18494 Reflectance confocal microscopy features in cutaneous leishmaniasis

Abstract

Reflectance confocal microscopy (RCM) is a technique that allows in vivo visualization of skin structures at a nearly histologic resolution. To the best of our knowledge, only two cases of RCM of cutaneous leishmaniasis (CL) have been published. We present 2 patients with a histopathologic diagnosis of CL in whom we performed RCM in 3 lesions. The first case was a 49-year old woman presented with a red papule on her right cheek, that had lasted for 7 months. Dermoscopy showed erythema and central hyperkeratosis. The second case was a 63-year-old woman with 3 red papules on her left cheek lasting for 6 months. Dermoscopy showed generalized erythema, ‘yellow tears’ and vascular structures. In this latest case, first clinical diagnosis was cutaneous lupus or granulomatous rosacea. In both cases, MCR and skin biopsy were performed; in the second patient, in 2 of the 3 lesions. RCM (Vivascope 1500; Mavig, Munich, Germany) revealed similar features in both cases: a polymorphic inflammatory infiltrate with multinucleated cells and longitudinal vessels in the upper dermis. Particularly in the first case we observed central hyperkeratosis and follicular plugging and in the second case we observed hyperreflecting interwoven fibres forming roundish structures similar to one of the published cases. However, we did not observe brick-like structures described in the epidermis as reported by Alarcon et al. Although histology remains the gold standard for the diagnosis of cutaneous leishmaniasis, confocal microscopy can help us avoiding unnecessary biopsies, especially in locations such as the face.