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Wu Y, Sun L. Clinical value of dermoscopy in psoriasis. J Cosmet Dermatol 2024; 23:370-381. [PMID: 37710414 DOI: 10.1111/jocd.15926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/25/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Dermoscopy is a noninvasive technique that has attracted increasing attention in the field of inflammatory skin diseases (such as psoriasis) in recent years. OBJECTIVE This study aimed to provide an up-to-date overview of the role of dermoscopy in the diagnosis and extra-diagnosis of psoriasis. METHODS This study sought to review the published literature regarding use of dermoscopy in the evaluation of psoriasis. RESULTS The diagnostic value of dermoscopy in psoriasis vulgaris, nail psoriasis, and other types of psoriasis was summarized from the aspects of vascular pattern, scale pattern, and other features. Meanwhile, the application value of dermoscopy in the differential diagnosis, efficacy and severity assessment, prediction and monitoring of psoriasis was discussed. CONCLUSION Dermoscopy has good clinical value in the diagnosis and differential diagnosis of psoriasis and shows great prospects for severity assessment and efficacy prediction monitoring.
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Affiliation(s)
- Yifeng Wu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Liyun Sun
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
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Chessa MA, Rapparini L, Filippi F, Baraldi C, Piraccini BM, Neri I. Paradoxical Psoriasis: A Dermoscopic and Histopathologic Teaching Point. Dermatol Pract Concept 2024; 14:dpc.1401a13. [PMID: 38364375 PMCID: PMC10868953 DOI: 10.5826/dpc.1401a13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 02/18/2024] Open
Affiliation(s)
- Marco Adriano Chessa
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy
| | - Luca Rapparini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy
| | - Federica Filippi
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlotta Baraldi
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Iria Neri
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Chaduvula J, Chintada D, Vijayashree J, Chalamalasetty SS, Vudayana K, Vaggu A. A Clinico-Epidemiological Study of Hyperkeratotic Palmoplantar Lesions and Its Correlation With Dermoscopy and Histopathology in a Tertiary Care Center. Cureus 2023; 15:e36561. [PMID: 37102039 PMCID: PMC10123213 DOI: 10.7759/cureus.36561] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/28/2023] Open
Abstract
Introduction Hyperkeratotic lesions on the palms and soles are one of the most frequent clinical presentations encountered in dermatological practice, with a myriad of underlying etiologies that closely resemble one another and are clinically indistinguishable. Histopathological examination is the tool used by dermatologists to arrive at a final diagnosis, but it is invasive and not feasible under all circumstances. Dermoscopy is a new age, increasingly popular, noninvasive diagnostic technique of great value that is used to diagnose underlying etiology by acting as a bridge between clinical and histopathological pictures. This study aimed to evaluate the various etiologies underlying palmoplantar hyperkeratosis and the role of dermoscopy in the diagnosis of each disease along with its ability to delineate a close differential diagnosis and ensure appropriate treatment. Materials and methods This was a hospital-based observational cross-sectional study conducted from July 1 to December 31, 2022. Consenting patients with hyperkeratotic palmoplantar lesions on clinical examination attending the dermatology outpatient department at our tertiary care hospital were included after institutional ethical clearance was obtained. Patients with HIV, hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) infection, or a history of hyperkeratotic lesions since birth, i.e., inherited palmoplantar keratodermas, were excluded from the study. A total of 60 patients aged between 18 and 60 years who met the above criteria were included. A complete history was taken; a thorough examination was performed. Routine investigations and tissue histology were done. Potassium hydroxide (KOH) mount and patch testing were done as and when required. Dermoscopy with DermLite DL4 was performed in all cases on lesional areas, and the findings were noted. Results Palmoplantar psoriasis has been found to be the most common cause of hyperkeratosis in our study with 24 (40%) out of 60 cases, followed by chronic hand-foot eczema found in 19 (31%) cases. Dermoscopic findings that help in differentiating various etiologies are vascular findings and scaling types. Vascular findings, mainly regularly arranged dots and globules, were more prominent in palmoplantar psoriasis. Yellow white scaling was frequently observed in hyperkeratotic hand eczema. Most of the cases corresponded with their provisional diagnoses on histopathology, but four out of 19 histopathologically confirmed cases of eczema showed clinical resemblance to palmoplantar psoriasis, along with dermoscopic features of psoriasis. Two out of four cases of histopathologically confirmed palmoplantar LP were clinically considered palmoplantar psoriasis and hyperkeratotic hand-foot eczema. Conclusion Although hyperkeratoses of palms and soles are a common clinical entity, the similarity between the clinical features of the underlying conditions causes a diagnostic dilemma for treating dermatologists. Dermoscopy is a noninvasive, quick, reproducible, supportive investigation in the diagnosis of these conditions that certainly aids in reaching closer to a differential diagnosis and for better delineation, but it does not avert the need for a skin biopsy. Further confirmation with histopathological examination is advisable, especially in these conditions as they show close morphological similarity. A combination of all these investigations and clinical examinations gives better diagnoses and appropriate treatment.
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Affiliation(s)
- Jahnavi Chaduvula
- Department of Dermatology, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Dilipchandra Chintada
- Department of Dermatology, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Jami Vijayashree
- Department of Dermatology, Great Eastern Medical School and Hospital, Srikakulam, IND
| | | | - Kirankanth Vudayana
- Department of Dermatology, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Anandkumar Vaggu
- Department of Dermatology, Great Eastern Medical School and Hospital, Srikakulam, IND
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Pakornphadungsit K, Suchonwanit P, Thadanipon K, Visessiri Y, Rutnin S. Dermoscopic Features and Their Diagnostic Values Among Common Inflammatory and Infectious Dermatoses: A Cross-Sectional Study. Clin Cosmet Investig Dermatol 2023; 16:211-220. [PMID: 36718215 PMCID: PMC9884057 DOI: 10.2147/ccid.s397212] [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: 11/11/2022] [Accepted: 01/14/2023] [Indexed: 01/25/2023]
Abstract
Background Dermoscopy is a non-invasive tool widely used to improve the diagnostic accuracy of general dermatological conditions. Objective To determine the dermoscopic features and their diagnostic value in distinguishing common inflammatory and infectious dermatoses. Materials and Methods A cross-sectional study was conducted on patients clinically diagnosed with common inflammatory or infectious skin diseases. Baseline characteristics and clinical and dermoscopic findings were recorded. Dermoscopic variables were analyzed using a correlation matrix. A skin biopsy was performed for each patient for a definitive diagnosis. Results Of 102 patients, 43 with dermatitis, 30 with psoriasis, 14 with lichen planus (LP), 5 with pityriasis rosea (PR), and 10 with others were included. Dull red background, patchy vessels, and scales showed significant positive correlations with dermatitis (r = 0.401, 0.488, and 0.327, respectively; p < 0.01), whereas bright red background, glomerular vessels, regular vascular distribution, and diffuse scales revealed significant positive correlations with psoriasis (r = 0.412, 0.266, 0.798, and 0.401, respectively; p < 0.01). For LP, whitish reticulate structures, purplish background, and dotted vessels mixed with linear vessels in the peripheral distribution were significantly positively correlated (r = 0.831, 0.771, 0.224, and 0.558, respectively; p < 0.05). Yellowish background and peripheral scales were predictive of PR diagnosis (r = 0.254 and 0.583, respectively; p < 0.01). Conclusion Dermoscopy can be used as an adjunctive tool to differentiate conditions among common inflammatory and infectious dermatoses in order to minimize unnecessary invasive diagnostic procedures.
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Affiliation(s)
- Kallapan Pakornphadungsit
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kunlawat Thadanipon
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yingluck Visessiri
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suthinee Rutnin
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Correspondence: Suthinee Rutnin, Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, Thailand, 10400, Tel +66-2-2011141, Fax +66-2-201-1211 ext 4, Email
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Avcı EB, Erdemir VA, Erdem O, Işık R, Aksu AEK. Evaluation of serum vascular endothelial growth factor level and findings of nailfold capillaroscopy by dermatoscope in the differential diagnosis of palmoplantar psoriasis and palmoplantar eczema. Microvasc Res 2023; 145:104441. [PMID: 36195239 DOI: 10.1016/j.mvr.2022.104441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/09/2022] [Accepted: 09/23/2022] [Indexed: 02/03/2023]
Abstract
OBJECT This study aimed to evaluate VEGF level, capillaroscopic findings, and these features for differential diagnosis of palmoplantar psoriasis and eczema patients. METHODS This comparative cross-sectional study included 40 patients clinical and histopathologically diagnosed with eczema or psoriasis (20 psoriasis and 20 eczema) and 30 patients of similar age and gender without inflammatory disease in the control group. Serum samples of patients were collected and analyzed for VEGF by enzyme-linked immunosorbent assay (ELISA) and at the same time, we applied capillaroscopy with computerized dermatoscopy qualitatively and semiquantitatively. RESULTS In the qualitative evaluation, a decrease in capillary density and a significant increase of the avascular area was in palmoplantar plaque psoriasis (PPP) and palmoplantar eczema (PPE) patients compared to the control group. In the semiquantitative evaluation, the mean score decreased capillary density was significantly higher in PPE than in the PPP and control groups (p < 0.001). Minor morphological change (tortuous, crossed and enlarged capillary) scores were significantly higher in patients with PPE compared to PPP and control groups (p = 0.011). Major morphological change (mega, meandering, branching, bushy, bizarre, and disorganized polymorphic capillary) score was significantly higher in patients with PPP than PPE and the control group (p < 0.001). Major morphological change and m-PPPASI scores were correlated in PPP patients (p < 0.05). Disorganized capillaries in PPP patients were significantly higher than in the PPE and control groups (p < 0.001). There was no significant correlation between serum VEGF value and clinical severity and capillaroscopy findings of the patients. CONCLUSION Significant morphological changes were detected between PPP, PPE, and control groups in the qualitative and semi-quantitative evaluation of capillaroscopic findings. In the differential diagnosis of PPP and PPE, major morphological change, especially the presence of disorganized polymorphic capillaries, was considered an important finding in the capillaroscopic evaluation. These capillaroscopic findings may be helpful to discriminate eczema and psoriasis. However, there was no significant relationship between serum VEGF level and the patients' capillaroscopic findings and clinical severity.
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Affiliation(s)
- Elif Bal Avcı
- Department of Dermatology, Taksim Training and Research Hospital, Istanbul, Turkey.
| | - Vefa Aslı Erdemir
- Department of Dermatology, Göztepe Prof Dr Süleyman Yalçın City Hospital, Medeniyet University, Istanbul, Turkey
| | - Ozan Erdem
- Department of Dermatology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Reyhan Işık
- Department of Medical Biochemistry, Istanbul Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Ayşe Esra Koku Aksu
- Department of Dermatology, Istanbul Training and Research Hospital, Health Science University, Istanbul, Turkey
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Doshi B, Adabala S, Manjunathswamy BS. A cross-sectional study to assess the role of dermoscopy in differentiating palmar psoriasis, chronic hand eczema, and eczema in psoriatico. Indian Dermatol Online J 2022; 13:78-85. [PMID: 35198472 PMCID: PMC8809167 DOI: 10.4103/idoj.idoj_782_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 04/11/2021] [Accepted: 09/05/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Overlapping clinical features often make the differentiation between palmar psoriasis, hand eczema, and eczema in psoriatico a difficult task. In such cases, history and biopsy often aid in the diagnosis. Dermoscopy acts as a link between clinical dermatology and dermatopathology. Aim: To study the dermoscopic features in biopsy-proven cases of palmar psoriasis, hand eczema, and eczema in psoriatico. Methods: A 1-year cross-sectional study was conducted using a video dermatoscope, Dinolite premier AM4113ZT, on 60 patients having clinical diagnosis of either of palmar psoriasis, hand eczema, and eczema in psoriatico. Statistical analysis was performed using R i386 3.6.3 software. Results: Among 60 patients, 38 were psoriatics followed by 14 of eczema and 8 of eczema in psoriatico. On dermoscopy, characteristic features of psoriasis lesions were diffuse scaling in 76.3% (29/38), white scales in 60.5% (23/38), and dotted vessels in 76.3% (29/38) along with regular distribution of vessels in 71% (27/38); in hand eczema lesions, diffuse scaling in 78.5% (11/14), white and yellow scales in 57.1% (8/14), and dotted vessels in 78.5% (11/14) along with a patchy distribution of vessels in 57.1% (8/14); in eczema in psoriatico, diffuse scaling in 75% (6/8), white and yellow scales in 62.5% (5/8), and dotted vessels in 87.5% (7/8) along with regular distribution of vessels in 50% (4/8). Conclusion: The various patterns and combinations reflecting specific features give an insight into the cases of palmar psoriasis, hand eczema, and eczema in psoriatico on dermoscopy. However, a study with larger sample size is required to validate the findings of our study. Limitations: Inability to perform a patch test for eczema due to unavailability.
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