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Sun H, Duan Y, Zhao J, Li R. Characteristics of exogenous pigment diseases under reflectance confocal microscopy. Skin Res Technol 2023; 29:e13318. [PMID: 37231927 PMCID: PMC10316469 DOI: 10.1111/srt.13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Hongyong Sun
- Department of DermatologyPeople's Hospital of Inner Mongolia Autonomous RegionHohhotChina
| | - Yan Duan
- Department of DermatologyPeople's Hospital of Inner Mongolia Autonomous RegionHohhotChina
| | - Juan Zhao
- Department of DermatologyPeople's Hospital of Inner Mongolia Autonomous RegionHohhotChina
| | - Ruiya Li
- Department of DermatologyPeople's Hospital of Inner Mongolia Autonomous RegionHohhotChina
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2
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Martin A, Gouveia BM, Rawson R, Guitera P. Complex management of lentigo maligna in the setting of chrysiasis, argyriasis, and tattoo using in vivo reflectance confocal microscopy. J Dermatol 2022; 49:703-709. [PMID: 35514028 PMCID: PMC9542206 DOI: 10.1111/1346-8138.16390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/21/2022] [Accepted: 03/11/2022] [Indexed: 11/29/2022]
Abstract
Lentigo maligna (LM) can be difficult to diagnose and recurrence is not uncommon. In vivo reflectance confocal microscopy (RCM) improves diagnostic accuracy of LM. LM can be difficult to discern from coexistent metal‐induced cutaneous hyperpigmentation (MICH). We are the first to describe three cases of LM associated with gold, silver, and metal oxide (from tattoos) and the RCM findings, respectively. The images obtained via RCM were analyzed by two RCM experts, and histopathology reviewed by a dermatopathologist. MICH under RCM appeared as intensely hyperreflective dots (when found freely) or clusters of variable sizes (when engulfed by macrophages) limited to the dermis. Dermal dendritic cells and melanophages were also found in association but distinct from the confluence of dendritic cells at the dermoepidermal junction observed in LM. We showed longitudinal changes within the dermis in MICH, not previously reported, where these hyperreflective dots congregate into clusters. RCM was able to distinguish the features of LM from MICH, delineate treatment margins, and monitor for recurrence.
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Affiliation(s)
- Arthur Martin
- The Melanoma Institute of Australia, New South Wales, Australia.,Medical School of The University of Sydney, Sydney, New South Wales, Australia
| | | | - Robert Rawson
- The Melanoma Institute of Australia, New South Wales, Australia.,Medical School of The University of Sydney, Sydney, New South Wales, Australia.,The Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Pascale Guitera
- The Melanoma Institute of Australia, New South Wales, Australia.,Medical School of The University of Sydney, Sydney, New South Wales, Australia.,The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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3
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Hypothetical Mechanism of Skin Argyria. COATINGS 2022. [DOI: 10.3390/coatings12040532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. Argyria is an acquired skin condition that appears after the exposure or consumption of silver, leading to blue or grey coloration of the skin and mucosa. The aim of the present work was to draw researchers’ attention to two aspects of the argyria that until now have not received enough consideration. They are: (1) the process of delivering silver compound from the gastrointestinal tract to the skin and (2) the possibility for silver chloride to participate in this process along with the silver proteinates. Methodology. Illustrative experiments included the observation of color change (visual and using UV-Vis spectrometry) under different light exposure conditions of silver chloride sol in a sweat-simulating solution, in vials and under pig skin (in direct contact). Results and Discussion. A hypothetical mechanism based on a perspiration system for delivering the silver compounds from the gastrointestinal tract to the skin for argyria was proposed. It was also proposed not to completely exclude the partial participation of silver chloride along with the silver proteinates in this process.
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4
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Cinotti E, Tognetti L, Cartocci A, Lamberti A, Gherbassi S, Orte Cano C, Lenoir C, Dejonckheere G, Diet G, Fontaine M, Miyamoto M, Perez‐Anker J, Solmi V, Malvehy J, del Marmol V, Perrot JL, Rubegni P, Suppa M. Line-field confocal optical coherence tomography for actinic keratosis and squamous cell carcinoma: a descriptive study. Clin Exp Dermatol 2021; 46:1530-1541. [PMID: 34115900 PMCID: PMC9293459 DOI: 10.1111/ced.14801] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early and accurate diagnosis of cutaneous squamous cell carcinomas (SCCs) and actinic keratoses (AK) is fundamental to reduce their associated morbidity and to select the correct treatment. Line-field confocal optical coherence tomography (LC-OCT) is a new imaging device that can characterize healthy skin and basal cell carcinoma, but no large studies on keratinocyte cell tumours have yet been published. AIM To identify and describe LC-OCT criteria associated with SCC and AK, and to compare LC-OCT findings in these tumours. METHODS A retrospective observational multicentre study was conducted. Lesions were imaged with the LC-OCT device before surgery and examined histologically. LC-OCT criteria for AK/SCC were identified and their presence was evaluated in all study lesions. Univariate and multivariate analyses were performed to compare AK and SCCs, and to investigate differences between in situ and invasive tumours. RESULTS In total, 158 patients with 50 AK and 108 SCCs (62 in situ and 46 invasive) were included. Cytological and architectural alterations were found in most lesions, and differences were found between AK and SCCs. Although the visualization of the dermoepidermal junction (DEJ) was often hampered by hyperkeratosis and acanthosis, an outlined DEJ without broad strands was observed in almost all AK and almost all in situ SCCs, but in only three invasive SCCs (P < 0.001) when the DEJ was detectable. CONCLUSION Our results suggest that LC-OCT can help clinicians in the identification of AK and SCC and their differentiation, providing a real-time and noninvasive examination. Further studies are needed to confirm our data.
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Affiliation(s)
- E. Cinotti
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - L. Tognetti
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - A. Cartocci
- Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - A. Lamberti
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - S. Gherbassi
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - C. Orte Cano
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - C. Lenoir
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - G. Dejonckheere
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - G. Diet
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - M. Fontaine
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - M. Miyamoto
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - J. Perez‐Anker
- Melanoma UnitHospital Clinic BarcelonaUniversity of BarcelonaBarcelonaSpain
- CIBER de Enfermedades RarasInstituto de Salud Carlos IIIBarcelonaSpain
| | - V. Solmi
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - J. Malvehy
- Melanoma UnitHospital Clinic BarcelonaUniversity of BarcelonaBarcelonaSpain
- CIBER de Enfermedades RarasInstituto de Salud Carlos IIIBarcelonaSpain
| | - V. del Marmol
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - J. L. Perrot
- Department of DermatologyUniversity Hospital of Saint‐EtienneSaint‐EtienneFrance
| | - P. Rubegni
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - M. Suppa
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
- Department of DermatologyInstitut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
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5
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Clinical and Forensic Aspects of the Different Subtypes of Argyria. J Clin Med 2021; 10:jcm10102086. [PMID: 34068024 PMCID: PMC8152497 DOI: 10.3390/jcm10102086] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/29/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
Argyria encompasses the different cosmetic alterations that can develop if enough silver particles deposit in a specific tissue, typically in the skin, ranging from localized dark-blue macules to a generalized slate-gray/bluish tinge following systemic absorption. This work aims to fully review the state of the art regarding pathophysiology, diagnosis, treatment, and relevant clinical and forensic features of argyria. Argyria has been diagnosed in a wide range of ages, both sexes and varied ethnicities, with no known individual predisposing factors. Ultraviolet radiation with subsequence increases of melanin production aggravates the discoloration due to a reduction in the silver deposits. Physical examination and silver exposure in the anamnesis can be highly suggestive of the diagnosis, but a histopathological analysis with Energy-Dispersive X-ray Spectroscopy is required to unequivocally determine the discoloration etiology. Safe and effective treatment has only been accomplished with laser techniques, though only a few cases have been reported and with limited follow-up time. In conclusion, argyria typically has an occupational or iatrogenic etiology. It should be suspected when a patient presents with typical skin or eye lesions. A seemingly viable treatment modality, with laser technology, is finally within the horizon.
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Abstract
ABSTRACT A case of localized argyria in a 36-year-old female jeweler is described who presented with 2 discrete and asymptomatic bluish-black pigmented macules on the pulp of her left middle finger. A skin biopsy from both lesions demonstrated deposition of brown/black pigmented granules along the basement membrane zone of eccrine glands, blood vessels, nerves, and the dermo-epidermal junction fully in keeping with silver deposition. In addition, there was yellow-brown deposition seen within the interstitial dermis mimicking an early form of ochronosis, so called "pseudo-ochronosis." This latter feature is rarely described in cases of argyria. Transmission electron microscopy and energy dispersive x-ray spectroscopy confirmed the presence of electron dense particles up to 150 nm in diameter and the presence of silver, respectively. On further questioning, the patient had a history of localized and chronic exposure to silver, which specifically involved holding and manipulating silver wires and rings over the left middle finger. This case highlights an unusual and rare presentation of localized argyria in a jeweler. In addition, our case showed preferential silver deposition on dermal elastic fibers which has not been previously described in the literature.
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7
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Cinotti E, Bruzziches F, Habougit C, Berot V, Tognetti L, Rubegni P, Perrot JL. Fulguration-induced tattoo. Clin Exp Dermatol 2020; 45:911-912. [PMID: 32415991 DOI: 10.1111/ced.14288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 11/27/2022]
Affiliation(s)
- E Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - F Bruzziches
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - C Habougit
- Department of, Pathology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - V Berot
- Departments of, Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - L Tognetti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - P Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - J L Perrot
- Departments of, Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
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8
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Fuchs CSK, Ardigo M, Haedersdal M, Mogensen M. In Vivo Reflectance Confocal Microscopy of Gold Microparticles Deposited in the Skin. A Case Report on Cutaneous Chrysiasis. Lasers Surg Med 2019; 52:13-16. [PMID: 31709601 DOI: 10.1002/lsm.23179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 11/10/2022]
Abstract
Cutaneous chrysiasis is gold deposition in the dermis, described after parenteral administration of gold salts or after topical exposure to gold-containing materials. Gold microparticles (GMPs) have versatile therapeutic effects and are increasingly used in medicine. This case report describes the development of a blue-gray macule following the facial application of GMPs and laser treatment of acne vulgaris. Dermoscopy showed a nonspecific homogenous blue-gray pattern, gradually fading over an 8-month-period. Reflectance confocal microscopy (RCM) detected hyperreflective, subcellular particles in the papillary dermis, localized around hair follicles, eccrine glands, and inside macrophages. Histopathological evaluation, darkfield illumination with hyperspectral imaging, and neutron activation analysis confirmed the presence of GMPs in the dermis. RCM allowed non-invasive fast visualization of aggregates of hyperreflective particles in the dermis and can potentially be used for monitoring localized cutaneous chrysiasis and other metal deposition conditions over time. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Christine S K Fuchs
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, DK-2200, Denmark
| | - Marco Ardigo
- Clinical Dermatology Department, San Gallicano Dermatological Institute-IRCCS, Rome, 00144, Italy
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, DK-2200, Denmark
| | - Mette Mogensen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, DK-2200, Denmark
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Isak V, Beerli T, Cozzio A, Flatz L. A Rare Case of Localized Argyria on the Face. Case Rep Dermatol 2019; 11:23-27. [PMID: 31043936 PMCID: PMC6477469 DOI: 10.1159/000494610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/16/2018] [Indexed: 12/04/2022] Open
Abstract
Due to its antibacterial actions, silver sulfadiazine is widely used as a topical agent in the treatment of wounds, including burns. Widespread or prolonged topical application of silver sulfadiazine dressings can lead to argyria including systemic symptoms due to the resorption of silver. Here, we report a patient experiencing localized argyria due to sunlight exposure after topical use of silver sulfadiazine cream on his face.
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Affiliation(s)
- Verena Isak
- Department of Dermatology, Venerology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Tobias Beerli
- Department of Dermatology, Venerology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Antonio Cozzio
- Department of Dermatology, Venerology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Lukas Flatz
- Department of Dermatology, Venerology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Lacarrubba F, Ardigò M, Di Stefani A, Verzì AE, Micali G. Dermatoscopy and Reflectance Confocal Microscopy Correlations in Nonmelanocytic Disorders. Dermatol Clin 2018; 36:487-501. [PMID: 30201157 DOI: 10.1016/j.det.2018.05.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dermatoscopy and in vivo reflectance confocal microscopy are noninvasive techniques that provide a horizontal approach, with an en face view of the skin structures. Both techniques assist in the clinical diagnosis of a variety of inflammatory and infectious cutaneous disorders. In many cases, they have shown concordance. Their combined use represents, in several instances, a promising option to reach the final diagnosis without the need for invasive procedures.
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Affiliation(s)
- Francesco Lacarrubba
- Dermatology Clinic, University of Catania, Via Santa Sofia 78, Catania 95123, Italy.
| | - Marco Ardigò
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, Rome, Italy
| | | | - Anna Elisa Verzì
- Dermatology Clinic, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Giuseppe Micali
- Dermatology Clinic, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
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11
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Alternative uses of dermoscopy in daily clinical practice: An update. J Am Acad Dermatol 2018; 79:1117-1132.e1. [PMID: 29920317 DOI: 10.1016/j.jaad.2018.06.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/30/2018] [Accepted: 06/11/2018] [Indexed: 01/06/2023]
Abstract
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.
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