17/2015] [Indexed: 11/29/2022]
Abstract
Clinical differentiation between palmar psoriasis and chronic hand eczema may sometimes be a diagnostic challenge; in such cases histopathological analysis helps to differentiate the two conditions. In the present study, palmar psoriasis and chronic hand eczema were investigated using dermoscopy and the significance of specific dermoscopic features was assessed in order to improve their non-invasive differentiation. Ten patients with biopsy-proven palmar psoriasis and 11 patients with biopsy-proven chronic hand eczema were included in the study. We found that the presence of diffuse white scales was significant in palmar psoriasis whereas the presence of yellowish scales, brownish-orange dots/globules and yellowish-orange crusts was significant in chronic hand eczema.
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Affiliation(s)
- Enzo Errichetti
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy
| | - Giuseppe Stinco
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy
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Abstract
The diagnosis of prurigo nodularis is mainly clinical, based on its distinctive features. However, in some cases it may be difficult to differentiate it from other nodular dermatoses only on the clinical basis, thus requiring histopathological examination to reach a definitive diagnosis. The aim of this study was to describe for the first time the dermoscopic features of prurigo nodularis and the useful contribution of dermoscopy in the differential diagnosis of such dermatoses. Fourteen patients with histopathologically proven prurigo nodularis were included in the study. The results of our study suggest that the detection of a "white starburst pattern" surrounding brown-reddish/brown-yellowish crust(s), erosion(s) and/or hyperkeratosis/scales is a useful clue to support the clinical diagnosis of prurigo nodularis, distinguishing it from the other main differential diagnoses.
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Affiliation(s)
- Enzo Errichetti
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy
| | - Angelo Piccirillo
- Department of Dermatology and Venereology, San Carlo Hospital, Potenza, Italy
| | - Giuseppe Stinco
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy
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