The rash that becomes purpuric, petechial, hemorrhagic, or ecchymotic

Dermatologic manifestations of hematologic disorders

Distinguishing key morphologic features and understanding the pathophysiology of common cutaneous manifestations of hematologic disorders is essential to ensure prompt and appropriate treatment. In fact, classic cutaneous signs may provide the first clue to the diagnosis of an underlying hematologic disease. Disorders of coagulation, vascular abnormalities, or cutaneous infiltration and deposition are responsible for the underlying pathophysiology of cutaneous manifestations in the majority of cases. Hematologists often feel ill-equipped in identifying morphologic changes in the skin. Thus, the purpose of this review is to provide a comprehensive overview of classic cutaneous manifestations and diagnostic considerations of the associated hematologic conditions. Though there is a specific focus on non-malignant disorders, those straddling the spectrum of malignancy are also discussed. In many disease states, the skin may serve as an important marker of an emerging hematologic disorder, so close collaboration and multidisciplinary input remain essential to provide optimal and timely care for these patients.

Dermoscopic Features of Cutaneous Vasculitis

INTRODUCTION

Dermoscopy has become widespread in the diagnosis of inflammatory skin diseases. Cutaneous vasculitis (CV) is characterized by inflammation of vessels, and a rapid and reliable technique is required for the diagnosis.

OBJECTIVES

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

METHODS

Eighty-nine patients with clinically suspected CV were included in the study. Dermoscopic images were obtained before biopsy using a polarized dermoscopy. Dermoscopic images were independently evaluated, and interobserver variability was calculated. Decision Tree, Random Forest, and K-Nearest Neighbors were used as ML classification models.

RESULTS

The histopathological diagnosis of 58 patients was CV. Three patterns were observed: homogeneous pattern, mottled pattern, and meshy pattern. There was a significant difference in background color between the CV and non-CV groups (P = 0.001). The milky red and livedoid background color were specific markers in the differential diagnosis of CV (sensitivity 56.7%, specificity 96.3%, sensitivity 29.4%, specificity 99.2%, respectively). Red blotches were significantly more common in CV lesions (P = 0.038). Red dots, comma vessels, and scales were more common in the non-CV group (P = 0.002, P = 0.002, P = 0.003, respectively). Interobserver agreement was very good for both pattern (κ = 0.869) and background color analysis (κ = 0.846) (P < 0.001). According to ML classifiers, the background color and lack of scales were the most significant dermoscopic aspects of CV.

CONCLUSIONS

Dermoscopy may guide as a rapid and reliable technique in CV diagnosis. High accuracy rates obtained with ML methods may increase the success of dermoscopy.

Non-traumatic ecchymoses: A literature review from a medico-legal perspective

Ecchymosis, as a general term, refers to discoloration of the skin due to the presence of extravasated blood into the dermis and/or subcutaneous tissue. However, it can occasionally be observed without any trauma, as a symptom of disease, a clinical condition, or even during the course of treating a disease. It is extremely important that these non-traumatic lesions are known and recognized and can be distinguished from traumatic ecchymoses by both clinicians and forensic scientists. This review of the literature includes detailed descriptions of non-traumatic periorbital ecchymosis, Slapped Cheek Syndrome, Cullen's Sign, Grey Turner's Sign, Stabler's Sign, Ransohoff Sign, Bryant's Sign, postsacral ecchymosis, perianal ecchymosis, Fox's Sign, other lower leg ecchymosis, and ecchymosis on various body regions. In this article, it is emphasized that failure to correctly identify these findings may subject practitioners to malpractice lawsuits, and failure to correctly identify findings by forensic experts may result in unjust legal judgments against people or loss of rights. It is also this review encourages accurate diagnosis of non-traumatic ecchymoses.