Dermatoscopy of Parasitic and Infectious Disorders

Dermoscopy of skin parasitoses, bites and stings: a systematic review of the literature

Besides classic applications, dermoscopy has gained significant appreciation also for non-tumoral dermatoses (general dermatology). In this field, skin parasitoses (infestations), bites and stings have been reported among the conditions that may benefit most from dermoscopic examination. However, published data on this topic are sparse and often lack a standardized analytical approach. In this systematic review of the literature, we sought to summarize available data on dermoscopy of cutaneous parasitoses, bites and stings, analysing dermoscopic features and used setting (polarisation or not/magnification), pathological correlation and level of evidence of published studies as well as trying to align dermoscopic terminology of reported findings following a standardized methodology. A total of 150 publications addressing 29 different dermatoses and reporting 96 different dermoscopic findings were included in the analysis. Most of the them displayed a level of evidence of V (113 single case reports and 36 case series), with only one study featuring a level of evidence of IV (case-control study). Additionally, our analysis also displayed poor uniformity in the terminology used in published articles (even for the same dermatosis). Therefore, albeit promising, dermoscopy of cutaneous parasitoses, bites and stings needs future systematized studies for a better characterization.

Home Treatment of Single Cutaneous Warts Combining Face-To-Face and Teledermatology Consultation: A New Perspective

During the COVID‐19 pandemic, teledermatology services were set up and enhanced to take care of those benign conditions like cutaneous warts (CWs) which, if undiagnosed or treated with delay, could have worsened, enlarged, and potentially spread to the community. The aim of this hybrid exploratory trial was to combine face‐to‐face clinical and dermoscopic evaluation with teledermatology follow‐up in the management of CWs with a cryogenic pen based on nitrous oxide for home treatment. Twelve adult patients affected by CWs were enrolled. During the first face‐to‐face visit, single CWs were selected for the study by clinical and dermoscopic evaluation. The home schedule consisted of one application to be repeated after 2 weeks, when signs of CWs were still evident. Patients were also asked to send a clinical photo of the treated lesion at weekly intervals. A final face‐to‐face evaluation was scheduled to verify the response to home treatment by clinical and dermoscopy evaluation. A total of 20 CWs located on the trunk and the extremities were treated: a complete clinical and dermoscopic resolution was observed in 16 out of 20 lesions (80%), and a partial response in two cases. The adverse events observed during treatment were comparable to those normally observed with cryotherapy of CWs. In conclusion, home treatment of CWs with the cryogenic pen, that should be always preceded by dermatologist diagnosis and prescription, is safe and effective, especially if combined with face‐to‐face and teledermatology consultations, pointing out its important role during pandemic times or in any other environmental limitations that may impair the access to medical care services. The combination of face‐to‐face consultations for initial and final visits and teledermatology during the treatment phase could represent a model for other dermatologic conditions as well (e.g., acne, rosacea, psoriasis, atopic eczema etc.).

Dermatoscopy

The dermatoscope has gained tremendous popularity among dermatologists as an adjunctive tool to better visualize subsurface structures and identify patterns that may improve the diagnosis of a wide range of skin diseases. Initially, the pigmented lesion experts who were the early adopters promoted the use of the dermatoscope to increase diagnostic accuracy of early melanomas and decrease the harvesting of benign lesions. With current near universal adoption of the diagnostic technique by dermatologists, the dermatoscope is now employed to help identify a wide variety of inflammatory, infectious, and vascular conditions of the skin, hair, and nails, resulting in the emergence of several branches of dermatoscopy-inflammoscopy, trichoscopy, onychoscopy, and entodermoscopy. The future of dermatoscopy will involve incorporation of artificial intelligence that will make the assessment process increasingly objective, more accurate, and universally available. Despite the wide acceptance and adoption of dermatoscopy, the overall impact of its widespread use still remains unclear, whether it has decreased biopsy rates of benign lesions, reduced health care costs, or improved patient outcomes.

Twenty-five practical recommendations in primary care dermoscopy

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.

Entodermoscopy Update: A Contemporary Review on Dermoscopy of Cutaneous Infections and Infestations

Infectious cutaneous diseases are very common, especially in certain geographic and tropical regions. Sometimes they may simulate other dermatoses, ordering verification of diagnosis with particular investigations. Dermoscopy is among one of the most important tools readily available in the outpatient setting for the dermatologist to confirm the diagnosis. In this up-to date review, literature concerning the various dermoscopic features of parasitic, viral, dermatophytic and bacterial cutaneous infections is composed. In addition artefacts as well as practical issues in dermoscopy usage are discussed; with the aim to empower dermatologists to promptly and non-invasively diagnose and manage cutaneous infections and infestations.

Dermoscopy of genital diseases: a review

The male and female external genital regions are anatomical areas in which various types of skin disorders may occur. Although most of these conditions can be diagnosed by means of clinical examination and an accurate medical history, in most cases further investigations with time-consuming and/or invasive procedures are needed in order to reach the correct diagnosis. Dermoscopy, as a modern non-invasive tool, is able to better diagnose pigmented and non-pigmented skin tumours along with various inflammatory and infectious skin and appendage disorders. The aim of this paper was to provide a review of the use of dermoscopy in genital disorders based on published data and to include personal experience gained from real life, focusing on any possible gender difference and whether disease mucosal/semimucosal dermoscopy features may differ from those observed on the skin. In conclusion, genital dermoscopy should always be considered during clinical inspection in order to enhance the diagnosis or to rule out those conditions that may look similar but that show a different dermoscopy pattern, thus narrowing down the differential diagnoses and avoiding unnecessary invasive investigations.

Trichoscopy in the Differential Diagnosis of Pseudonits

AIM

The purpose of the study was to describe the trichoscopic features of pseudonits and to assess the usefulness of trichoscopy in their differential diagnosis.

METHODS

A retrospective study was performed on those patients seen for the suspicion of head or pubic lice and who underwent trichoscopy with polarized light at ×10 magnification for a more accurate diagnosis. Forty-two patients (28 males/14 females, mean age: 34.5 years, range: 7-59) were evaluated.

RESULTS

In 30 cases, trichoscopy confirmed the suspicion of head (24 cases) or pubic (6 cases) lice, whereas in 12 cases it allowed for a final diagnosis of seborrheic dermatitis (5 cases), hair casts (3 cases), trichobacteriosis (2 cases), white piedra (1 case), and trichorrhexis nodosa (1 case), by showing different types of pseudonits.

CONCLUSION

Hair examination using trichoscopy in routine clinical practice may provide useful information for the correct diagnosis, ranging from common head and pubic lice infestations to rarer shaft abnormalities. Differentiating pseudonits from nits is essential to make the correct diagnosis in order to prevent unnecessary treatment, anxiety, and/or embarrassment.

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.