Dermatoscopy

Handheld dermatoscope versus digital camera for hair counts in laser facial hair removal

The lack of uniform and objective techniques to evaluate treatment efficacy in photo-epilation studies leads to contradictory results. Thus, there is an urgent need to explore commonly accepted assessment tools. One of the most common methods uses hair counts via digital photography. However, macrophotography may not be able to depict the vellus-like hair induced by photo-epilation. On the other hand, handheld dermatoscopy is practical, affordable and offers high-quality magnification. Hair counts from a handheld dermatoscope and a digital camera were compared in 73 women who underwent 6 sessions with the Alexandrite 755 nm laser. Significantly more hairs were counted using the dermatoscope than using the digital camera (76.9 ± 41.3 vs. 58.6 ± 31.4, p < .005), independently of hair thickness and hair density. The difference in hair counts between the two instruments was inversely related to hair thickness and directly related to hair density. The handheld dermatoscope may be a more effective tool than the widely used digital camera in evaluating the response to laser hair removal treatment.

Slit lamp polarized dermoscopy: a cost-effective tool to assess eyelid lesions

PURPOSE

Dermoscopy is a complementary examination of skin lesions, which allows the observation of anatomical features invisible to the naked eye. Its use increases the diagnostic accuracy of skin tumors. The development of polarized dermoscopy allowed the observation of deeper skin structures, without the need of skin contact. The purpose of this study was to present a low-cost prototype through the adaptation of polarized lenses on a slit lamp in order to assess anatomical aspects invisible to conventional biomicroscopy in eyelid lesions.

METHODS

Twenty two eyelid lesions were documented using a prototype, compound of two polarizing filters, orthogonal to each other, adapted to a slit lamp with an integrated digital camera. Images of the eyelid lesions were also obtained with non-polarized biomicroscopy and with a portable dermatoscope, and were compared regarding anatomical aspects.

RESULTS

Anatomical structures imperceptible to conventional ophthalmic examination were evidenced using the polarized lenses, demonstrating that this tool can be useful to the ophthalmologist when assessing eyelid lesions. We have obtained high-quality images of the lesions. The slit lamp provided higher magnification, better focus control and easier assessment of eyelid lesions than the portable dermatoscope.

CONCLUSION

Ophthalmologists already use the slit lamp in their practice. The adaptation of polarized lenses to this device is a cost-effective, fast and non-invasive method that permits to improve the diagnostic accuracy of eyelid lesions, evidencing anatomical structures imperceptible to conventional ophthalmic examination.

Nailfold Capillaroscopy With USB Digital Microscopy in Connective Tissue Diseases: A Comparative Study of 245 Patients and Healthy Controls

Background: Nailfold capillaroscopy (NFC) is a valuable tool to detect microcirculation abnormalities in connective tissue diseases (CTDs). However, whether the universal serial bus (USB) digital microscopy used as onychoscopy is as effective as the videocapillaroscopy in determining the diagnostic and prognostic values of CTDs remains to be determined. Objective: This study aims to investigate NFC features of systemic lupus erythematosus (SLE), dermatomyositis (DM), and systemic sclerosis (SSc) patients and compare with normal controls as well as examine which feature could differentiate among CTDs. Furthermore, we aim to explore different capillaroscopic abnormalities and their association with disease activity. Methods: Nailfold images were taken from patients and healthy controls using a USB digital microscopy. Patterns on the capillary morphology, diameter, architecture, and density were recorded and compared. We further determined the NFC findings in SLE, DM, and SSc and corresponded to their respective disease activity scoring system. Results: A total of 245 participants, consisting of 54 SLE, 32 DM, and 51 SSc patients, as well as 108 controls, were enrolled. All capillaroscopic features, except for tortuous capillaries, were significantly more common in CTDs than healthy control (all p < 0.05). A multinomial logistic regression analysis revealed that bushy capillaries had significantly higher odds for both SLE and DM than SSc (OR: 4.10, 95% confidence interval (CI): 1.71-9.81, p = 0.002 and OR: 7.82, 95% CI, 2.86-21.38, p < 0.001, respectively). Elongated capillaries demonstrated significant odds for SLE compared with SSc (OR: 3.35, 95% CI: 1.005-11.20, p = 0.049), while prominent subpapillary plexus showed greater odds for SLE compared with both DM and SSc (OR: 2.75, 95% CI: 1.07-7.02, p = 0.03 and OR: 5.78, 95% CI: 2.29-14.58, p < 0.001, respectively). The presence of hemorrhage, enlarged capillaries, and the low-density index had significantly higher odds in favor of SSc than SLE. Bushy capillaries were the only pattern with a strong association for DM over SSc. The presence of enlarged capillaries indicated higher SLE severity, but no specific finding was related to DM or SSc skin scores. Conclusions: Nailfold capillaroscopic examination using a digital microscope is a valuable method for the diagnosis of SLE, DM, and SSc. Several morphologic patterns can help differentiate among CTDs; however, the prognostic significance of this method requires further investigations.

Image Quality Assessment of Digital Image Capturing Devices for Melanoma Detection

The fast-growing incidence of skin cancer, especially melanoma, is the guiding principle for intense development of various digital image-capturing devices providing easier recognition of melanoma by dermatologists. Handheld and digital dermoscopy, following of mole changes with smartphones and digital analysing of mole images, is based on evaluation of the colours, shape and deep structures in the skin moles. Incorrect colour information of an image, under- or overexposed images, lack of sharpness and low resolution of the images, can lead to melanoma misdiagnosis. The purpose of our study was to determine the colour error in the image according to the given lighting conditions and different camera settings. We focused on measuring the image quality parameters of smartphones and high-resolution cameras to compare them with the results of state-of-the-art dermoscopy device systems. We applied standardised measuring methods. The spatial frequency response method was applied for measuring the sharpness and resolution of the tested camera systems. Colour images with known reference values were captured from the test target, to evaluate colour error as a CIELAB (Commission Internationale de l’Eclairage) ΔE*ab colour difference as seen by a human observer. The results of our measurements yielded two significant findings. First, all tested cameras produced inaccurate colours when operating in automatic mode, and second, the amount of sharpening was too intensive. These deficiencies can be eliminated through adjusting the camera parameters manually or by image post-production. The presented two-step camera calibration procedure improves the colour accuracy of captured clinical and dermoscopy images significantly.

Patient Attitude towards Videodermatoscopy for the Detection of Skin Cancer: A Cross-Sectional Study

BACKGROUND

Videodermatoscopy (VD) is a useful device for supporting dermatologists in the distinction between benign and malignant lesions. However, only few patients have access to VD in daily practice.

OBJECTIVES

To investigate patient attitudes towards VD.

METHOD

A cross-sectional study was conducted between May and June 2018. Patients were asked to complete a self-administered questionnaire on the popularity of VD. Descriptive analysis was performed including contingency tables and χ2 tests to investigate associations between sociodemographic data and the popularity of VD.

RESULTS

A total of 61.2% (123/201) of the patients had not heard of VD at the time of assessment or were unsure. Of the 38.8% of patients (78/201) who already knew of VD, 64.1% (50/78) reported that they had already been investigated by VD; 57.5% (111/193) were willing to pay an extra fee for VD. A high level of education and private insurance status had a statistically significant association with the popularity of VD (p = 0.036 and p = 0.026, respectively).

CONCLUSIONS

There was a strong information deficit, especially in patients with lower education and statutory health insurance. Nevertheless, the willingness to pay an extra fee for a VD-assisted skin examination was high. Dermatologists should actively offer and inform their patients about VD when performing skin cancer screening.

Alternative uses of dermoscopy in daily clinical practice: An update

Dermoscopy is a noninvasive diagnostic tool that is currently being used for neoplastic skin lesions, several inflammatory and infectious diseases, and skin appendage disorders. As the clinical applications of dermoscopy beyond pigmented lesions are constantly increasing, the aim of this article is to provide an update on this topic. This comprehensive review substantiates how several diseases may show peculiar dermoscopy features so as to enhance the diagnosis and avoid (in selected cases) unnecessary histologic confirmation. In other cases, dermoscopy features may be shared with other conditions, with the advantage of narrowing down the differential diagnosis by ruling out those dermatoses with similar clinical aspect but different dermoscopic presentation.