Handheld Dermoscope Research Articles

Clinical, Dermoscopic, and Mycological Association in Onychomycosis in a Tertiary Care Hospital

Background: Onychomycosis (OM) refers to fungal infection of the nail unit. It is one of the most common nail disorders, accounting for 50% of all nail disorders and about 30% of all cutaneous fungal infections. OM is mostly diagnosed clinically, but Dermoscopic (DS) examination aids in diagnosis. Objectives: The purpose of the study is to study the association between clinical, dermoscopic, and mycological patterns of OM. Materials and Methods: A total of 200 patients with clinical suspicion of OM were included in the study. All patients underwent clinical examination, dermoscopic examination with a handheld dermoscope Dermlite II pro (3 Gen, San Juan, Capistrano, CA, USA) with a ×10 magnification, KOH assessment, and culture analysis. The most frequent dermoscopic patterns were identified and their associations with the clinical subtype of OM were analyzed. Results: Out of the 200 cases, 65 cases were male and 135 cases were female. The most common findings seen on clinical examination of nails were discoloration of nail plates (178) and onycholysis (109). Distal irregular termination (91) was the most common dermoscopic finding seen followed by spike pattern (76). A significant association was seen between dermoscopic patterns such as superficial transverse striation, spike pattern, and different types of OM (P < 0.05). Eighty-two cases were positive for fungal elements by direct microscopy, 68 were positive by culture, and 18 patients showed positive result for both. The most common causative organism found on culture examination was Candida albicans (24). Conclusion: Dermoscopy is an easy-to-perform, noninvasive, and cost-effective method which aids in early diagnosis of OM.

Recent developments in dermoscopy for dermatology.

Dermoscopy is considered to be a bridge between clinical observation and histopathological examination, allowing the in vivo examination of skin microstructures that are not visible to the naked eye, from the epidermis to the superficial dermis. Dermoscopy has undergone rapid development, witnessing the history from natural light to polarized light, from handheld dermoscopy to videodermoscopy, and from classic dermoscopy to digital dermoscopy. Its application extends from the initial differential diagnosis of pigmented skin diseases (melanocytic and nonmelanocytic) to general dermatology, including appendage (nail and hair) abnormalities and diseases related to infection and inflammation. We aimed to provide the latest developments in dermoscopy from the perspective of handheld dermoscopy, videodermoscopy, fluorescence-advanced videodermatoscopy, polarized transilluminating dermoscopy, and digital dermoscopy. In this review, we searched the PubMed, Embase, Web of Science, and Cochrane Library databases for reviews, case reports, and observational studies on dermoscopy. We provided an updated review of dermoscopy based on published literature. Dermoscopy is an indispensable diagnostic tool in dermatology, and it is expected to be further developed in the future.

<p>Clinical and Onychoscopic Features of Benign and Malignant Conditions in Longitudinal Melanonychia in the Thai Population: A Comparative Analysis</p>

BackgroundLongitudinal melanonychia can arise from many underlying conditions, both benign and malignant. Practitioners tend to be reluctant to perform a biopsy of this condition due to procedure-related pain and the possibility of permanent nail dystrophy. Onychoscopy has become a useful tool to provide a provisional diagnosis and assist in deciding on a nail biopsy.ObjectiveTo investigate and differentiate the clinical and onychoscopic features of subungual melanoma (SUM)/subungual melanoma in situ (SMIS) and other benign melanocytic conditions (BM).Materials and MethodsIn this cross-sectional study, a total of 32 cases of longitudinal melanonychia were examined, and baseline characteristics were recorded. Onychoscopic pictures were taken by handheld dermoscopy with 10x and 50x magnification. A biopsy was then performed in each case, and a pathological diagnosis was obtained.ResultsOf the 32 cases, 6 were diagnosed with SMIS and 26 with BM (21 simple lentigines, 5 junctional nevi). The median age was significantly higher among the SMIS group (56 vs 31 years) (p = 0.034). Regarding onychoscopic findings, cases with SMIS were significantly associated with a greater band width percentage (p = 0.014), multicolor presentation (p = 0.005), the presence of granular pigmentation (p = 0.034), and micro-Hutchinson’s sign (p = 0.015). In addition, subungual hyperkeratosis, a newly recognized onychoscopic feature, was more significantly associated with SMIS in comparison to BM (p = 0.002).ConclusionOnychoscopy provides useful information to aid in the differential diagnosis of longitudinal melanonychia. From our study, onychoscopy can be utilized to assist in making a decision whether to perform a biopsy in patients with longitudinal melanonychia suspicious of malignant melanocytic conditions.

Dermoscopy predicts outcome in hemoporfin-mediated photodynamic therapy of port-wine stains: A prospective observational study

To the Editor: Port-wine stain (PWS) is defined as ectasia of the vessels in the dermis, affecting the dermal papillae capillary loops, the horizontal plexus at the dermal-subcutaneous junction, or a combination of these.1Anderson R.R. Levins P.C. Grevelink J.M. Lasers in dermatology.in: Fitzpatrick T.B. Eisen A.Z. Wolff K. Freedberg I.M. Austen K.F. Dermatology in General Medicine. 4th ed. McGraw-Hill, New York1971: 1755-1766Google Scholar Recent studies have identified 2 main dermoscopic patterns of PWS. Type 1 is a superficial pattern composed of red globules and dots that correspond to dilated capillary loops in the papillary dermis. Type 2 is a deep pattern that features red ring structures corresponding to dilated ectatic vessels located deep in the horizontal vascular plexus.2Piccolo V. Russo T. Moscarella E. et al.Dermatoscopy of vascular lesions.Dermatol Clin. 2018; 36: 389-395Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar Histopathologic examination is the standard approach to determine the depth of the vascular lesion, but it is invasive. Dermoscopy can preoperatively predict the outcome of treatment and the minimal effective fluence in pulsed dye laser treatment.3Eubanks L.E. McBurney E.I. Videomicroscopy of port-wine stains: correlation of location and depth of lesion.J Am Acad Dermatol. 2001; 44: 948-951Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar,4Shirakawa M. Ozawa T. Wakami S. et al.Utility of dermoscopy before and after laser irradiation in port wine stains.Ann Dermatol. 2012; 24: 7-10Crossref PubMed Scopus (17) Google Scholar PWS in areas that typically respond well to laser treatment were more likely to have a superficial type 1 but those that have a poorer response were more likely to have a deeper type 2. The immediate vessel disappearance after pulsed dye laser treatment observed by dermoscopy can predict the minimal effective fluence and prevent adverse effects. Hemoporfin-mediated photodynamic therapy (HMME-PDT) is considered to be a successful and well-tolerated treatment option for PWS.5Zhao Y. Tu P. Zhou G. et al.Hemoporfin photodynamic therapy for port-wine stain: a randomized controlled trial.PLoS One. 2016; 11: e0156219Crossref PubMed Scopus (38) Google Scholar The response of different depth vessels to HMME-PDT and the relationship between dermoscopic features and the efficacy of HMME-PDT have not been reported to our knowledge. We present a prospective observational study of 16 patients with PWS who received HMME-PDT. The Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (2019S1170) approved this study. All of the detailed methods are in the Supplemental file available on Mendeley at https://doi.org/10.17632/b968gsy7bp.1. Group A consisted of 8 patients with the type 1 pattern, and group B consisted 8 patients with the type 2 pattern (Table I). Dermoscopic images of PWS lesions were taken from each patient using the hand-held dermoscope with 50× polarized light (CH-DSIS-2000 Plus; Guangzhou Chuanghong Medical Technology Co, Ltd, Guangzhou, China). Clinical efficacy was observed after 1 treatment of HMME-PDT.Table IProfile of the patients in the studyPatient No.Age, ySexPWS locationResponse∗No improvement (NI): <20%; some improvement (SI): 20%-59%; great improvement (GI): 60%-89%; nearly completely resolved (CR): 90%.Group A 110FemaleRight cheekCR 231MaleMandible and neckGI 34FemaleMandibleCR 48MaleRight chinGI 56MaleLeft cheekGI 611MaleLeft cheekGI 74FemaleLeft cheek and orbitCR 84FemaleLeft temporalCRGroup B 18MaleRight cheekNI 240FemaleMandible and neckSI 36FemaleRight cheekNI 47MaleRight cheekNI 518MaleLeft cheekNI 69MaleLeft cheekNI 78MaleRight cheekNI 819MaleRight cheekNIPWS, Port wine stain.∗ No improvement (NI): <20%; some improvement (SI): 20%-59%; great improvement (GI): 60%-89%; nearly completely resolved (CR): 90%. Open table in a new tab PWS, Port wine stain. Patients in the 2 groups had markedly different responses after 1 treatment with HMME-PDT. Patients in group A (type 1 pattern) had an excellent response to HMME-PDT, whereas those in group B (type 2 pattern) had a poor response (Fig 1). In HMME-PDT treatment, the 532-nm laser can activate the photosensitizer injected into the blood vessels to produce highly reactive singlet oxygen, which can destroy the endothelial cells.5Zhao Y. Tu P. Zhou G. et al.Hemoporfin photodynamic therapy for port-wine stain: a randomized controlled trial.PLoS One. 2016; 11: e0156219Crossref PubMed Scopus (38) Google Scholar HMME-PDT can more easily destroy or remove deformed vessels that are superficial because of the limited range of wavelength penetration. It is still difficult to penetrate PWS lesions with thicker vessel walls, deeper locations, and larger diameters. Possibility of the need for multiple treatments should be discussed in the initial consultation. Dermoscopy is a simple, noninvasive technique that allows the microvascular patterns in PWS to be assessed and recorded. We have observed that the type 1 pattern is readily treated with HMME-PDT and an excellent response can be expected, whereas the type 2 pattern resists treatment. Further studies will increase the sample size, refine the dermoscopic patterns, and study the relationship between different patterns and HMME-PDT results.

A Study to Establish Correlation between Dermoscopic and Clinical Findings of Dermatophytosis

Background: Dermatophytosis is a growing menace these days. Dermoscopy is a simple and non invasivediagnostic technique used in dermatology. But there are few studies on dermoscopy of dermatophytosis.Objective: The present study aims to study thedermoscopic findings of dermatophytosis and to study itscorrelation with clinical and histopathological findings.Materials and Method: It was a cross sectional study done over a period of 3 months.100 patients with clinicaldiagnosis of any form of dermatophytosis, were included after taking an informed consent. Diagnosis ofdermatophytosis was made clinically followed by KOH examination. Clinical examination, photographsand dermoscopy was done in all cases. Dermoscopy was taken by hand held dermoscope (Dermlite 4 genDL4, California USA), with a magnification of 10x. Biopsy was done in selected patients.Results: Out of 100 patients, male-to-female ratio was 1.5:1. Mean age was 38 ± 8.7 years. Mean durationof disease was 3months. Tinea corporis was the most common type, followed by tinea cruris and tineafacie. Dermoscopic findings of tinea corporis, cruris and facie were -peripherally distributed white scales,red to grey background, red to brownish black dots and globules at periphery, follicular micropustues andperifollicular scales. Tinea capitis showed black dots, broken hair and Morse code hair. Onychomycosisshowed yellowish brown discoloration with subungual hyperkeratosis and jagging of free edge of nail plate.Conclusion: In absence of adequate lab facilities, dermoscopy acts as a complentary tool to clinicaldiagnosis. Dermoscopy helps to initiate early treatment, thus helping to reduce tinea menace.

Faster Evaluation of ABCD Rule and Total Dermoscopic Score for Nevomelanocytic Lesions: Dermoscopic Score Scale

Background: Dermoscopy is a dermatological examination method that is made with a special magnifying device called dermoscope (or dermatoscope). The device is usually used in the evaluation of nevomelanocytic lesions, and it is especially important in determining A, B, C, and D scores used in the calculation of “total dermoscopic score (TDS)”. This score facilitates the identification of malignancy risk of lesions. For this evaluation, there is a need for several mathematical calculations, which are quite time-consuming. Objectives: This study aimed to develop a new scale to calculate the score quicker to accelerate the determination of malignancy risk of nevomelanocytic lesions. Methods: All possible scores, which were obtained by the addition of individually multiplying all possible values of A, B, C, and D letters by their own coefficients, were mathematically calculated with a simple calculator. The quartets of ABCD giving the same score were reduced to their lowest numbers. All possible AB and CD pairs were systematically arranged on a scale that had a column of AB and a row of CD values. All results of the quartets were gradually placed on a scale from minimum to maximum. Results: A total of 810 quartets of ABCD were determined. By the reduction of ones giving the same scores, a total of 207 values were obtained. All quartets and their total scores were placed on a scale called “dermoscopic score scale”. On the scale, white, yellow, and red score areas indicated benign, suspicious, and high-risk nevomelanocytic lesions for melanoma. Conclusions: This scale helps faster obtain TDS of nevomelanocytic lesions by decreasing the calculation period, especially when an analog handheld dermoscope is used.

Evaluation of Subclinical Nail changes in Patients with Chronic Plaque Psoriasis using Dermoscopy

Abstract Background Dermoscopy is a non-invasive technique that allows the visualization of subtle clinical features of the skin surface and appendages details not visible to the naked eye, allowing magnifications of up to 200x. It is widely used for evaluating and diagnosing all nail diseases, as it provides important information. As any other examination, nail dermoscopy (onychoscopy) requires a good knowledge of nail anatomy &amp; physiology and the pathogenesis of the nail diseases, and it is helpful for the diagnosis of numerous nail diseases and tumors. Nail disorders are defined according to their appearance and the part of the nail affected (from distal to proximal): hyponychium, onychodermal band (ODB), nail bed, nail plate, lateral nail folds (perionychium), lunula (distal part of the matrix), cuticle, nail matrix and proximal nail fold. Objective To study the dermoscopic findings of subtle nail changes in patients with chronic plaque psoriasis and compare it with that nail changes in healthy controls by both polarized and non polarized mode of dermoscope, aiming to assist clinicians in correctly evaluating and diagnosing nail changes with the help of dermoscopy. Methods We conducted a comparative descriptive study on 50 patients having chronic plaque psoriasis, 26 were males (52.0%) and 24 were females (48.0%), as well as 50 normal healthy control subjects, 31 were males (62.0%) and 19 were females (38.0%). Patients and controls were randomly recruited from the outpatient clinic of dermatology department at Ain Shams University Hospitals, during the period from February 2018 till September 2018. And the age of both groups ranged from 14 to 70 years. Results Our study revealed that the most common fingernail changes found in psoriatic patients were nail plate thickening and crumbling followed by Dilated nailbed capillaries at the onychodermal band, Oncholysis, Subungual hyperkeratosis, Pitting, Longitudinal ridges, Scales, Salmon patch, Leukonychia, Splinter hemorrhage, Lunula red spot and Trachyonychia. And the most common toenail changes found in psoriatic patients were Subungual hyperkeratosis followed by Nail Plate Thickening &amp;Crumbling, Oncholysis, Pitting, Longitudinal ridges, Scales, Salmon patch, Trachyonychia, Dilated nailbed capillaries at the onychodermal band, Splinter hemorrhage, Leukonychia and Lunula red spot. We found there was no difference between polarized and non polarized mode of dermoscope in examination of fingernails and toenails except that the non polarized mode showed the changes of the Dilated capillaries at the onychodermal band more obviously. And also, there was no difference between wet and dry method of polarized mode of dermoscope. Conclusion This study confirms that a handheld dermoscope is a very efficient and simple tool for detection of any nail abnormality.

Characterization of Phthirus pubis With Ex Vivo Dermoscopy.

Pubic lice are smaller, less pigmented, and less mobile than head lice, and thus more difficult to observe with naked eye.1 In addition, the increasing habit of pubic hair removal has led to a falling incidence of pubic lice owing to the destruction of its natural habitat.2 This may be responsible for the atypical patterns of Phthirus pubis infestation in other parts of the body (eyebrows, axillae, trunk)2 and may be an underestimated cause of resistant pruritus and dermatitis. In vivo dermoscopy is useful for identifying nits and lice on the skin in these cases.1,3 However, a better characterization of the parasite can be made by collecting it from the skin surface with a transparent adhesive tape. This ex vivo dermoscopy is a simple and convenient method that allows for a more hygienic and detailed examination (Fig. 1), with no need of other devices, such as direct,3 confocal,4 or electron microscopy.5P. pubis has a short and broad body with 6 legs. The first pair of legs is slim; the second and third pairs are thicker and carry brown claws for grasping hair. The anterior portion has small mouthparts, used for probing the skin and withdrawing blood from dermal vessels. The ingested blood flows through the digestive tract, identified as brown-reddish structures in both sides and middle of the body (Video, Supplemental Digital Content 1, https://links.lww.com/OLQ/A453). External openings of the respiratory system, called spiracles, are seen as several brown dots at the periphery of the body. Air enters through them and is delivered to the organs by air tubes, depicted as a network of brown longitudinal and transverse lines.4,5Figure 1: Dermoscopic characterization of P. pubis (DermLite DL4W, contact, polarized light). Broad and triangular body with 2 anterior slim legs, and 4 posterior thick legs with dark brown claws (C). D indicates digestive system, brown-reddish colored due to ingested blood; M, mouthparts with antennae; S, spiracles, corresponding to the external openings of the respiratory system, which is conformed by arranged and branching air tubes (T).First-line treatment is topical 1% permethrin. Other pediculicide drugs include 0.2% phenothrin, 0.5% malathion, 1% lindane, and topical or oral ivermectin.6 In conclusion, ex vivo handheld dermoscopy is a useful technique for a quick bedside diagnosis of pediculosis and species identification.Video: Ex vivo dermoscopy showing an alive P. pubis removed from the skin (Supplemental Digital Content 1, https://links.lww.com/OLQ/A453). Note the peristaltic movements pumping the ingested blood through the digestive system (DermLite DL4W, contact, polarized light).

Preventing Cross-Infection During Polarized Dermoscopy Using Hand Held Dermoscopes.

Preventing Cross-Infection During Polarized Dermoscopy Using Hand Held Dermoscopes.

Uncovering subtle nail involvement in lichen planus with dermoscopy: a prospective, controlled study.

IntroductionThere are very few studies investigating the dermoscopic aspect of nail involvement in lichen planus and these studies described dermoscopic features of only clinically visible nail involvement in lichen planus.AimTo reveal subtle dermoscopic nail findings in patients with lichen planus.Material and methodsThe study included 40 patients with lichen planus and 40 healthy volunteers. All fingernails of the patients and healthy volunteers were examined by a handheld dermoscope and the findings detected were recorded. The patients were grouped by age, gender, disease duration and extent of the disease. The statistical analysis was performed using Chi square test.Results82.5% of the patients and 17.5% of the healthy volunteers showed at least one dermoscopic nail finding. The frequency of multiple splinter haemorrhage (p < 0.05), multiple leukonychia (p < 0.05), longitudinal erythronychia (p < 0.05), prominent hyponychial vascular structures (p < 0.05) and onycholysis (p < 0.05) observed in the patients group was statistically significant. The other findings included distal short longitudinal lines, onychorrhexis, solitary splinter haemorrhage and solitary punctate leukonychia and showed no statistically significant differences between the two groups.ConclusionsTo the best of our knowledge, this is the first study focusing on uncovering subtle nail involvement in lichen planus. The presence of dilated hyponychial vascular structures in lichen planus was first described in the present study. It can be concluded that the frequency of nail involvement in lichen planus is more than known. Dermoscopic imaging of the nails of all patients with lichen planus may help establish early diagnosis and treatment to avoid permanent nail damage.

Dermoscopic rainbow pattern: A strong clue to malignancy or just a light show?

OBJECTIVE:Rainbow pattern is a dermoscopic finding composed of multiple colors simulating a rainbow. It is known as a characteristic feature of Kaposi’s sarcoma. Here, we reported different non-Kaposi’s sarcoma conditions with a rainbow pattern aiming to discuss the diagnostic significance of the finding.METHODS:In this multicenter study, dermoscopic images of the non-Kaposi’s sarcoma lesions having a histopathological diagnosis were reviewed for the presence of a rainbow pattern. Dermoscopic examination was performed by a polarized handheld dermoscope with x10 magnification.RESULTS:A total of 840 lesions were reviewed and 21 (2%) non-Kaposi sarcoma lesions having dermoscopic rainbow pattern were detected. These lesions were as follows; pyogenic granuloma (n=4, 19%), hypertrophic scar (n=4, 19%), basal cell carcinoma (n=2, 10%), dermatofibroma (n=2, 10%), angiokeratoma (n=2, 10%), blue nevus (n=1, 5%), granuloma annulare (n=1, 5%), strawberry angioma (n=1, 5%), epidermal cyst (n=1, 5%), malignant melanoma (n=1, 5%), dissecting cellulitis (n=1, 5%) and subungual hematoma (n=1, 5%). The most common localization was limb (n=14, 67%) followed by face (n=3, 14%).CONCLUSION:We suggest that the rainbow pattern is a complex and quite unspecific optic phenomenon which can be seen both in vascular and non-vascular lesions. Its diagnostic significance should be considered in the context of the other structural dermoscopic finding. To the best of our knowledge, to our knowledge, this is the most comprehensive study focusing on rainbow pattern in non-Kaposi’s sarcoma lesions. Here, we also reported rainbow pattern in dissecting cellulitis, granuloma annulare and subungual hematoma which has not been shown to have rainbow pattern previously.

Trichoscopy findings of frontal fibrosing alopecia on the eyebrows: A study of 151 cases

Eyebrowloss (madarosis) is a frequent sign of frontal fibrosing alopecia (FFA), and it can be the first sign of the disease. To describe trichoscopy findings of FFA on the eyebrows. The analysis included 151 women with histologically proven diagnosis of FFA and eyebrow loss. Trichoscopy of the eyebrow area was performed with either a FotoFinder videodermatoscope or handheld dermoscope DermLite II pro. The most frequent signs on trichoscopy were yellow dots (92.7%), multiple pinpoint dots (79.5%), short thin hairs/vellus (76.2%), black dots (66.2%), and dystrophic hairs (60.9%). Tapering hairs were found in 21 (13.9%) patients and dystrophic hairs in 92 (60.9%) patients. Inner limitations of a case series (there was no comparison with healthy control individuals or patients with other hair disorders) and lack of histologic correlation to the trichoscopy findings. Although FFA is a scarring alopecia, the most common trichoscopy signs found in the eyebrows are usually related to noncicatricial alopecia. Therefore, in most cases, trichoscopy of the eyebrows does not resemble the trichoscopy of FFA on the scalp. Black dots, dystrophic hairs, and broken hairs are frequent signs. Occasionally, tapered hairs can be present on the eyebrows in FFA, leading to misdiagnosis of alopecia areata.

151 Pilot study on dermoscopic patterns in cutaneous amyloidosis using a handheld dermoscope

151 Pilot study on dermoscopic patterns in cutaneous amyloidosis using a handheld dermoscope

Onychoscopy with red light for vascular pattern identification: a study of 33 patients.

Nail dermoscopy (onychoscopy) during physical examination assists in correct diagnosis. Often further magnifications are necessary for an effective differential diagnosis. With the addition of a red light to the dermoscope, important vascular features can be visualized. To describe common features observed at onychoscopy with a new device that combines the regular white light with the red light illumination, demonstrating that it is useful for diagnosis of nail disorders. We enrolled 33 consecutive patients referred to the Nail Diseases Dermatology Unit of the University of Modena and Reggio Emilia and to the Outpatient Consultation for Nail Disease of the Dermatology Unit of the University of Bologna. Patients were assessed with a standard hand-held dermoscope and at the red light dermoscope. Dermoscopic images were collected. The new prototype was used during daily clinical practice and allowed a more accurate visualization of some details that classic onychoscopy can miss. In particular, with the help of the red light it was possible to better visualize nail lesions that were characterized by some kind of colour change or vascular alterations. The new device of red light for vascular pattern onychoscopy can be a new investigation method to observe nail alterations, especially due to vascular pattern, even with low magnification, without the necessity to use higher resolutions.

Dermoscopic aspect of verrucous epidermal nevi: new findings

Background/aimVerrucous epidermal nevi are cutaneous hamartomas with many clinical variants. Dermoscopic features of verrucous epidermal nevus have rarely been investigated. We aimed to identify dermoscopic findings of the entity which will facilitate the diagnostic process by reducing the use of invasive diagnostic methods.Materials and methodsThe study included the patients with histopathologically approved verrucous epidermal nevus. Clinical, dermoscopic, and histopathological features of the patients were retrospectively reviewed and the findings identified were recorded. Dermoscopic examination was performed with a polarized-light handheld dermoscope with 10-fold magnification.ResultsThe most common dermoscopic features were thick brown circles, thick brown branched lines, and terminal hairs. The most common vessel pattern was dotted vessels. Branched thick brown lines, brown globules, brown dots forming lines, serpiginous brown dots, white and brown exophytic papillary structures, fine scale, thick adherent scale, and cerebriform structures were the other findings.ConclusionWe observed many vascular and nonvascular dermoscopic findings which were not described previously for the entity. Dermoscopic examination of the verrucous epidermal nevi may lead to more reliable clinical interpretation and thus may reduce the need for histopathological investigation.

Nailfold capillaries in connective tissue diseases in skin of color: A dermoscopic view

Introduction: Dermoscopy has gained tremendous importance in the recent past. It helps in the visualization of subsurface structures, whereby details of skin lesion are studied in depth. Nailfold capillaries are involved early in the course of disease process in connective tissue diseases. Videocapillaroscopy is used to examine the patterns in the nailfold capillaries. However, training, cost, and skilled technique limits the use of it. Dermoscopy, being handheld and easy to perform, is best alternative to videocapillaroscopy. Authors evaluated the utility of dermoscopy in the study of nailfold capillaries in connective tissue diseases in patient with the skin of color. To the best knowledge of authors, this is the first study from the Indian subcontinent. Materials and Methods: The study was conducted in a tertiary care hospital from January 2017 to June 2017. It was a cross-sectional pilot study. Sixteen consecutive patients with connective tissue diseases were included in the study. Connective tissue diseases comprised of systemic sclerosis, lupus erythematosus, mixed connective tissue disease, dermatomyositis, and rheumatoid arthritis. DermLite 3 dermoscope with Sony camera was employed. Polarized mode and ultrasound gel were used. Results: Of 16 patients, three, two, and three had systemic sclerosis, systemic lupus erythematosus, and discoid lupus erythematosus, respectively. Mixed connective tissue disease, dermatomyositis, and rheumatoid arthritis were seen in one, one, and five patients, respectively. One patient had Rowell syndrome. Scleroderma and nonspecific scleroderma patterns were observed in 75% and 12.5% of patients, respectively. In two patients, the nailfold capillaries appeared normal. Conclusion: Dermoscopy is an in vivo cost-effective method for studying nailfold capillaries in connective tissue diseases. Results obtained using handheld dermoscope were comparable to that of a videocapillaroscope. Authors recommend further studies involving large sample size of the population with skin of color to affirm the nailfold capillaries pattern observed in this study.

An effective and practical diagnostic clinical method in primary scarring alopecia: Dermoscopy

Objective: There are several studies on the dermoscopy of the cicatricial alopecia. When the national literature is reviewed, however, only one original study focusing on the subject exists. Here, we aimed to investigate the dermoscopic features of the patients with primary cicatricial alopecia. Materials and Methods: In this study, dermoscopic findings of 40 patients with clinical and histopathological diagnosis of primary cicatricial alopecia were retrospectively reviewed. Dermoscopic examination was performed by a handheld dermoscope with 10-fold magnification. Photographing was performed using a dermoscope attached to a cell phone camera with 2-fold digital zoom. Results: Tubular perifollicular scale in lichen planopilaris (n = 12), cutaneous clefts with emerging hairs and three-dimensional yellow dots in dissecting cellulitis (n = 6), tufted hairs in folliculitis decalvans (n = 6), and follicular plugs and branching vessels in discoid lupus erythematosus (n = 6) were the main findings. No characteristic finding was found for pseudopelade of Brocq (n = 8) and frontal fibrosing alopecia (n = 2). Conclusion: Dermoscopy is a noninvasive, effective, and practical diagnostic tool for the differential diagnosis of primary cicatricial alopecia. The retrospective nature, lack of a control group, and relatively small number of the patients are the main limitations of our study.

Dermoscopy of stage llA mycosis fungoides.

OBJECTIVE:Differential diagnosis of mycosis fungoides (MF) in the early stages can be challenging. Dermoscopy has been reported to be useful in the evaluation of early MF. However, to our knowledge, there is no study that specifies these early stages as stage IA, IB or IIA. The present study aims to evaluate the dermoscopic findings of stage IIA MF in comparison with plaque psoriasis (PP).METHODS:Thirty-four patients aged between 16-70 years with stage IIA MF (n=17) and PP (n=17) were evaluated in this prospective study. Dermoscopic examinations were performed by manual dermatoscopy (Dermlite DL4). χ2 test was used.RESULTS:In patients with stage IIA MF, orange-yellow patches (88.2%), short, fine and linear vessels (82.3%), geometric white scales (70.5%), perifollicular white scales (47%) and white patches (35.2%) were common, while dotted vessels (94.1%), diffuse lamellar white scales (88.2%) and dotted and globular vessels (70.5%) were common in patients with PP. Although spermatozoa-like structures, purpuric dots, collarette white scales and Y-shaped arborizing vessels were common in patients with MF, this was not statistically significant. Geometric white scales (clinically; cigarette paper-like wrinkly scales) correlated with alternating parakeratosis and orthokeratosis in the stratum corneum histopathologically.CONCLUSION:A unique aspect of our study is that this study provides insights about the importance of scales in differentiating MF from PP. Orange-yellow and white patches, short, fine and linear vessels, geometric and perifollicular white scales may be useful in distinguishing stage IIA MF from PP by hand-held dermoscopy.

Wide area digital dermoscopy

Digital dermoscopy is a useful tool in dermatology, but the evaluation of large lesions is limited by the diameter of the dermatoscope lenses, thus requiring analyses of multiple separate photographs. We suggest the use of a digital image montage technique to create wide area digital dermoscopy (WADD) images, which provides a high-definition single-image broad dermoscopic view (Fig 1). Panoramic dermoscopyJournal of the American Academy of DermatologyVol. 88Issue 1PreviewTo the Editor: We read with interest the article from Dellatorre et al1 describing a technique to create wide-area dermoscopic images. We propose panoramic dermoscopy as a quick and easily available alternative: the panorama mode (or similar) in the camera app of a smartphone attached to a handheld dermoscope can be used to build panoramic dermoscopic pictures. We recently described this method in the frontal hairline of patients with frontal fibrosing alopecia.2 Full-Text PDF

Evaluation of Treatment Response by Using a Handheld Dermoscope in Patients with Alopecia Areata

Evaluation of Treatment Response by Using a Handheld Dermoscope in Patients with Alopecia Areata