Dermoscopic features in nodular chromoblastomycosis

Successful management of chromoblastomycosis utilizing conventional antifungal agents and imiquimod therapy

Chromoblastomycosis (CBM), a chronic fungal infection affecting the skin and subcutaneous tissues, is predominantly caused by dematiaceous fungi in tropical and subtropical areas. Characteristically, CBM presents as plaques and nodules, often leading to scarring post-healing. Besides traditional diagnostic methods such as fungal microscopy, culture, and histopathology, dermatoscopy and reflectance confocal microscopy can aid in diagnosis. The treatment of CBM is an extended and protracted process. Imiquimod, acting as an immune response modifier, boosts the host's immune response against CBM, and controls scar hyperplasia, thereby reducing the treatment duration. We present a case of CBM in Guangdong with characteristic reflectance confocal microscopy manifestations, effectively managed through a combination of itraconazole, terbinafine, and imiquimod, shedding light on novel strategies for managing this challenging condition.

Dermoscopy of Bacterial, Viral, and Fungal Skin Infections: A Systematic Review of the Literature

Over the last three decades, the use of dermoscopy has been extended to inflammatory and infectious dermatoses. Regarding the latter, while the first applications concerned skin parasitoses, there has been a significant increase in the publication trend regarding nonparasitic dermatoses over recent years, yet data on this topic are sparse and often lack a standardized analytical approach. This systematic literature review summarizes published data on dermoscopy of bacterial, viral, and fungal dermatoses (dermoscopic findings, used setting, pathological correlation, and level of evidence of studies) and provides a homogeneous terminology of reported dermoscopic features according to a standardized methodology. A total of 152 papers addressing 43 different dermatoses and describing 184 different dermoscopic findings were included in the analysis. The majority of them displayed a level of evidence of V (107 single case reports and 40 case series), with only 5 studies showing a level of evidence of IV (case-control studies). Moreover, our analysis also underlined a high variability in the terminology used in published articles (even for the same dermatosis). Therefore, despite significant potential, future studies designed according to a systematic and standardized approach are required for a better characterization of dermoscopy of nonparasitic skin infections.

Accuracy of direct examination and culture as compared to the anatomopathological examination for the diagnosis of chromoblastomycosis: a systematic review

Background

Chromoblastomycosis is a skin infection caused by dematiaceous fungi that take the form of muriform cells in the tissue. It mainly manifests as verrucous plaques on the lower limbs of rural workers in tropical countries.

Objectives

The primary objective of this review is to evaluate the accuracy of diagnostic methods for the identification of chromoblastomycosis, considering the histopathological examination as the reference test.

Methods

MEDLINE, LILACS and Scielo databases were consulted using the terms “chromoblastomycosis” AND “diagnosis”. The eligibility criteria were: studies that evaluated the accuracy of tests for the diagnosis of chromoblastomycosis. Eleven studies were selected. Statistical analysis included the calculation of sensitivity and specificity of the diagnostic methods.

Results

Considering the histopathological examination as the reference test, the culture showed a sensitivity (S) of 37.5% - 90.9% and a specificity (Sp) of 100%; while direct mycological examination showed S =  50% - 91.6% and Sp of 100% . Considering the culture as the reference test, the serology (precipitation techniques) showed S  of 36% - 99%; and Sp  of 80% - 100%; while the intradermal test showed S  of 83.3% - 100% and Sp  of 99.4% - 100%.

Study limitations

The small number of studies and very discrepant sensitivity results among them do not allow the calculation of summary measures through a meta-analysis.

Conclusions

Direct mycological examination, culture, intradermal test and serology show sensitivity and specificity values ​​for the diagnosis of chromoblastomycosis with no significant difference between the studies.

Dermoscopy of skin infestations and infections (entomodermoscopy) - Part II: viral, fungal and other infections

In addition to the infestations and bacterial infections reported in part I, the study of entomodermoscopy also involves descriptions of dermoscopic findings of a growing number of viral and fungal infections, among others. In this article, the main clinical situations in viral infections where dermoscopy can be useful will be described, that is in the evaluation of viral warts, molluscum contagiosum, and even in recent scenarios such as the COVID-19 pandemic. As for fungal infections, dermoscopy is particularly important, not only in the evaluation of the skin surface, but also of skin annexes, such as hairs and nails. The differential diagnosis with skin tumors, especially melanomas, can be facilitated by dermoscopy, especially in the evaluation of cases of verruca plantaris, onychomycosis and tinea nigra.

The curious case of an elusive solitary plaque

A 60-year-old male patient presented with a solitary pink plaque over the inner aspect of the left forearm of 4 years duration. The lesion was persistent and unresponsive to treatment. A skin biopsy was done with differential diagnosis of lupus vulgaris, tuberculoid leprosy, and granuloma annulare. Histopathology revealed features suggestive of morphea and the patient was treated accordingly. Despite treatment, the lesion continued to grow in size and a repeat biopsy was done as clinical doubt regarding the diagnosis persisted. Dermoscopy, KOH wet mount, and histopathology revealed characteristic features that clinched the diagnosis and aided in correct management of the patient with complete clearance of lesion after 4 months of therapy.