Diagnosis Of Inflammatory Skin Diseases Research Articles

Dermoscopic Features of Cutaneous Vasculitis.

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. We aimed to define CV dermoscopic features and increase the diagnostic accuracy of dermoscopy with machine learning (ML) 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. 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. 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.

Improved polarimetric analysis of human skin through stitching: advantages, limitations, and applications in dermatology

Polarimetry is a powerful tool for the analysis of the optical properties of materials and systems, such as human skin. However, in many polarimetric setups, the field of view is limited to a few square centimeters. In these cases, it is possible to resort to stitching techniques, which involve combining multiple Mueller matrix measurements obtained from different overlapping regions of the sample. In this paper, we propose a stitching technique for polarimetric data and discuss its advantages and limitations. We also describe the potential of image stitching for improving the accuracy and robustness of in vivo polarimetry in the presence of random patient movement. We conducted our research using a diverse set of samples which included porcine skin, human skin from arms and fingers, cold cuts of chicken and gelatine, alongside synthetically created sample data. Our results demonstrate the effectiveness of this technique for the application in dermatology. Each additional in vivo measurement enhances the field of view by approximately one third, thereby considerably augmenting the total observation area. We show that stitching enables for the polarimetric assessment of large skin patches which is useful for the diagnosis of inflammatory skin diseases.

The role of eosinophils in the differential diagnosis of inflammatory skin diseases

Eosinophils are known to be present in inflammatory skin diseases, but their diagnostic utility is not well established. Upon review of the published status of lesional eosinophils, several categories were identified. 1) Lesional eosinophils highly characteristic such that, in their absence, the pathologist may question the diagnosis. These include arthropod bite reactions and scabies, urticarial dermatitis, and other eosinophilic dermatoses. 2) Lesional eosinophils rare or absent, such that, in their presence, the pathologist may question the diagnosis. These include pityriasis lichenoides, graft versus host disease, and connective tissue disorders. 3) Lesional eosinophils variable and, while in some cases expected, are not required for diagnosis. These include drug reactions, atopic dermatitis and allergic contact dermatitis. 4) Lesional eosinophils variable and not expected but may be seen to a limited extent. These include lichen planus and psoriasis.

Comparison of dermoscopy and reflectance confocal microscopy accuracy for the diagnosis of psoriasis and lichen planus.

Dermoscopy and reflectance confocal microscopy (RCM) as noninvasive tools are gaining increasing importance in the diagnosis of inflammatory skin disorders. The purpose of our study was to calculate and compare the diagnostic accuracy of dermoscopy and RCM in common inflammatory skin diseases. We retrospectively collected clinical, dermoscopic, and RCM images of psoriasis and lichen planuscases from March 2018 to February 2021 in China-Japan Friendship Hospital. There were 10 experts evaluated dermoscopic and RCM images independently. Sensitivity, specificity, positive predict value, and negative predictive value for each and all investigators were calculated. The diagnostic accuracy was also measured by the area under the curve (AUC) for the Receiver Operator Characteristic (ROC) Curves. We collected 82 psoriasis and 47 lichen planus cases. Dermoscopy was more sensitive than RCM in the diagnosis of psoriasis, and overall diagnostic accuracy of dermoscopy was also higher than RCM measured by AUC (0.879 vs. 0.835, p = 0.0001). For lichen planus, RCM had higher sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy than dermoscopy (AUC 0.916 vs. 0.813, p<0.0001). Dermoscopy and RCM play a significant role in assisting the diagnosis of psoriasis and lichens planus. These two noninvasive diagnostic tools have their own advantages and disadvantages for the evaluation of different inflammatory skin diseases, and they can be combined in clinical practice to improve the accuracy of the diagnosis of inflammatory skin diseases.

Dermoscopy Differentiates Guttate Psoriasis from a Mimicker-Pityriasis Rosea.

Guttate psoriasis (GP) and pityriasis rosea (PR) are a part of papulosquamous disorders that have very similar clinical features and often require histopathology to confirm the diagnosis. Dermoscopy has emerged as a noninvasive, cost-effective technique that can aid in the diagnosis of inflammatory skin diseases like GP and PR. To study and compare the dermoscopic features of GP and PR. Twenty consecutive patients each with GP or PR were enrolled in the study. The diagnosis of GP and PR were made clinically and on histopathology. Dermoscopic images were taken of the representative lesions from each patient using a manual dermoscope attached to a digital camera after applying ultrasound gel. Vascular morphology, vascular arrangement, background color, along with color and distribution of scales were noted in each case. Statistical analysis was done using chi-square test to determine the significance of findings in both groups. The combination of a bright red background with dotted vessels in uniform diffuse distribution with diffuse white scales was highly specific for the diagnosis of GP. Lesions of PR showed a red background with dotted blood vessels in nonspecific distribution. Scales were either white in color or brown pigmented with patchy distribution. Brown pigmentation and brown dots were additional findings in cases of PR. Combinations of dermoscopic patterns can aid in the diagnosis of GP and PR in the majority of the cases.

Reliable, low-cost, fully integrated hydration sensors for monitoring and diagnosis of inflammatory skin diseases in any environment.

Present-day dermatological diagnostic tools are expensive, time-consuming, require substantial operational expertise, and typically probe only the superficial layers of skin (~15 μm). We introduce a soft, battery-free, noninvasive, reusable skin hydration sensor (SHS) adherable to most of the body surface. The platform measures volumetric water content (up to ~1 mm in depth) and wirelessly transmits data to any near-field communication-compatible smartphone. The SHS is readily manufacturable, comprises unique powering and encapsulation strategies, and achieves high measurement precision (±5% volumetric water content) and resolution (±0.015°C skin surface temperature). Validation on n = 16 healthy/normal human participants reveals an average skin water content of ~63% across multiple body locations. Pilot studies on patients with atopic dermatitis (AD), psoriasis, urticaria, xerosis cutis, and rosacea highlight the diagnostic capability of the SHS (P AD = 0.0034) and its ability to study impact of topical treatments on skin diseases.

Histopathological Diagnosis of Inflammatory Skin Diseases with Psoriatic Hyperplasia : Differential Diagnosis between Psoriasis Vulgaris and Related Diseases

Histopathological Diagnosis of Inflammatory Skin Diseases with Psoriatic Hyperplasia : Differential Diagnosis between Psoriasis Vulgaris and Related Diseases

Pattern analysis of inflammatory skin diseases according to A.B.Ackerman-always up to date

The exact microscopic diagnosis of inflammatory skin diseases requires the linking of histopathological findings with clinical features. This is not easy when skin biopsies are rarely assessed and the terminology of dermatopathology and dermatology is itself unfamiliar.The infiltrates of almost all inflammatory skin diseases tend to show eight specific patterns in high magnification. By further classifying according to architectural and cytological features, aspecific diagnosis can be made in most cases. At the same time, clinically suspected diagnoses are simply excluded or greatly reduced in number. This procedure, starting with the overview magnification and the recognition of clearly defined histomorphological features, corresponds to an algorithm.Another algorithmic approach uses histomorphological changes under high magnification. Here, "nonspecific" findings are added to the pattern analysis as adiagnostic vehicle.Occasionally, inflammatory skin diseases cannot be assessed conclusively with current modern methods. Such pathology reports should be written descriptively and possible differential diagnoses should be mentioned as notes. The report should be written in alanguage understandable to the clinician.Artificial intelligence, with its ability to transform and integrate extensive clinical as well as image data, will play an important role in the future of decision making, diagnosing, and personalizing medicine. In the field of pathology, it could be seen as asecond opinion. It is important that physicians always contribute their opinion where important algorithmic decisions are made, such as in algorithm design, data quality, interpretation, action, and feedback.

A deep learning, image based approach for automated diagnosis for inflammatory skin diseases.

BackgroundAs the booming of deep learning era, especially the advances in convolutional neural networks (CNNs), CNNs have been applied in medicine fields like radiology and pathology. However, the application of CNNs in dermatology, which is also based on images, is very limited. Inflammatory skin diseases, such as psoriasis (Pso), eczema (Ecz), and atopic dermatitis (AD), are very easily to be mis-diagnosed in practice.MethodsBased on the EfficientNet-b4 CNN algorithm, we developed an artificial intelligence dermatology diagnosis assistant (AIDDA) for Pso, Ecz & AD and healthy skins (HC). The proposed CNN model was trained based on 4,740 clinical images, and the performance was evaluated on experts-confirmed clinical images grouped into 3 different dermatologist-labelled diagnosis classifications (HC, Pso, Ecz & AD).ResultsThe overall diagnosis accuracy of AIDDA is 95.80%±0.09%, with the sensitivity of 94.40%±0.12% and specificity 97.20%±0.06%. AIDDA showed accuracy for Pso is 89.46%, with sensitivity of 91.4% and specificity of 95.48%, and accuracy for AD & Ecz 92.57%, with sensitivity of 94.56% and specificity of 94.41%.ConclusionsAIDDA is thus already achieving an impact in the diagnosis of inflammatory skin diseases, highlighting how deep learning network tools can help advance clinical practice.

Comparison of clinical diagnosis with histopathology in inflammatory skin diseases: a retrospective study of 455 cases

Background Skin biopsies are performed to support the clinical diagnosis of inflammatory skin diseases. Clinical information is conveyed to the pathologist as a list of differential diagnosis. Aims The aims of this article are to correlate the clinical diagnosis with histopathologic diagnosis and to determine the correlation rank order of differentials with histopathologic diagnosis. Methods Four hundred and fifty-five skin biopsies signed out as inflammatory lesions were identified using the laboratory information system. Clinical differential diagnosis from the biopsy requisition forms were tabulated and compared with the final histopathologic diagnosis. Results Out of the 455 individuals considered, 237 (52.08%) were men and 218 (47.9%) were women. The clinical diagnosis with more than 40 mentions included vasculitis, lichenoid dermatitis, discoid lupus erythematosus, psoriasis and eczema. The histopathologic diagnosis with more than 20 mentions included lichenoid dermatitis, cutaneous vasculitis, pemphigus vulgaris, psoriasis and Hansen’s disease. The median number of differential diagnosis per patient was 3 (range: 1–5). The final diagnosis was included in the differentials in 412 (90.5%) and absent in 43 (9.5%) cases. In 339/412 (82.3%) cases, the final diagnosis was the first differential. In 70/412 (16.9%) cases, the final diagnosis was listed as the second or third differential and in 3/412 (0.007%) cases as the fourth and fifth. Among the 37 discordant cases where the clinical details were available, the clinical description correlated with the final diagnosis in 15 cases; clinical and histopathologic diagnoses fell under the same broad disease category in 19 cases. Only 3/37 cases were truly discordant. Limitations The sample size and the possibility of lesions being overbiopsied are the only possible limitations. Conclusion The overall concordance between the first three clinical diagnosis and histopathology was a good 98%. A longer list of differential diagnosis is not helpful. In situations where a specific clinical diagnosis is deferred, an accurate description of the lesions aids the pathologist.

Dermal melanophages: Does quantitative assessment play a role in the diagnosis of inflammatory skin diseases?

Dermal melanophages: Does quantitative assessment play a role in the diagnosis of inflammatory skin diseases?

Spectrum of Interface dermatitis : An Observational study'

Inroduction: Major role of a dermatopathologists is to try to make specific diagnosis of inflammatory skin diseases. IFD means inflammatory infiltrate that abuts or obscures the dermo-epidermal junction in askin biopsy.This type of reaction is also seen in skin disorders associated with systemic illness like LE and skin changes of potentially fatal disorders such as Graft versus host disease, S-J syndrome and toxic epidermal necrolysis. Aims & Objectives- 1) To study the histopathology of interface dermatitis.(2)To study the common types of skin manifestations in interface dermatitis.(3)To determine other histological features associated with interface dermatitis.4)To identify the clinical concordance of various types of interface dermatitis. Methods : Present study is a retrospective , Hospital based study. Ethical consideration was taken. Study duration was Jan 2012 to Dec 2015. Results: In the present study, a total of 121 cases of IFD were studied, the majority of which [65] presented as papulo- squamous [ papules and plaques ] lesions. Of theses 121 cases, the most common type of IFD was LP and its variants (53.71 %).The next common was LDE (8.26 %) followed by PL(7.4% ). The least common was LN (0.8 % ) and dermatomyositis (1.6 %). Female preponderance was noted in case of IFD [ 59.9 % ]. The percentage of clinical concordance was good in cases of LP & its variants (90.77 %), DLE ( 83.33%) and in Dermatomyositis. Conclusion - A good clinicopathologic correlation is absolutely essential for the final diagnosis of IFD. DOI: 10.21276/AABS.1460

C4d and C3d immunohistochemical evaluation on formalin-fixed paraffin-embedded tissue for the diagnosis of bullous pemphigoid: systematic review of the literatures

Introduction: Several methods are available for the diagnosis of autoimmune bullous disease. Since the immunohistochemistry of complement component is easy and more accessible compared to other methods, it is thought that this technique as an efficient method can replace other difficult, and time-consuming procedures. Therefore, in this study we aimed to systematically review the literatures in which the diagnostic value of complement component 3d (C3d) and C4d had been investigated in bullous pemphigoid. Methods: A systematic search was conducted in the PubMed, Google scholar, and Scopus using following search method (((C3d OR C4d OR complement component 3d OR complement component 4d immunohistochemistry)) OR (C3d OR C4d marker OR complement component 3d OR complement component 4d marker)) AND (bullous pemphigoid OR cutaneous pemphigoid) to evaluate the diagnostic value of C3d and/or C4d for early and accurate detection of bullous pemphigoid on November 2015. Subsequently, the extracted data were described.Result: Total of 28 documents were collected and reviewed based on the purpose of this study. Of the collected articles, 21 documents were excluded in several steps of article selection process and only 7 relevant articles were included for data assessment. The results showed that the deposits of C3d and/or C4d in skin biopsies were found in 125 of 134 patients, indicating that immunohistochemistry is a reliable technique for the diagnosis of inflammatory skin diseases.Conclusion: The results of this review showed that C3d and/or C4d immunohistochemistry in skin biopsies is a reliable technique for the diagnosis of inflammatory skin diseases, particularly bullous pemphigoid.

Biopsies of Facial Dermatoses Made Simple

Biopsy of the face is rarely done for inflammatory skin diseases, unless the entire process is confined to the face. We hypothesized that facial dermatitis has a differential diagnosis that is more limited than the differential diagnosis of inflammatory skin diseases that affect other parts of the body. To our knowledge, the classification of inflammatory skin diseases occurring on the face has never been conducted before in the English literature. The most-recent 100 facial biopsies of inflammatory skin conditions were retrieved from our files, and the cases were categorized into the main inflammatory skin patterns. Forty-seven cases (47%) were categorized as interface dermatitis, 2 cases (2%) as psoriasiform dermatitis, 11 cases (11%) as spongiotic dermatitis, 16 cases (16%) as diffuse and nodular dermatitis, 8 cases (8%) as perivascular dermatitis, 14 cases (14%) as folliculitis and perifolliculitis, 1 case (1%) as panniculitis, and 1 case (1%) as fibrosing dermatitis. The number of diagnostic entities represented within each of these patterns was small. We believe that facial dermatitis should have its own more-circumscribed differential diagnosis. From a practical viewpoint, many of the inflammatory skin diseases that affect other parts of the body should be excluded from the differential diagnosis after the tissue is determined to be from a facial skin biopsy, and others should not be considered unless the biopsy is from the face.

Current Knowledge in Inflammatory Dermatopathology

The complex and fascinating spectrum of inflammatory skin disease, and the comprehension of it, is ever expanding and evolving. During the first decade of the 21st century, numerous advances in the understanding of inflammatory disease mechanisms have occurred, particularly in psoriasis and atopic dermatitis. Continuation of this trend will assure a future in which molecular tests for biomarkers of immediate clinical relevance are used in routine patient care, not only for diagnosis but also for prognosis and management. This article focuses on selected recent or noteworthy developments that are clinically relevant for the histologic diagnosis of inflammatory skin diseases.

Www.derm101.com: A growing online resource for learning dermatology and dermatopathology

The internet is increasingly being used to distribute knowledge in medicine in novel and unconventional ways. In this article, we give a brief introduction into the website www.derm101.com, which was founded by A. B. Ackerman for the purpose of teaching dermatology and dermatopathology. A clinical atlas, online books such as the 3rd edition of his volume "Histologic diagnosis of inflammatory skin diseases", works on clues and differential diagnoses in dermatopathology, a resource on therapeutic strategies in dermatology, a video lecture library on controversial issues in dermatology, the quarterly online journal Dermatopathology: Practical and Conceptual and much more can be found on derm101.com. The site is enriched with new contents biweekly and offers several interactive teaching devices. Currently, www.derm101.com is the most comprehensive online library of dermatology resources.

Histologic Diagnosis of Inflammatory Skin Diseases. An Algorithmic Method Based on Pattern Analysis, 3rd edn

Histologic Diagnosis of Inflammatory Skin Diseases. An Algorithmic Method Based on Pattern Analysis, 3rd edn

A. Bernard Ackerman: Histologic diagnosis of inflammatory skin diseases (3rd edn.)

A. Bernard Ackerman: Histologic diagnosis of inflammatory skin diseases (3rd edn.)

Histologic Diagnosis of Inflammatory Skin Diseases. An Algorithmic Method Based on Pattern Analysis, 3rd edn

HistopathologyVolume 46, Issue 6 p. 707-708 Histologic Diagnosis of Inflammatory Skin Diseases. An Algorithmic Method Based on Pattern Analysis, 3rd edn D Slater, D SlaterSearch for more papers by this author D Slater, D SlaterSearch for more papers by this author First published: 18 May 2005 https://doi.org/10.1111/j.1365-2559.2005.02174.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume46, Issue6June 2005Pages 707-708 RelatedInformation

Histological diagnosis of inflammatory skin diseases. Use of a simple algorithm and modern diagnostic methods

The histological diagnosis of inflammatory skin diseases on a day-to-day routine basis poses the difficult task to characterise a dynamic clinical process by histomorphological analysis of one single lesion. Very complex algorithms which are meant to lead to the correct diagnosis are difficult to use. To facilitate the process and reduce the number of algorithms the following method is proposed: 1. Histological examination under low power Definition of lesions altered by scratching 2. Localisation of the significant pathological alterations as follows: Changes in epidermis and dermis Blister formation Changes in dermis/subcutis without characteristic changes in the epidermis Changes mainly in the subcutis 3. Closer examination using a simple algorithm and planning of further investigations following defined criteria: In the case of changes in epidermis and dermis definition of spongiotic, psoriasiform or lichenoid dermatitis (Abb. 1). In the case of blister formation definition of the blister following the given algorithm (Abb. 1). In the case of changes in dermis/subcutis without characteristic changes in the epidermis after exclusion of vasculitis and lymphoma definition of the main pattern as lymphocytic, neutrophilic, eosinophilic, lymphoplasmocytic or granulomatous and following the given algorithm (Abb. 2). In the case of changes mainly in the subcutis after exclusion of vasculitis and lymphoma definition of the main pattern of panniculitis as septal or/and lobular (Abb. 2). Exclusion of PAS positive microorganisms and checking if the general pattern fits into infectious correlation. Use of clinicopathological correlation.