Bonbon toffee sign: a new dermatoscopic feature for sebaceous hyperplasia

Efficient Topical Treatment of Canine Nodular Sebaceous Hyperplasia with a Nitric Acid and Zinc Complex Solution

Nodular sebaceous gland hyperplasia in the often middle-aged to old dog is a common, benign proliferation that results in exophytic, pink to yellow, alopecic, and often multilobulated nodules. Removal is usually carried out by surgical excision. As many old dogs have comorbidities that increase the risk of anesthesia, a topical treatment is warranted. We hypothesized that the application of a solution containing nitric acid, zinc, copper, and organic acids (Verrutop®), would be a safe and efficient way to treat these nodules. Eleven dogs with a total of 29 nodules, grossly compatible with nodular sebaceous gland hyperplasia, were included in the study. Eighteen of the nodules were treated; 11 were left untreated. No anesthesia or sedation was needed. Four weeks after one application, 17/18 treated nodules had decreased by 100% in volume. There was a statistically significant difference in percentual volume change between the treated and untreated nodules from day 0 to day 28 (p < 0.0001). No serious side effects were noted. Sebaceous hyperplasia cannot always be distinguished grossly from sebaceous tumors. Cytological evaluation can be helpful, and in cases of deviant macroscopic features, local recurrence, or more aggressive behavior, the appropriate intervention would be to biopsy or excise the nodule for histopathology. Topical application of Verrutop® is an easy, low-cost, and efficient way to remove canine sebaceous gland hyperplasia with minimal side effects in cases where surgery and anesthesia are not desired.

Healing Process after High-Intensity Focused Ultrasound Treatment of Benign Skin Lesions: Dermoscopic Analysis and Treatment Guidelines

Background: High-Intensity Focused Ultrasound (HIFU) has emerged as a precise and non-invasive modality for tissue ablation and healing. This study presents a detailed dermoscopic analysis of skin healing post-High-Intensity Focused Ultrasound (HIFU) treatment, focusing on common benign skin lesions, such as seborrheic keratosis, sebaceous hyperplasia, vascular lesions, and sebaceous nevi. Methods: Prior to HIFU treatment, a comprehensive assessment was conducted, integrating ultrasound scanning and clinical evaluations. The TOOsonix System ONE-M was employed for HIFU treatments, with parameters tailored to each lesion type. Results: A common pattern observed across all lesions includes initial whitening post treatment, followed by scab formation and the development of a pink area with reparative vessels. This study, however, highlights distinct differences in fibrosis patterns and healing timelines across different lesion types. Each lesion type exhibited unique fibrosis patterns post treatment. Flatter variants of seborrheic keratosis healed within a month, displaying hypopigmentation and reparative vessels, alongside a distinct lattice fibrosis pattern in more verrucous forms, which took about two months to heal. Sebaceous hyperplasia, characterized by rapid healing within three weeks, demonstrated fibrosis with pink areas and perpendicular white lines, concluding with a slight depression. Vascular lesions varied in healing time based on depth, with superficial ones showing whitening and crust formation, while deeper lesions had vessel occlusion and size reduction accompanied by concentric fibrotic bands. Sebaceous nevi presented the longest healing duration of three months, characterized by amorphous white-gray structures, scab formation, and the emergence of pink areas with branching vessels, leading to clear skin with reduced white lines. Conclusions: in conclusion, this meticulous clinical evaluation highlights the unique healing characteristics and timelines for each skin lesion type treated with HIFU. These insights are invaluable for optimizing follow-up assessments, identifying potential complications, and refining treatment protocols. By providing detailed insights into the healing timelines and patterns for different types of lesions, patients can be better informed about their post-treatment journey.

Dermoscopic features of benign sebaceous proliferations in dogs: Description, assessment and inter-observer agreement

BACKGROUND

Dermoscopy is a useful, noninvasive technique also used to assess sebaceous lesions in humans. Sebaceous hyperplasia, sebaceous adenoma and sebaceous epithelioma are common cutaneous lesions in dogs; however, their dermoscopic features have not been investigated.

HYPOTHESIS/OBJECTIVES

The objectives of this study are to describe the dermoscopic features of canine sebaceous lesions and to assess the interobserver agreement on dermoscopic parameters.

ANIMALS

Thirty-four lesions excised from 17 client-owned dogs, histologically confirmed as sebaceous proliferations, were included in this study.

MATERIALS AND METHODS

Sebaceous lesions were evaluated in vivo at ×10 magnification with a handheld dermoscope. Each dermoscopic image was assessed independently by two ECVD board-certified veterinary referral clinicians and an ECVD resident.

RESULTS

Thirty sebaceous hyperplasias, two sebaceous adenomas and two sebaceous epitheliomas were included. Dermoscopically, most lesions (91%) had single or multiple, well-defined, white-yellowish structures composed of grouped ovoid areas (clods). Irregular linear and, less commonly, arborising vessels were detected at the periphery of the yellow lobular-like structures in 93% of sebaceous hyperplasias and in 50% of neoplastic lesions. Erosions were seen in 6% of sebaceous hyperplasias and 50% of neoplastic lesions. Good interobserver agreement was found for white/yellowish clods (k = 0.75), yellow scales (k = 0.83), brown/grey dots (k = 0.80), erosions (k = 0.82) and red/brownish scales/crusts (k = 0.75). There was moderate agreement for fissures (k = 0.48) and vascular pattern (k = 0.51-0.53).

CONCLUSIONS AND CLINICAL RELEVANCE

Dermoscopy represents a useful technique to assess sebaceous gland proliferations in dogs, as it is in humans.

Detection of sebaceous gland hyperplasia with dermoscopy and reflectance confocal microscopy

Background

Sebaceous gland hyperplasia (SGH) is a benign cutaneous proliferation of the sebaceous glands that are mostly present on the face or the neck of older adults. They typically appear as single or multiple soft umbilicated papules; however, in challenging cases, it can be difficult to distinguish them from trichoepitheliomas, base cell carcinomas, or other tumors. Although pathological results have diagnostic value, the significance of non-invasive examinations in diagnosis and differential diagnosis is also worth exploring.

Objectives

This study aimed to describe the dermoscopic and reflectance confocal microscopy (RCM) features of SGH.

Methods

A total of 31 patients diagnosed with SGH, according to clinical and histopathological standards, were examined using dermoscopy and RCM between March 2018 and January 2022.

Results

Dermoscopically, lesions revealed a yellowish-red background and a faint-yellow background in 25 (80.65%) and six cases (19.35%), respectively. White-yellowish lobulated structures in the center of the lesion were present in 31 patients (100%) and umbilications in 19 patients (61.29%). Crown vessels at the periphery of the lesions were observed in 11 patients (35.48%), whereas irregular linear vessels were observed on the surface of the lesions in 18 patients (58.06%). Under RCM, all lesions presented a honeycomb pattern in the epidermis and the typical morulae-shaped sebaceous lobules in the dermis. A dilated follicular infundibulum was observed in 15 patients (48.39%) and dilated vessels in 26 patients (83.87%).

Conclusion

Dermoscopy and RCM enabled us to describe the imaging features of SGH. Combining these two useful tools provides a non-invasive basis for accurate clinical diagnosis.

Dermoscopy of cutaneous adnexal tumors: a systematic review of the literature

Cutaneous adnexal tumors (ATs) encompass a variegated group of hamartomas and benign or malignant tumors, originating from the hair follicle, sebaceous, eccrine or apocrine glands that may simulate other cutaneous neoplasms. This study aims to provide a comprehensive overview of the spectrum of clinical and dermoscopic features of ATs, to better define these lesions and assist in differential diagnosis. We performed a two-step systematic search of literature in PubMed, Embase, and Cochrane Library databases from inception until September 4, 2020. In the first step we aimed to define histological variants of ATs with descriptions of dermoscopic criteria. The second step included a search for the name of each previously identified AT variants in the same databases adding "AND (epilum* or dermosc* or dermatosc*)". All study types in English-language reporting dermoscopic images of ATs were included. Collisions between ATs and other inflammatory or neoplastic skin lesions were excluded, with the exception of collisions with a sebaceous nevus. The protocol of this study was prospectively registered in PROSPERO (CRD42021244677). In total, 206 articles met our inclusion criteria, encompassing 372 ATs in 365 patients. Most ATs were apocrine-eccrine (n=217, 58.3%, n=173 benign) with a prevalence of poromas (n=82), followed by follicular ATs (n=88, 23.7%, n=83 benign) and sebaceous ATs (n=67, 18.0%, n=49 benign). Most patients had a single AT lesion (320, 86.0%), while 42 (11.3%) had multiple ATs. A syndrome causing multiple ATs was identified in 15 patients. Histopathological analysis revealed 82% benign (n= 305) and 18.0% malignant (n=67). ATs were classified according to their ability to mimic 4 groups of more common skin tumors: basal cell carcinoma, squamous cell carcinoma, melanocytic lesions and benign cutaneous lesions. Moreover, we have highlighted the ability of malignant variants of ATs to simulate benign skin lesions. This systematic review offers a comprehensive overview of the common clinical and dermoscopic features of follicular, sebaceous and apocrine-eccrine ATs and details possible differential dermoscopic features.

Premature or nevoid sebaceous hyperplasia? Two case reports of a rare disease

Early or familial cases of sebaceous hyperplasia (SH) with multiple lesions, thought to be associated with genetic predisposition, have been reported in young individuals. Rarely reported variants include the giant, diffuse, zosteriform, and/or linear (nevoid) form. However, premature SH, defined as benign proliferation of sebaceous glands that occurs during or after puberty, is histologically similar to SH. Whether the definitions of nevoid SH or premature SH are the same remains unclear. We report two sporadic cases of premature SH.

Dermoscopy of Adnexal Tumors

Cutaneous adnexal tumors include lesions with apocrine, eccrine, follicular, sebaceous, and mixed differentiation. Most are benign and sporadic, although malignant forms are occasionally observed and some cases develop in the setting of inherited syndromes. These tumors often cause immense diagnostic difficulty. Dermoscopy is a noninvasive technique that has greatly improved the diagnostic accuracy of different skin lesions, including these tumors. We provide a review of the literature on the dermoscopic structures and patterns associated with adnexal tumors. Most patterns associated with this kind of tumor are nonspecific and are observed in other nonadnexal tumors, especially in basal cell carcinomas.

Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy

BACKGROUND

Evolving dermoscopic terminology motivated us to initiate a new consensus.

OBJECTIVE

We sought to establish a dictionary of standardized terms.

METHODS

We reviewed the medical literature, conducted a survey, and convened a discussion among experts.

RESULTS

Two competitive terminologies exist, a more metaphoric terminology that includes numerous terms and a descriptive terminology based on 5 basic terms. In a survey among members of the International Society of Dermoscopy (IDS) 23.5% (n = 201) participants preferentially use descriptive terminology, 20.1% (n = 172) use metaphoric terminology, and 484 (56.5%) use both. More participants who had been initially trained by metaphoric terminology prefer using descriptive terminology than vice versa (9.7% vs 2.6%, P < .001). Most new terms that were published since the last consensus conference in 2003 were unknown to the majority of the participants. There was uniform consensus that both terminologies are suitable, that metaphoric terms need definitions, that synonyms should be avoided, and that the creation of new metaphoric terms should be discouraged. The expert panel proposed a dictionary of standardized terms taking account of metaphoric and descriptive terms.

LIMITATIONS

A consensus seeks a workable compromise but does not guarantee its implementation.

CONCLUSION

The new consensus provides a revised framework of standardized terms to enhance the consistent use of dermoscopic terminology.

Yellow and orange in cutaneous lesions: clinical and dermoscopic data

Colour of the lesions is clue for the clinical and dermoscopic diagnosis. Nevertheless, we have detected in the literature an uneven relevance of the colours as a diagnostic criterion. Thus, while red, brown and blue have taken important role in dermoscopic descriptions, other like yellow and orange have been given much less importance. This article reviews those lesions in which the yellow and orange colours have been considered constitutive or essential for diagnosis, and on the other hand it emphasizes the entities in which may appear these colours and are not well reflected in the literature. We believe that organize all this information will help us in a better understanding of these pathologies.

Perioral lesions and dermatoses

The purpose of this article is to review the common neoplasms, infections, and inflammatory dermatoses that may present around or near the mouth. Dental professionals are well positioned to evaluate perioral skin conditions, further contributing to patients' general health. This article includes a review of seborrheic keratosis, warts, actinic keratoses, actinic cheilitis, and squamous cell carcinoma, among several other perioral cutaneous lesions.

Sebaceous lesions and their associated syndromes: part I

Sebaceous neoplasms have long been a source of confusion to dermatologists and pathologists alike. Disagreements regarding nomenclature, classification, and management have been longstanding. Sebaceous lesions represent a broad spectrum of interesting entities that range from hamartomas, hyperplasias, and benign tumors to highly malignant neoplasms. This article discusses the clinical and pathologic features of sebaceous hyperplasia, nevus sebaceous of Jadassohn, sebaceous adenoma, seboacanthoma, sebaceous epithelioma, sebaceoma, mantleoma, basal cell carcinoma with sebaceous differentiation, sebomatricoma (sebomatrixoma), and sebaceous carcinoma. Controversies regarding these lesions will be explored, and any relationship with Muir-Torre syndrome will be discussed.