Follicular Plugging Research Articles

Histopathologic Comparisons of Discoid Lupus Erythematosus and Folliculotropic Mycosis Fungoides in a Series of 43 Cases.

Folliculotropic mycosis fungoides (FMF) is a rare cutaneous malignancy that can be mistaken for inflammatory diseases, such as discoid lupus erythematosus (DLE), due to the variability of histopathological findings. This study aims to provide dermatopathologists with evidence-based histopathologic criteria to distinguish DLE from FMF by reporting overlapping and distinguishing microscopic features. Forty-three biopsies from patients with a confirmed diagnosis of DLE or FMF were graded for the presence or absence of 18 histopathologic features. The main histopathologic findings present in nearly all DLE and FMF biopsies were folliculocentric and folliculotropic patterns. Comedones, granulomas, and folliculitis were not prominent. Follicular hyperplasia, follicular plugging, interstitial mucin, lichenoid/interface dermatitis, and plasma cells were significantly more common in DLE biopsies, while follicular mucinosis and eosinophils were significantly more common in FMF samples. Cytologic atypia ranged from none to mild in DLE and mild to moderate in FMF. Rarely, both sets of biopsies contained epidermotropism, spongiosis, or peri-eccrine infiltration. While many histopathological features present in DLE overlap with features found in FMF, such as folliculocentrism and folliculotropism, significant differences do exist. Therefore, when diagnosing FMF, it is important to follow established criteria that differentiate this malignancy from inflammatory conditions such as DLE.

Dermatoscopic features of vulvar lichen sclerosus in children: A retrospective study.

To explore the dermoscopic features of lichen sclerosus in different parts of the external genitalia in children. A retrospective analysis of the dermoscopic features of 42 female children with vulvar lichen sclerosus treated in the Department of Dermatology of Shanxi Children's Hospital from January 2020 to May 2023. Among the 42 female children, aged 3-14 years (mean: 7.24 ± 2.43 years), the duration of vulvar lichen sclerosus ranged from 3 months to 2 years (mean: 9.83 ± 4.93 months). Clinical lesions occurred in the labia minora in 18 cases (42.9%), labia majora in 38 cases (90.5%), posterior fourchette in 36 cases (85.7%), perianal area in 13 cases (31.0%), anterior fourchette in 17 cases (40.5%), clitoris in seven cases (16.7%), and interlabial sulcus in 11 cases (26.2%). Dermoscopic findings common in the labia majora included follicular keratotic plugs, cloverleaf-like structures, comedo-like openings, and linear vessels (p < .05); however, purple-red globules and patches and white linear streaks were more common in the posterior fourchette (p < .05), whereas dotted vessels were more common in the labia minora (p < .05). Common dermoscopic findings in pediatric vulvar lichen sclerosus were yellow-white structureless areas, white linear streaks, follicular keratotic plugs, and cloverleaf-like structures; yellow-white structureless areas and white linear streaks showed the highest specificity. The dermoscopic findings varied among different affected areas, which provides a basis for further understanding of the characteristics of different sites of vulvar lichen sclerosus in the pediatric population.

Efficacy and safety of non-cross-linked hyaluronic acid compound in the treatment of keratosis pilaris: A split-body randomized clinical trial.

Keratosis pilaris (KP) is a prevalent benign dermatological condition characterized by small bumps at the hair follicles alongside surrounding redness, significantly impacting both aesthetics and mental well-being. This study investigated the potential benefits of a non-cross-linked hyaluronic acid (HA) compound for treating KP. A split-body, investigator-blinded, randomized, intraindividual comparative clinical trial was conducted. The non-cross-linked HA compound was injected into KP-affected regions on both upper arms. The treatment was delivered across four sessions scheduled at 4-week intervals. Blinded physicians and patients assessed differences in erythema, skin roughness, and overall scores between treated and control areas at the final follow-up visit. At the 12th and 24th weeks post-treatment, a four-point scale was utilized to assess subjects' perceived treatment efficacy. Additionally, dermoscopic images, histological alterations, and adverse events were monitored. Physician assessments revealed a significant reduction in roughness and overall scores for treated areas compared to controls. Patient self-assessments also reflected improvements in roughness, redness, and overall scores for treated sides at the final visit, with 35.71% of patients demonstrating sustained improvement in redness and 71.43% reporting persistent improvements in roughness at 24th weeks post-treatment. The dermatoscopic examinations revealed a notable enhancement in both the quantity of follicular plugs and the extent of erythema among the subjects in the treatment group. Histopathological outcomes also demonstrated improvement. This study suggests that the non-cross-linked HA compound effectively improves skin roughness and promotes hair shaft growth in KP treatment, demonstrating a favorable safety profile. These findings position it as a potentially viable alternative therapy in clinical practice.

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

Abstract 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.

Exploring the Link: Trichostasis Spinulosa and Its Association with Early Phymatous Rosacea

Introduction: Rosacea is a chronic inflammatory skin condition with several clinical subtypes, including phymatous rosacea, which is distinguished by thickened skin, enlarged pores, and irregular surface nodularities, primarily affecting the nose. This manuscript aims to explore the underrecognized connection between early to moderate phymatous rosacea and trichostasis spinulosa (TS), a follicular disorder characterized by the retention of multiple telogen hairs. Methods: A total of consecutive 13 patients with initial phymatous changes and black dilated openings were enrolled. Detailed dermatological assessments, including dermoscopy, were conducted to identify and confirm trichostasis spinulosa. Dermoscopy of the black openings confirmed the presence of hair tufts emerging from dilated follicular openings and plugs. Patients underwent minor procedures using a comedo extractor to remove the hair bundles. Results: All extracted follicular units showed typical characteristics of trichostasis spinulosa, including bundles of telogen hairs surrounded by a sebokeratinous plug. Conclusion: We postulate that the fibrotic processes characteristic of phymatous rosacea may promote the development of TS. Recognizing TS as an early indicator of phymatous rosacea could help prevent disease progression.

Chronic annular plaques with new peripheral follicular plugging

Chronic annular plaques with new peripheral follicular plugging

Dermoscopy of Actinic Lichen Planus in Skin of Color.

Actinic Lichen Planus (ALP) is a rare photosensitive variant of lichen planus. Four subtypes can be distinguished: pigmented, annular (AALP), plaque-like and dyschromic ALP. This is a retrospective; descriptive and analytical study investigating the dermoscopic patterns of different subtypes of ALP in skin of color. Sixteen adult patients were included in this study; the majority of them were young females, while five patients with the pigmented subtype of ALP were more than 50 years old. This subtype was more prevalent in patients with phototype IV. AALP was described in men with a very dark phototype.In pigmented melasma-like ALP, dermoscopy showed an annular granular pattern, white reticular and circular Wickham striae (WS) with hypopigmentation lacking skin creases, dots inside circles and an eccentric pigmentation on circles. In ALP, annular, circular WS; and perifollicular white halos with follicular plugs were described. The black hole pattern with dotted vessels was seen in the dyschromic ALP. White-yellow-bluish WS were noticed in plaque-type ALP with circumferential radial lines at the periphery. This descriptive study of dermoscopic patterns of various subtypes of ALP in skin of color highlighted new dermoscopic descriptions that vary according to the clinical variant or the morphology; lesions distribution; and phototype. Also, many epidemiological differences were found between our results and the literature concerning the older age of onset in melasma-like pigmented ALP, and the male predominance in annular ALP.

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

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. 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. 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. 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.

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

Dermoscopic findings are used to diagnose and evaluate disease activity in patients with cutaneous lupus erythematosus (CLE). 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. 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. 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. Certain dermoscopic features may facilitate the differential diagnosis of DLE and LET.

Clinical analysis of lupus miliaris disseminatus faciei: a cross-sectional study and literature review.

The clinical similarity of lupus miliaris disseminatus faciei (LMDF) and other papular granulomatous facial disorders often makes its correct diagnosis challenging. Diagnosis often requires the assistance of pathological examination, and dermoscopy can be used as an auxiliary and non-invasive examination method, however, the current findings remain incomplete. This study aimed to summarize the clinical, histopathological and dermoscopic features of LMDF in the Chinese Han population and aiming to provide practical significance to correct diagnosis. 109 patients of LMDF were collected in the Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University from August 2015 to August 2023. The clinical and histopathological manifestations of all patients, as well as the dermoscopic image features of 44 cases, including background, follicular findings, vessels, and other structures, were summarized and evaluated. The most significant histopathological features of LMDF in 109 cases is epithelioid granulomatous infiltrate in the superficial dermis, with or without caseation. The most significant dermoscopic features of LMDF in all 44 cases were orange structureless background (30/44), follicular plug (32/44), follicular white scar-like area (32/44), unspecific linear vessels (24/44), linear vessels with branch (24/44) and white streaks (18/44). Histopathologically, LMDF is characterized by the presence of epithelioid granulomatous infiltrate in the superficial dermis, with or without caseation. Dermoscopically, it exhibits a distinctive orange structureless background, follicular plug, follicular white scar-like area, nonspecific linear vessels, linear vessels with branches, and white streaks.

Extraintestinal manifestation of Crohn’s disease in an 11-year-old girl: a rare case report with review

Crohn’s disease (CD) is an inflammatory condition of the gastrointestinal tract with extraintestinal manifestations. Of all the patients affected by CD 40% experience at least one extraintestinal manifestation of the disease, the skin being the most common site of extraintestinal involvement. We are reporting a case of 11-year-old female child presented to us in the Dermatology OPD with redness and swelling of both upper and lower lip for a duration of 1 year, with swelling of right labia major for 3 months. Skin biopsy showed keratotic plugging, follicular plugging, and loss of rete ridges. Entire dermis and subcutis shows noncaseating granulomas without any giant cells with lymphohistiocytic cuffing around it. The patient was treated with prednisolone followed by methotrexate and supportive measures. There was a decrease in the swelling of face and vulva after a period of 1 month on the treatment. We report this case to draw the attention over the rare cutaneous manifestation of CD.

Dermoscopic findings and comparison of usefulness of longitudinal versus transversal sections in the histological diagnosis of alopecia X.

A combination of dermoscopic and histological findings may provide useful information for the diagnosis of hair follicle diseases. However, there are no studies on dermoscopic-histopathological correlations in dogs affected by alopecia X, and comparison of longitudinal versus transversal sectioning of skin biopsy specimens in the assessment of this hair loss disorder has not been thoroughly investigated. The aim of this study was to correlate dermoscopic and histological features using both longitudinal and transversal sectioning of skin biopsy samples to gain additional information for the diagnosis of alopecia X. Nineteen Pomeranian dogs affected by alopecia X and five healthy Pomeranians as controls. Dermoscopic-histological correlation was performed within the diseased group, whereas histological comparisons against controls. The demographic and clinical characteristics also were related to the histological findings. The dermoscopic findings revealed scattered, thinned, short hairs mixed with amorphous keratoseborrhoeic-like material (follicular plugging), perifollicular and intrafollicular scaling, and hyperpigmentation varying from pinpoint black spots to a diffuse texture. Dermoscopic findings correlated with histological findings for selected qualitative and quantitative findings. The usefulness of transversal sections was demonstrated in accurately determining the hair follicular density and counts, growth arrest phases and in identifying mineralisation of hair follicle basement membrane when compared to the longitudinal. Conversely, no correlations between histological findings and demographic and clinical characteristics were detected. These data provide evidence of the usefulness of dermoscopic evaluation as an accessory diagnostic tool and of transversal sections of skin biopsies as complementary to the diagnosis of alopecia X.

Unstable solar lentigo mimicking lentigo maligna melanoma: A case report

Solar lentigo (SL) is a hyperpigmented macule that develops due to chronic ultraviolet exposure. A 35-year-old housewife, presented with an asymptomatic pigmented patch on the right side of her nose for the last 10 years, with a rapid increase in size and variability in pigmentation over the last 3 years. She had no history of excessive sun exposure. Upon examination, there was a solitary, hyperpigmented, well to ill-defined patch of irregular shape and margin, measuring 3 cm * 2.5 cm, with variability in colour and areas of regression, almost covering Right side of nose. The patch appeared light brown with areas of dark brown and black. Differential diagnoses considered were Lentigo maligna melanoma (LMM), Solar Lentigo (SL), and flat seborrheic keratosis. Dermoscopy (Polarised illuco IDS-1100 dermoscope) revealed diffuse brown pigmentation with a faint pigmented network, along with dark brown to black globules and blotches. Due to the asymmetry of pigmentation, a punch biopsy was performed from the area of darkest pigmentation to rule out LMM. In Histology, the epidermis exhibited hyperkeratosis, follicular plugging, acanthosis, and downward elongation of the rete ridges. There was hyperpigmentation of the basal layer, an increased number of melanocytes, and the presence of melanophages in the papillary dermis. The biopsy report was consistent with Solar Lentigo (SL), and we concluded it as unstable solar lentigo (USL). This case is presented due to its clinical and dermoscopic resemblance to LMM and to increase awareness of USL and the importance of periodic surveillance.

Application and Comparison of Dermoscopy and Reflectance Confocal Microscopy in the Target Treatment of Genital Lichen Sclerosus: A Single-Arm Prospective Study.

The treatment of genital lichen sclerosus (GLS) remains challenging. Baricitinib has been introduced in the treatment of GLS, but there's no imaging evaluation for GLS patients treated with it. No comparison of dermoscopy and reflectance confocal microscopy (RCM) assessments in GLS has been conducted. We performed this study to evaluate the efficacy and safety of baricitinib for GLS and to compare the value of dermoscopy and RCM assessments in GLS. Participants were treated with baricitinib for 6months and assessed at week 0, 2, 4, 6, 8, and every 4weeks for the next 16weeks. All patients were evaluated for clinical, dermoscopic, and RCM variables, with numeric scores assigned to each parameter. Twenty-six GLS patients were included in this study. All patients achieved Investigator's Global Assessment score ≤ 1 (with ≥ 2-grade improvement) at week 20. The scores of pruritus and pain decreased since week 2 (both P < 0.05). The DLQI and VQLI scores significantly decreased since week 4 (both P < 0.0001). White structureless areas improved at week 2 and white shiny streaks and follicular plugs improved at week 4 under dermoscopic examination. Vessels (P < 0.001) and brown structureless areas (P = 0.003) increased at week 8. In RCM, inflammatory cells count significantly decreased at week 2 (100.03 ± 33.24, P < 0.0001), with substantial regression at week 8 (16.98 ± 5.54, P < 0.0001). Epidermal thickness increased at week 12 (157.44 ± 37.87μm versus 134.13 ± 36.60μm, P = 0.0284). Irregular papillae, spongiosis, and fiber structures improved at week 20, week 4, and week 6 (all P < 0.01). Transient hypercholesterolemia (11.54%), thrombocytosis (7.69%), and elevated alanine aminotransferase (7.69%) occurred during treatment. Both dermoscopy and RCM can be useful and non-invasive adjuvant tools for the evaluation and therapeutic monitoring of GLS. We recommended white structureless areas under dermoscopy and inflammatory cells count under RCM as variables for dermatologic imaging evaluation for GLS. Baricitinib is effective and safe for GLS, while randomized controlled trials are warranted.

Dermoscopy of acute radiation-induced dermatitis in patients with head and neck cancers treated with radiotherapy

Head and neck cancer (HNC) was the seventh most common cancer in the world in 2018. Treatment of a patient may include surgery, radiotherapy (RT), chemotherapy, targeted therapy, immunotherapy, or a combination of these methods. Ionizing radiation used during RT covers relatively large volumes of healthy tissue surrounding the tumor. The acute form of radiation-induced dermatitis (ARD) are skin lesions that appear usually within 90 days of the start of RT. This is a prospective study which compares 2244 dermoscopy images and 374 clinical photographs of irradiated skin and healthy skin of 26 patients at on average 15 time points. Dermoscopy pictures were evaluated independently by 2 blinded physicians. Vessels in reticular distribution, white, yellow or brown scale in a patchy distribution, perifollicular pigmentation and follicular plugs arranged in rosettes were most often observed. For these dermoscopic features, agreement with macroscopic features was observed. Two independent predictors of severe acute toxicity were identified: gender and concurrent chemotherapy. Knowledge of dermoscopic features could help in the early assessment of acute toxicity and the immediate implementation of appropriate therapeutic strategies. This may increase the tolerance of RT in these groups of patients.

Dermoscopic features of follicular mycosis fungoides of nonscalp areas: Report of 11 cases and literature review

AbstractBackgroundFolliculotropic mycosis fungoides (FMF) is a rare variant of MF that involves hair follicles and requires a more aggressive treatment regime. Significantly, some patients with classic MF can eventually have some degree of follicular involvement.ObjectivesThe aim of this study was to describe the dermoscopic features of FMF in nonscalp areas to facilitate early diagnosis and posttreatment monitoring.MethodsThe clinical and dermoscopic features in 11 FMF patients were analyzed and compared with the reports in the literature.ResultsObliteration of hair follicles, loss of terminal hairs and hair loss were detected in all patients. Follicular accentuation, follicular dilation and broken hairs were found in almost all patients (90.9%). Other common follicular‐based dermoscopic features (&lt;50%) were follicular plugging, perifollicular orange colour, perifollicular erythema and vessels, hyperpigmented halo around the follicle, follicular hyperkeratosis, comedo‐like lesions and perifollicular scales. The most frequent ‘dominant’ dermoscopic features were follicular accentuation with follicular plugging and dilation of follicular opening.ConclusionsIdentification of specific distinguishing dermoscopic patterns of FMF not only could be helpful in classifying MF patients but also could provide prognostic information regarding the disease course and aid in therapeutic decisions. In MF patients, dilation of follicular opening and spiky follicular keratosis are considered the most specific dermoscopic features of follicular involvement since they are uncommon in other conditions.

Study of clinicodermoscopic features of topical steroid damaged face patients

Background: Topical steroid dependent or damaged face is an alarming upcoming entity rampant in India due to over-the-counter availability of topical corticosteroids containing products. The present study aimed to study the clinical and dermoscopic changes in patients with topical steroid damaged face and to correlate them with potency and duration of application of the TCS. Methods: 80 patients visiting the dermatology OPD &amp; IPD at SAIMS Hospital &amp; PG Institute, Indore, with the chief complains of redness, itching, red raised lesions, burning, swelling, photosensitivity, pigmentation; with a history of application of topical corticosteroids of any potency on face for continuous 7 days or intermittent for 15 or more days were enrolled for the study. Results: Mean age of the patients was 31.5±8.13 years. Male to female ratio was 1:9. Twelve (15.2%) patients abused TCS for more than one year. Presenting complains of the patients were redness (82.5%), itching (66.3%), hypertrichosis (47.5%), pigmentation (66.3%), burning (38.8%) and acne (28.8%). The most common dermoscopy findings i.e., unpatterned brown pigmentation (86.3%), polygonal vessels (73.8%), fine scales (52.5%), hypertrichosis (53.8%), follicular plugs (32.5%), micropustules (15%) and ivory patches (11.3%) were observed in a statistically higher proportion of cases dermoscopically Conclusions: Dermoscopy in TSDF can help dermatologists in a multitude of ways from confirming the diagnosis to differentiating from other causes of red face and predicting the approximate duration of TCS abuse.

Case Report: Post herpes zoster comedones: A new entity under Wolf’s isotopic response

The emergence of a completely new skin condition at the precise location of a different, unrelated and previously healed skin disease is referred to as a "Wolf's isotopic response". It is also referred as post-herpetic isotopic response because it typically manifests after contracting the varicella-zoster virus causing herpes zoster. Wolf’s isotopic response is a rare, unique and widely accepted phenomenon. In this study, we discuss the various theories proposed behind its etiology. Further studies can help us understand the pathomechanism behind the localization of skin diseases thereby, helping us manage the condition effectively. Here, we describe a case of a 36-year-old male who presented in the outpatient department with multiple open and closed comedones distributed along the site of T2 dermatome previously infected by herpes zoster infection. Dermoscopic examination revealed multiple, round, brown-colored follicular keratinous plugs with peri-lesional erythema. Histopathological analysis showed a large dilated follicular canal containing orthokeratotic stratum corneum consistent with closed comedone formation. The patient was diagnosed with post-herpetic zosteriform comedones and was prescribed oral isotretinoin 20 mg, topical tretinoin 0.05% cream with a moisturizer and asked to follow up regularly. The lesions gradually healed over a five-month period. In our case, timely medical intervention helped preventing the further progression of the disease. However, further studies involving large sample sizes can help us identify the underlying mechanism behind this phenomenon.

Dermoscopy of cutaneous sarcoidosis: a cross-sectional study

BackgroundAlthough traditionally used for the diagnosis of skin tumors, in the past few years dermoscopy as a clinical diagnostic aid for inflammatory and infectious skin manifestations has also received more and more attention. The clinical variability of cutaneous sarcoidosis (CS) often makes its correct diagnosis challenging. Dermoscopy can be used as an auxiliary examination method. ObjectiveOur aim was to evaluate the role of dermoscopy in the diagnosis and differential diagnosis of CS. MethodsThis was a retrospective analysis of 39 CS clinical and dermoscopic images collected in the Department of Dermatology, Huashan Hospital Affiliated with Fudan University from August 2013 to February 2021. ResultsRetrospective dermoscopic evaluation revealed small grouped, translucent orange globular structures in all 39 cases. Variable diameter linear vessels were found in 38 cases. A central scar-like area was seen in 26 cases. Bright white streaks were seen in 30 cases. The follicular plugs were seen in 15 cases. Study limitationsFirst, the number of cutaneous sarcoidosis cases the authors collected is small. Second, due to the lack of a control group, the sensitivity and specificity of the proposed criteria were not calculated. Finally, since our study mainly includes suspicious lesions that were biopsied for diagnostic purposes, there may be a selection bias. ConclusionLesions showing on dermoscopy grouped translucent orange ovoid structures associated with linear vessels should raise the suspicion of CS. Central scar-like areas and bright white streaks are also helpful in the diagnosis of CS.

CPC07 Lupus comedonicus: a not so common entity

Abstract Lupus comedonicus (LC) is an exceedingly rare variant of chronic cutaneous lupus erythematosus (CCLE), with only 13 reported cases in the literature to date. While its aetiology remains unknown, hallmarks include the presence of comedones on erythematous plaques, particularly in seborrhoeic areas. We report a case of LC involving the scalp, concha bowl and upper back. A 53-year-old female smoker with a 20-pack-year history and previous unprovoked pulmonary embolism presented to dermatology with a 2-year history of alopecia and rash affecting her face and upper back. She was initially reviewed by oral medicine for ulcers, where erythematous buccal mucosal plaques with white striations were seen. The initial biopsy showed a patchy lichenoid inflammatory infiltrate, raising suspicions for lichen planus; however, repeat biopsy highlighted perivascular inflammation and keratin plugging suggestive of lupus. Full skin examination revealed patchy scarring alopecia with perifollicular scale and erythema. Erythematous infiltrated plaques were seen on the face with similar more indurated lesions on the upper back associated with open comedones. The eponymous Shuster sign was observed in the left conchal bowl, with associated follicular occlusion. Laboratory studies all returned within normal limits, including antinuclear antibody titres and complement levels. Differential diagnosis included lupus erythematosus tumidus, discoid lupus erythematosus and LC. Lesional biopsies taken from her back confirmed LC, highlighting lichenoid inflammation involving follicles and interfollicular skin, with superficial and deep perivascular infiltrate. We commenced oral hydroxychloroquine at 200 mg once daily for management, with topical mometasone furoate 0.1% to be used while awaiting its full effect. Smoking cessation has also been advised given the potentially antagonistic effect of smoking with lupus and hydroxychloroquine. Hypotheses of the pathogenesis of LC include the effect of sun exposure. Ultraviolet radiation is known to not only enhance the activity of CCLE but may also contribute to the formation of comedones. Actinic damage alters collagen of normal skin, promoting sebum retention and follicular plugging. Given its infrequency, LC could be mistaken for benign conditions, including acne vulgaris, naevus comedonicus and Favre–Racouchot disease. It is plausible that the small case numbers are due to current underdiagnoses. It is important for dermatologists to be aware of and accurately diagnose LC. Apart from its potentially destructive, scarring complications, especially in untreated and misdiagnosed cases, it is associated with systemic lupus in 30% of cases. Delay in diagnosis and therapeutic management can be associated with significant potential morbidity and even mortality.