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Soliman SH, Bosseila M, Hegab DS, Ali DAM, Kabbash IA, AbdRabo FAG. Evaluation of diagnostic accuracy of dermoscopy in some common hypopigmented skin diseases. Arch Dermatol Res 2024; 316:562. [PMID: 39177715 DOI: 10.1007/s00403-024-03259-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/18/2024] [Accepted: 07/30/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Diagnosis of cutaneous hypopigmentation can sometimes be challenging. Dermoscopy may play a role in identifying hypo or-depigmented dermatoses. The aim was to investigate which dermoscopic criteria represent potent indicators for the diagnosis of vitiligo, nevus depigmentosus, pityriasis alba, hypopigmented pityriasis versicolor, idiopathic guttate hypomelanosis, hypopigmented mycosis fungoides (MF), lichen sclerosus et atrophicus and ash leaf hypopigmented macules of tuberous sclerosis, and evaluate their diagnostic accuracy. 168 individuals diagnosed with one of these hypopigmented disorders were evaluated for the presence or absence of predetermined dermoscopic criteria. Evaluation of dermatoscopic characteristics in each condition and analysis for sensitivity and specificity of dermatoscopic diagnosis in these hypopigmented lesions was performed. The starburst pattern, micro-koebnerization, and trichrome pattern were unique to vitiligo diagnosis. Vitiligo had higher comet-tail appearance, perifollicular pigmentation, and perilesional hyperpigmentation than other hypopigmented illnesses. Other hypopigmented lesions had greater incidence of amoeboid pattern, faint or diminished pigment network, islands of pigmentation, ill-defined boundaries, pseudopods, and widespread scaling than vitiligo. Finally, perifollicular scaling, comedo-like openings, blue-gray specks, and fibrotic regions excluded vitiligo. Dermoscopy can help identify common hypopigmented skin lesions and reduce the need for skin biopsy. Nevus depigmentosus, pityriasis alba and idiopathic guttate hypomelanosis were the top three hypopigmented dermatoses that could be diagnosed by dermoscopy with 100% sensitivity. Vitiligo was in the second rank (94.7%), followed by lichen sclerosis et atrophicus (93.3%) then hypopigmented MF at 81.2% sensitivity. Dermoscopy sensitivity was lowest in pityriasis versicolor and ash leaf macules of tuberous sclerosis (52.6% and 46.7%, respectively).
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Affiliation(s)
- Sarah Hamdy Soliman
- Department of Dermatology and Venereology, Faculty of Medicine, Tanta University Hospital, 31527, Al-Bahr St., Tanta, Egypt.
| | - Manal Bosseila
- Dermatology Department, Faculty of Medicine Kasr Al-Ainy, Cairo University, Cairo, Egypt
| | - Doaa Salah Hegab
- Department of Dermatology and Venereology, Faculty of Medicine, Tanta University Hospital, 31527, Al-Bahr St., Tanta, Egypt
| | | | - Ibrahim Ali Kabbash
- Public health@ Community Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Fatma Abdel Ghafar AbdRabo
- Department of Dermatology and Venereology, Faculty of Medicine, Tanta University Hospital, 31527, Al-Bahr St., Tanta, Egypt
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Godínez-Chaparro JA, Roldán-Marín R, Vidaurri-de la Cruz H, Soto-Mota LA, Férez K. Dermatoscopic Patterns in Vitiligo. Dermatol Pract Concept 2023; 13:dpc.1304a197. [PMID: 37992390 PMCID: PMC10656144 DOI: 10.5826/dpc.1304a197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 11/24/2023] Open
Abstract
Vitiligo is a chronic, acquired autoimmune pigmentary skin disease, most times it can be diagnosed clinically. Dermoscopy can confirm vitiligo in a non-invasive way. It is a diagnostic technique that visualizes sub-macroscopic morphological structures which correspond with specific histological structures. It detects subtle changes in the pigment pattern, evaluates vitiligo activity, attempts of re-pigmentation, leucotrichia, and differentiates it from other hypo pigmentary disorders. Most dermatoscopic clues used to assess vitiligo activity are found at the perifollicular level in the center and edge of the lesion. Perifollicular pigmentation is present in both active lesions and treated pigmented lesions with treatment. However, perifollicular depigmentation represents poor response, in treated lesions, and poor prognosis in untreated ones. The center of the lesion has reduced and/or absent pigment network, in active and stable lesions. If on dermoscopy the center of the lesion shows islands of pigment, erythema, or telangiectasias, re-pigmentation is suggested. At the periphery of the lesion, unstable vitiligo usually shows up as a diffuse border, trichrome pattern, micro-Koebner/comet tail phenomenon, satellite lesions, or a tapioca sago pattern. In stable lesions it is more frequent to find well defined or trichromic border. Pigmented lesions commonly present sharp borders and marginal or perilesional hyperpigmentation.
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Affiliation(s)
- Juan Alberto Godínez-Chaparro
- Pediatric Dermatology Service, High Specialty Medical Unit of the Dr. Gaudencio González Garza General Hospital, La Raza National Medical Center, Mexican Social Security Institute, Mexico City, Mexico
- Postgraduate Studies and Research Section, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Rodrigo Roldán-Marín
- Onocodermatology Clinic in the Experimental Medicine Unit of the Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Helena Vidaurri-de la Cruz
- Pediatric Dermatology Service, General Hospital of Mexico Dr. Eduardo Liceaga, Ministry of Health. Mexico City, Mexico
| | - Luis Adrián Soto-Mota
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico’s Ministry of Health, Mexico City, Mexico
| | - Karen Férez
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico’s Ministry of Health, Mexico City, Mexico
- Mexican Foundation for Vitiligo and Skin Diseases, Mexico City, Mexico
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Chatterjee M, Rajput G, Hemdani R. Review article: Dermoscopy in pediatric dermatosis. APOLLO MEDICINE 2023. [DOI: 10.4103/am.am_178_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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Gupta P, Vinay K, Bishnoi A, Kumaran MS, Parsad D. A prospective observational study to sequentially determine the dermoscopic features of vitiligo and its association with disease activity in patients on medical treatment: Dermoscopy and disease activity in vitiligo. Pigment Cell Melanoma Res 2023; 36:33-41. [PMID: 36112075 DOI: 10.1111/pcmr.13069] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/17/2022] [Accepted: 09/14/2022] [Indexed: 12/31/2022]
Abstract
Prospective data on correlation between dermoscopic features of vitiligo and disease activity are scarce. This study was conducted to sequentially determine the dermoscopic features of vitiligo and to evaluate their association with disease activity. A cohort of 30 patients with 60 active vitiligo patches on medical therapy was subjected to sequential clinical and dermoscopic examination at four weekly intervals till 16 weeks. Disease activity at each visit was assessed using serial clinical photographs and modified vitiligo activity severity index. The dermoscopic images were merged and analysed for a predefined set of dermoscopic parameters by two blinded dermatologists. Paired analysis of dermoscopic features was done between baseline, and stabilized vitiligo patches at 12 and 16 weeks. Pigment network changes (absent and reduced pigment network, p < .001), perifollicular depigmentation (p = .02), ill-defined margins (p = .04) and satellite lesions and micro-Koebner phenomenon (p < .001) were associated with active vitiligo while perifollicular repigmentation (p < .001) was associated with stabilizing and repigmenting vitiligo. Satellite lesions and micro-Koebner's phenomena were suggestive of unstable disease irrespective of site of target lesion, while perifollicular repigmentation was suggestive of stabilized/repigmenting disease only at non-acral sites. We found sequential dermoscopy to be useful to assess disease activity and potential for repigmentation in localized vitiligo.
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Affiliation(s)
- Priyansh Gupta
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Ismail SI, Hegazy RA, Gawdat HI, Esmat S, Mahmoud E, Rashed L, Hegazy AA, Saadi DG. Differentiating active from stable vitiligo: the role of dermoscopic findings and their relation to CXCL-10. J Cosmet Dermatol 2022; 21:4651-4658. [PMID: 35298096 DOI: 10.1111/jocd.14922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/11/2021] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Distinguishing vitiligo activity/stability status is pivotal in the management of patients with vitiligo. CXCL10 is a chemokine released in the tissues and sera of patients with vitiligo and an indicator of disease activity. AIM This study aimed to assess the role of dermoscopy in detecting active and stable vitiligo by comparing the dermoscopic signs in vitiligo with Vitiligo Disease Activity Score (VIDA) score, clinical activity, and CXCL10 activity. METHODS Ninety-seven patients with vitiligo were enrolled in this cross-sectional study. Vitiligo activity/stability was assessed using VIDA scores, clinical examination, dermoscopy, and serum CXCL10 levels measured by enzyme-linked immunosorbent assay technique. Dermoscopic scores were calculated using BPLeFoSK score. RESULTS The dermoscopic score was concordant with the VIDA score in 83.5% of patients (n = 81), clinical assessment in 97.9% (n = 95), and serum CXCL10 level in 70.1% (n = 68). Dermoscopic signs of ill-defined border, satellite lesions, and micro-Koebner and starburst appearance were more common in active vitiligo, while a well-defined border was more common in stable lesions. CONCLUSION Dermoscopic examination is a practical, reliable, noninvasive, semi-objective tool in the assessment of vitiligo activity/stability that helps reach an informed decision on the disease status to choose the appropriate therapeutic modality.
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Affiliation(s)
- Sarah I Ismail
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab A Hegazy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba I Gawdat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samia Esmat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Esraa Mahmoud
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Laila Rashed
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amira Aly Hegazy
- Public Health and Community Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina G Saadi
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Awal G, Kaur J, Kaur K. Dermoscopy in Vitiligo: An emerging armamentarium in diagnosis and activity assessment. PIGMENT INTERNATIONAL 2022. [DOI: 10.4103/pigmentinternational.pigmentinternational_4_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chuh A, Zawar V, Fölster-Holst R, Sciallis G, Rosemann T. Twenty-five practical recommendations in primary care dermoscopy. J Prim Health Care 2021; 12:10-20. [PMID: 32223845 DOI: 10.1071/hc19057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/22/2019] [Indexed: 12/30/2022] Open
Abstract
Dermoscopy in primary care enhances clinical diagnoses and allows for risk stratifications. We have compiled 25 recommendations from our experience of dermoscopy in a wide range of clinical settings. The aim of this study is to enhance the application of dermoscopy by primary care clinicians. For primary care physicians commencing dermoscopy, we recommend understanding the aims of dermoscopy, having adequate training, purchasing dermoscopes with polarised and unpolarised views, performing regular maintenance on the equipment, seeking consent, applying contact and close non-contact dermoscopy, maintaining sterility, knowing one algorithm well and learning the rules for special regions such as the face, acral regions and nails. For clinicians already applying dermoscopy, we recommend establishing a platform for storing and retrieving clinical and dermoscopic images; shooting as uncompressed files; applying high magnifications and in-camera improvisations; explaining dermoscopic images to patients and their families; applying toggling; applying scopes with small probes for obscured lesions and lesions in body creases; applying far, non-contact dermoscopy; performing skin manipulations before and during dermoscopy; practising selective dermoscopy if experienced enough; and being aware of compound lesions. For clinicians in academic practice for whom dermatology and dermoscopy are special interests, we recommend acquiring the best hardware available with separate setups for clinical photography and dermoscopy; obtaining oral or written consent from patients for taking and publishing recognisable images; applying extremely high magnifications in search of novel dermoscopic features that are clinically important; applying dermoscopy immediately after local anaesthesia; and further augmenting images to incorporate messages beyond words to readers.
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Affiliation(s)
- Antonio Chuh
- Department of Family Medicine and Primary Care, The University of Hong Kong and Queen Mary Hospital, Pokfulam, Hong Kong; and JC School of Public Health and Primary Care, The Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong; and The Hong Kong Society of Primary Care Dermoscopy, Hong Kong; and Corresponding author.
| | - Vijay Zawar
- The Hong Kong Society of Primary Care Dermoscopy, Hong Kong; and Department of Dermatology, Godavari Foundation Medical College and Research Center, Dr Vasantrao Pawar Medical College, Nashik, India
| | - Regina Fölster-Holst
- The Hong Kong Society of Primary Care Dermoscopy, Hong Kong; and Universitätsklinikum Schleswig-Holstein, Campus Kiel, Dermatologie, Venerologie und Allergologie, Germany
| | - Gabriel Sciallis
- The Hong Kong Society of Primary Care Dermoscopy, Hong Kong; and Emeritus, Department of Dermatology, Mayo Medical School, Minnesota, USA
| | - Thomas Rosemann
- The Hong Kong Society of Primary Care Dermoscopy, Hong Kong; and Institute of Primary Care, University of Zürich, Zurich, Switzerland
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Vinay K, Ankad BS. Dermatoscopic Features of Pigmentary Diseases in Ethnic Skin. Indian Dermatol Online J 2021; 12:24-33. [PMID: 33768020 PMCID: PMC7982038 DOI: 10.4103/idoj.idoj_561_20] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/25/2020] [Accepted: 09/26/2020] [Indexed: 11/17/2022] Open
Abstract
Dermatoscopy is a non-invasive, handy tool, which is increasingly being used in diagnosis and prognostication of pigmentary dermatoses. Dermatoscopic changes in pigmentary pattern, scaling, and vasculature help us to differentiate among the myriad of hypo and hyper pigmentary diseases. This review gives a brief overview of the dermatoscopic features of pigmentary diseases, which are commonly encountered in clinical practice. We also provide a diagnostic approach based on salient dermatoscopic features.
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Affiliation(s)
- Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, Karnataka, India
| | - Balachandra S Ankad
- Department of Dermatology, S Nijalingappa Medical College, Bagalkot, Karnataka, India
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Errichetti E, Zelin E, Pinzani C, Kyrgidis A, Lallas A, Stinco G. Dermoscopic and Clinical Response Predictor Factors in Nonsegmental Vitiligo Treated with Narrowband Ultraviolet B Phototherapy: A Prospective Observational Study. Dermatol Ther (Heidelb) 2020; 10:1089-1098. [PMID: 32749663 PMCID: PMC7477062 DOI: 10.1007/s13555-020-00431-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Indexed: 01/14/2023] Open
Abstract
Introduction Few data on possible local factors that can influence the achievement of response in nonsegmental vitiligo (NSV) treated with narrowband ultraviolet B (Nb-UVB) phototherapy are available. Our objective is to evaluate possible correlations between therapeutic outcomes and dermoscopic and local (lesional) clinical findings of vitiligous lesions undergoing Nb-UVB phototherapy to find positive and/or negative response predictor factors to such treatment. Methods For each target patch, we calculated the extension area using a computer-aided method and assessed dermoscopic and local (lesional) clinical findings at baseline. After 30 phototherapy sessions (twice weekly), surface area of the lesions was reevaluated to assess clinical improvement, correlating the therapeutic outcome with initial clinical and dermoscopic features. Results A total of 70 lesions were finally included in the study. At the end of therapy, 18 patches (25.7%) achieved improvement, and the presence of perifollicular pigmentation on baseline dermoscopic examination was found to be associated with a 12-fold higher probability of having a positive therapeutic outcome. Similarly, face localization was also correlated with clinical amelioration, with a sevenfold higher probability for improvement. No association (p > 0.05) between therapeutic outcomes (either good or poor) and other dermoscopic or local clinical variables (including leukotrichia) was observed. Conclusions Therapeutic response of vitiligo to Nb-UVB phototherapy may be positively affected by local features of the lesions, i.e., face localization and presence of perifollicular pigmentation on baseline dermoscopic examination, which might be considered as positive response predictor factors to optimize treatment of vitiligo.
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Affiliation(s)
- Enzo Errichetti
- Department of Medical Area, Institute of Dermatology, University of Udine, Udine, Italy.
| | - Enrico Zelin
- Department of Dermatology and Venereology, University of Trieste, Trieste, Italy
| | - Caterina Pinzani
- Department of Medical Area, Institute of Dermatology, University of Udine, Udine, Italy
| | - Athanassios Kyrgidis
- Department of Otolaryngology-Head and Neck Surgery, Aristotle University, Thessaloniki, Greece
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Giuseppe Stinco
- Department of Medical Area, Institute of Dermatology, University of Udine, Udine, Italy
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Nirmal B, Antonisamy B, Peter CVD, George L, George AA, Dinesh GM. Cross-Sectional Study of Dermatoscopic Findings in Relation to Activity in Vitiligo: BPLeFoSK Criteria for Stability. J Cutan Aesthet Surg 2019; 12:36-41. [PMID: 31057267 PMCID: PMC6484572 DOI: 10.4103/jcas.jcas_75_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Stability in vitiligo is an important concept in guiding patient management and a vital prerequisite before vitiligo surgery. Disease activity of vitiligo based on patient’s history is imprecise. It is practically impossible to perform biopsy from all lesions of vitiligo to ascertain stability. Dermatoscopy can be used to examine all clinical lesions in a patient of vitiligo. There is a need to validate many reported dermatoscopic findings for universal use. Aims: To analyze the significance of dermatoscopic findings in the activity of vitiligo and to devise a cutoff score for stable vitiligo. Materials and Methods: Dermatoscopic examination was performed in 85 patients clinically diagnosed with vitiligo. Six dermatoscopic parameters, namely, border, pigment network, perilesional hyperpigmentation, perifollicular pigmentation, satellite lesions, and micro-Koebner phenomenon (acronym: BPLeFoSK) were evaluated against Wood’s lamp findings as standard. Chi-square test was used to test association between categorical variables. Cutoff values for stability for these six parameters were plotted in receiver operating curve. Results: A total of 131 vitiligo lesions were analyzed with dermatoscopy. Absence of satellite lesions and absence of micro-Koebner phenomenon were the most sensitive parameters (96.7% and 100%, respectively). Sharp border and absent or reticulate pigment network within the vitiligo patch were the most specific findings (100% and 91.5%, respectively). Conclusion: A cutoff score of more than or equal to 1.5 using the “BPLeFoSK criteria” indicates stability in the vitiligo lesion.
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Affiliation(s)
- Balakrishnan Nirmal
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - C V Dincy Peter
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Leni George
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anu A George
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gauri M Dinesh
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
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Jowkar F, Godarzi H, Parvizi MM. Can we consider silymarin as a treatment option for vitiligo? A double-blind controlled randomized clinical trial of phototherapy plus oral Silybum marianum product versus phototherapy alone. J DERMATOL TREAT 2019; 31:256-260. [DOI: 10.1080/09546634.2019.1595506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Farideh Jowkar
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Godarzi
- Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Parvizi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
Dermoscopy is a noninvasive technique for the diagnosis, prognosis, and monitoring of pigmentary disorders in brown skin. It can be used for the diagnosis of various facial melanoses, which can avoid the need for biopsy in many cases. It can also help in early identification of the adverse effect of topical steroids and hydroquinone when they are used for the treatment of these disorders. Dermoscopy can also reliably differentiate vitiligo from other disorders of hypopigmentation. It can also help in assessing the stability of vitiligo before surgery.
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Affiliation(s)
- Manas Chatterjee
- Department of Dermatology, INHS Asvini, Colaba, Mumbai 400005, India
| | - Shekhar Neema
- Department of Dermatology, Command Hospital, 17/1E, Alipore Road, Alipore Police Line, Alipore, Kolkata, West Bengal 700027, India.
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Al-Refu K. Dermoscopy is a new diagnostic tool in diagnosis of common hypopigmented macular disease: A descriptive study. Dermatol Reports 2018; 11:7916. [PMID: 31119026 PMCID: PMC6509478 DOI: 10.4081/dr.2018.7916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/29/2018] [Indexed: 12/20/2022] Open
Abstract
One of the most frequent complaints in dermatology clinics is the eruption of hypopigmented patchy skin lesions. The aim of the study was to investigate the utility of dermoscopy in common hypopigmented macular diseases. Patients with the followings diseases were examined by dermoscopy: vitiligo, pityriasis alba, nevus depigmentosus, achromic pityriasis versicolor, idiopathic guttate hypomelanosis, and extragenital guttate lichen sclerosus. This study showed that these hypopigmented macular diseases might display specific dermoscopic features. In vitiligo, the mean dermoscopic features were the presence of a diffuse white glow with perifollicular pigment, perilesional hyperpigmentation, leukotrichia and the pigmentary network. In idiopathic guttate hypomelanosis, the characteristic features were the presence of multiple, shiny, scaly macules with welland ill-defined edges borders that coalesced into polycyclic macules. For nevus depigmentosus, the mean features were hypopigmented patches with irregular border with a faint reticular network. For pityriasis alba, the fairly ill-demarcated hypopigmented macules with fine scales were the mean feature. In lichen sclerosus, there were white structureless areas, perilesional erythematous halo, follicular plugging and white chrysalis like structures. Dermoscopy of achromic pityriasis versicolor showed a fairly demarcated white area with fine scales localized in the skin creases.
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Chuh A, Zawar V, Sciallis G. Does dermatoscopy facilitate the detection and diagnosis of vascular skin lesions? A case–control study. J R Coll Physicians Edinb 2018; 48:210-216. [DOI: 10.4997/jrcpe.2018.304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Dermoscopy as an evolving tool to assess vitiligo activity. J Am Acad Dermatol 2017; 78:1017-1019. [PMID: 29229577 DOI: 10.1016/j.jaad.2017.12.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/29/2017] [Accepted: 12/03/2017] [Indexed: 11/23/2022]
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Kumar Jha A, Sonthalia S, Lallas A, Chaudhary RKP. Dermoscopy in vitiligo: diagnosis and beyond. Int J Dermatol 2017; 57:50-54. [PMID: 29076154 DOI: 10.1111/ijd.13795] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/05/2017] [Accepted: 09/14/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Vitiligo is essentially a clinical diagnosis, and dermoscopy may aid in noninvasive confirmation of diagnosis by excluding other clinically simulating hypopigmentary conditions. More importantly, dermoscopy is rapidly gaining ground as an important adjunct tool to evaluate disease activity. AIM To study the dermoscopic features of vitiligo and ascertain their correlation with disease activity. METHODS Retrospective analysis of dermoscopy of 60 cases suffering from vitiligo was undertaken. Dermoscopy was performed using Dermlite II hybrid m dermatoscope at 10× magnification in polarized mode, and photographs were captured by Apple iphone 6. Variables assessed in the dermoscopic evaluation included perifollicular changes, perilesional changes, altered pigmentary network, and presence of specific features such as the starburst appearance, comet tail appearance, leukotrichia, telangiectasia, and any new findings. RESULTS Sixty patients with stable, progressive, or repigmenting vitiligo were retrospectively studied. While perifollicular depigmentation (PFD) was predictive of stable vitiligo, perifollicular pigmentation (PFP) was characteristic of active disease. Starburst appearance, altered pigment network, and comet tail appearance, were also noted, and these were typical of progressive vitiligo. A new dermoscopic feature, the 'tapioca sago' appearance (sabudana), was observed in the skin adjacent to the vitiligo lesion only in patients with progressive vitiligo. CONCLUSION Dermoscopy is useful in assessing the stage of evolution and the status of disease activity in vitiligo. The most useful dermoscopic clues are observed in the perifollicular region, since progressive lesions display perifollicular pigmentation and stable/remitting lesions display perifolliclar depigmentation.
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Affiliation(s)
- Abhijeet Kumar Jha
- Department of Skin & V.D Patna Medical College & Hospital, Patna, Bihar, India
| | | | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - R K P Chaudhary
- Department of Skin & V.D Patna Medical College & Hospital, Patna, Bihar, India
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Errichetti E, Stinco G. Dermoscopy in General Dermatology: A Practical Overview. Dermatol Ther (Heidelb) 2016; 6:471-507. [PMID: 27613297 PMCID: PMC5120630 DOI: 10.1007/s13555-016-0141-6] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Indexed: 12/15/2022] Open
Abstract
Over the last few years, dermoscopy has been shown to be a useful tool in assisting the noninvasive diagnosis of various general dermatological disorders. In this article, we sought to provide an up-to-date practical overview on the use of dermoscopy in general dermatology by analysing the dermoscopic differential diagnosis of relatively common dermatological disorders grouped according to their clinical presentation, i.e. dermatoses presenting with erythematous-desquamative patches/plaques (plaque psoriasis, eczematous dermatitis, pityriasis rosea, mycosis fungoides and subacute cutaneous lupus erythematosus), papulosquamous/papulokeratotic dermatoses (lichen planus, pityriasis rosea, papulosquamous sarcoidosis, guttate psoriasis, pityriasis lichenoides chronica, classical pityriasis rubra pilaris, porokeratosis, lymphomatoid papulosis, papulosquamous chronic GVHD, parakeratosis variegata, Grover disease, Darier disease and BRAF-inhibitor-induced acantholytic dyskeratosis), facial inflammatory skin diseases (rosacea, seborrheic dermatitis, discoid lupus erythematosus, sarcoidosis, cutaneous leishmaniasis, lupus vulgaris, granuloma faciale and demodicidosis), acquired keratodermas (chronic hand eczema, palmar psoriasis, keratoderma due to mycosis fungoides, keratoderma resulting from pityriasis rubra pilaris, tinea manuum, palmar lichen planus and aquagenic palmar keratoderma), sclero-atrophic dermatoses (necrobiosis lipoidica, morphea and cutaneous lichen sclerosus), hypopigmented macular diseases (extragenital guttate lichen sclerosus, achromic pityriasis versicolor, guttate vitiligo, idiopathic guttate hypomelanosis, progressive macular hypomelanosis and postinflammatory hypopigmentations), hyperpigmented maculopapular diseases (pityriasis versicolor, lichen planus pigmentosus, Gougerot-Carteaud syndrome, Dowling-Degos disease, erythema ab igne, macular amyloidosis, lichen amyloidosus, friction melanosis, terra firma-forme dermatosis, urticaria pigmentosa and telangiectasia macularis eruptiva perstans), itchy papulonodular dermatoses (hypertrophic lichen planus, prurigo nodularis, nodular scabies and acquired perforating dermatosis), erythrodermas (due to psoriasis, atopic dermatitis, mycosis fungoides, pityriasis rubra pilaris and scabies), noninfectious balanitis (Zoon's plasma cell balanitis, psoriatic balanitis, seborrheic dermatitis and non-specific balanitis) and erythroplasia of Queyrat, inflammatory cicatricial alopecias (scalp discoid lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia and folliculitis decalvans), nonscarring alopecias (alopecia areata, trichotillomania, androgenetic alopecia and telogen effluvium) and scaling disorders of the scalp (tinea capitis, scalp psoriasis, seborrheic dermatitis and pityriasis amiantacea).
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Affiliation(s)
- Enzo Errichetti
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy.
| | - Giuseppe Stinco
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy
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Nugroho H, Ahmad Fadzil MH, Shamsudin N, Hussein SH. Computerised image analysis of vitiligo lesion: evaluation using manually defined lesion areas. Skin Res Technol 2012; 19:e72-7. [PMID: 22233154 DOI: 10.1111/j.1600-0846.2011.00610.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Vitiligo is a cutaneous pigmentary disorder characterized by depigmented macules and patches that result from loss of epidermal melanocytes. Physician evaluates the efficacy of treatment by comparing the extent of vitiligo lesions before and after treatment based on the overall visual impression of the treatment response. This method is called the physician's global assessment (PGA) which is subjective. In this article, we present an innovative digital image processing method to determine vitiligo lesion area in an objective manner. METHOD The digital method uses Independent Component Analysis (ICA) to generate melanin-based images representing skin areas due to melanin followed by Region Growing process to segment vitiligo lesion from normal skin. RESULTS Based on 41 digital images of vitiligo lesions taken from 18 patients, the proposed method achieved sensitivities of 0.9105 ± 0.0161, specificities of 0.9973 ± 0.0009 and accuracies of 0.9901 ± 0.0028 at 95% confidence level. CONCLUSION With the proposed method, physicians are able to assess vitiligo treatment efficacies objectively.
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Affiliation(s)
- Hermawan Nugroho
- Intelligent Signal and Imaging Research Centre, Department of Electrical & Electronic Engineering, Universiti Teknologi PETRONAS, Tronoh, Malaysia.
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Chuh A, Lee A, Wong W, Ooi C, Zawar V. Diagnosis of Pediculosis pubis: a novel application of digital epiluminescence dermatoscopy. J Eur Acad Dermatol Venereol 2007; 21:837-8. [PMID: 17567326 DOI: 10.1111/j.1468-3083.2006.02040.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chuh A, Zawar V. Epiluminescence dermatoscopy enhanced patient compliance and achieved treatment success in pseudofolliculitis barbae. Australas J Dermatol 2006; 47:60-2. [PMID: 16405487 DOI: 10.1111/j.1440-0960.2006.00226.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUMMARY A patient presented with recalcitrant pseudofolliculitis barbae and hypertrophic scarring. The use of epiluminescence dermatoscopy rendered clear visualization of U-shaped ingrowing hairs corresponding to the sites of individual papules. Such real-time demonstration led to an attitude change and good compliance with medical advice against over shaving, resulting in a successful treatment outcome.
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Affiliation(s)
- Antonio Chuh
- Department of Medicine, University of Hong Kong and Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
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Zalaudek I, Argenziano G, Di Stefani A, Ferrara G, Marghoob AA, Hofmann-Wellenhof R, Soyer HP, Braun R, Kerl H. Dermoscopy in General Dermatology. Dermatology 2006; 212:7-18. [PMID: 16319467 DOI: 10.1159/000089015] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Accepted: 07/06/2005] [Indexed: 11/19/2022] Open
Abstract
Dermoscopy improves the diagnostic accuracy in the clinical evaluation of pigmented skin lesions, but it is also useful for the assessment of vascular structures that are not visible to the naked eye. As a consequence, dermoscopy has been employed more and more for the differential diagnosis of nonpigmented skin disorders, including tumors but also inflammatory and infectious diseases. This article provides a review of the dermoscopic features seen in various nonpigmented tumoral and nontumoral skin lesions as well as the dermoscopic criteria used for monitoring skin reactions to various treatments.
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Affiliation(s)
- Iris Zalaudek
- Department of Dermatology, Medical University of Graz, Graz, Austria.
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