The use of dermoscopy for the diagnosis of plantar wart

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.

Pulsed dye laser versus Nd:YAG laser in the treatment of recalcitrant plantar warts: an intraindividual comparative study

Plantar warts are common cutaneous lesions caused by the human papillomavirus. Treatment of recalcitrant plantar warts stays a continuous challenge, and they are more refractory to treatment than common warts. To compare the efficacy of Long-Pulsed neodymium: yttrium-aluminum-garnet (Nd:YAG) laser versus pulsed dye laser (PDL) on the therapy of multiple recalcitrant plantar warts. Thirty patients with recalcitrant plantar warts were included in the current study. Half the number of warts were treated by PDL in each patient, while the other half were treated by Nd:YAG. Laser sessions were applied every 2 weeks for a maximum of six sessions. Patients were followed up both clinically and using dermoscopy. There was a complete clearance of warts in 20 patients (66.7%) with Nd:YAG laser and 19 patients (63.3%) with PDL with no statistically significant difference between both types of lasers. Pain during laser sessions was higher with Nd:YAG laser PDL and it was statistically significant (p = .0001). Both Nd:YAG laser and PDL showed efficacy and safety for the treatment of recalcitrant plantar warts. The use of dermoscopy adds great value in evaluating treatment response and in decreasing the incidence of recurrence.

Dermoscopy Features of Cutaneous Warts

Background

Cutaneous warts are benign epithelial skin lesions, caused by human papilloma virus (HPV). These warts can affect any part of the body, and the clinical presentation of cutaneous warts is highly variable, making it difficult to diagnose. Dermoscopy is a relatively new, non-invasive, diagnostic tool, which can assist in the identification of different types of skin lesions.

Purpose

The purpose of this research article is to determine the effectiveness of dermoscopy in discerning the most common characteristics of cutaneous warts, in order to provide sufficient information on characteristic features of cutaneous warts, which may aid in differentiating cutaneous warts from other similar skin lesions.

Patients and Methods

A total of 104 patients diagnosed with warts were included in our study. Each individual case had one of the four different types of warts: common warts (26 cases), palmer warts (27 cases), plantar warts (25 cases), flat warts (26 cases).

Results

In this study, we found that a percentage of cutaneous warts appear clinically nonclassical, overlapping with other lesions. A 42% (11 cases) of common warts were clinically nonclassical, and all of these cases presented with papillomatous growth. Other presentations were dotted, linear vessels, hairpin-like vessels and bleeding spots. All palmar wart cases were classical, while 8% (2 cases) of plantar warts were clinically nonclassical. The dermoscopic presentations were papillomatous growth, bleeding spots, dotted and linear vessels, structureless yellowish-gray appearance. Flat wart consisted of 11.5% (3 cases) with nonclassical clinical presentation. The dermoscopic presentation includes dotted and linear vessels, bleeding spots. Red, whitish (pale) and red-gray backgrounds.

Conclusion

Dermoscopy can improve the accuracy of diagnosing different types of clinically nonclassical cutaneous warts, as well as help in distinguishing them from other similar skin lesions.

Diagnostic techniques in HPV infections and the need to implement them in plantar lesions: A systematic review

INTRODUCTION

Human papillomavirus has been reported as the etiological cause of most cervical cancers and other potentially malignant lesions. It also affects other areas, producing benign tumors on the skin. Plantar warts are a common problem found in clinical practice and share signs and symptoms with other dermatological conditions. Diagnosis of HPV infection remains a hot topic in research.

METHOD

The present work systematically reviews the literature on the diagnostic techniques available in the clinical setting for any type of lesion produced by the virus and compares the techniques identified to those found in use for foot lesions.

RESULTS

Results showed a variety of diagnostic methods, including molecular techniques, which exhibit more sensitivity than other methods but are less frequently applied to plantar lesions, where visual inspection is the most frequent method but can lead to errors.

CONCLUSION

The techniques identified need to be applied to plantar lesions to improve differential diagnosis in clinical practice.

EXPERT OPINION

Research will continue to grow and a proper diagnostic technique for plantar lesions will be available in the near future.

Plantar Verruca and Dermoscopy: An Update

Traditionally, plantar warts or verrucae are often diagnosed by visual appearance and the lateral squeeze test. At times, these methods are not able to elucidate the difference between a plantar wart and a callus. The use of the dermatoscope can not only distinguish the difference between a wart and a callus, which ultimately helps to customize treatment plans to increase efficacy, but also be used to follow the therapeutic effects of treatment. The dermatoscope is a tool that can be used in the diagnosis of plantar verrucae and in assessment of the success of therapy.

A Dermoscopic Study of Cutaneous Warts and Its Utility in Monitoring Real-Time Wart Destruction by Radiofrequency Ablation

Context:

Cutaneous warts can affect up to 7–12% of the general population. Usually diagnosed clinically, there may be diagnostic dilemmas in atypical presentations or immunocompromised patients. Radiofrequency ablation is a common method of treatment of warts, but recurrences occur due to incomplete removal. Dermoscopy has been used in the diagnosis of various infectious dermatoses including warts.

Aims:

The study aimed to assess dermoscopic features of various types of viral warts and its efficacy in monitoring the treatment response following radiofrequency ablation.

Settings and Design:

Prospective non-comparative descriptive study in a tertiary care centre.

Subjects and Methods:

A prospective study was conducted comprising 60 patients with clinically diagnosed, previously untreated warts, including common warts, plane warts, palmar and plantar warts. Dermoscopic features of a representative lesion were evaluated in terms of definition, background color, vascularity, surrounding halo, dermatoglyphics, and presence of hemorrhage or crust. It was done at baseline and immediately after radiofrequency ablation of the wart to observe for complete removal of wart.

Results:

Most common dermoscopic features observed were presence of papillae surrounding haloes (61.67%), vascularity (dots>globules>linear vessels>loops; 58.33%), interrupted skin lines (51.67%), and brown colored background (48.3%). Nine cases (15%) demonstrated incomplete removal of the wart that was not visible with the naked eye and picked up only on dermoscopy. On follow up, at 6 months there were four recurrences (6.67%).

Conclusion:

Dermoscopy shows consistent features in the examination of warts. This can be a quick clinical aid in distinguishing it from close differentials. It is also valuable in reviewing the lesion real time after any ablative procedure to check if it has been removed in its entirety.

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.

Efficacy and safety of intralesional injection of vitamin D3 versus tuberculin PPD in the treatment of plantar warts: A comparative controlled study

BACKGROUND

Several destructive and immunotherapeutic methods are used in treatment of plantar warts, but an effective method with no or reduced recurrence has not been found till now.

OBJECTIVES

To evaluate the efficacy and safety of intralesional (IL) vitamin D₃ (Vit.D₃ ) injection vs IL tuberculin purified protein derivative (PPD) injection in the treatment of plantar warts.

METHODS

Sixty patients with plantar warts were randomized into 3 equal groups: group I treated using IL tuberculin PPD every 2 weeks, group II treated using IL Vit.D₃ every 4 weeks, and group III treated with IL saline every 2 weeks till complete clearance or for a maximum of 3 sessions. The follow-up period was 6 months.

RESULTS

There was a statistically significant improvement in therapeutic groups than control with more significant improvement in group II than I. Regarding number of sessions required for complete response, there was a positive significant correlation in both groups, but more significant in group I. There was a negative correlation between the number of lesions and the response to treatment in both groups. Group II showed significantly better response to treatment in male patients. Both modalities were well tolerated, with no remarkable side effects and no recurrence in cured patients of both groups.

CONCLUSIONS

Both IL PPD and Vit.D₃ injection are safe and effective for treatment of plantar warts even recalcitrant or multiple, with no postprocedural downtime, better results, and patient satisfaction. IL Vit.D₃ injection has a superior advantage than PPD.

A practical review of dermoscopy for pediatric dermatology part II: Vascular tumors, infections, and inflammatory dermatoses

In addition to the evaluation of melanocytic growths (Part I), dermoscopy is helpful in the identification and management of vascular tumors, skin infections, and inflammatory conditions. In this practical review, we present the classic dermoscopic findings of the following: vascular tumors, infectious conditions (molluscum contagiosum, scabies, verruca vulgaris), inflammatory conditions (psoriasis, atopic dermatitis), juvenile xanthogranuloma, and nevus sebaceus.

Dermatoscopy of Parasitic and Infectious Disorders

The use of dermatoscopy in the diagnosis and management of parasitic and infectious skin disorders has been defined as entodermoscopy, and several studies have confirmed its advantages in dermatology. Dermatoscopic patterns of several parasitic, viral, and fungal skin infections have been identified and herein described. A noninvasive, fast, and accurate diagnosis plays an important role in containing the spread of contagious skin disorders.

Dermoscopic assessment of skin toxicities in patients with melanoma during treatment with vemurafenib

Introduction

The use of vemurafenib in melanoma has improved the survival of patients; however, it is associated with skin toxicities.

Aim

To assess skin toxicities by dermoscopy in patients treated with vemurafenib.

Material and methods

Eight patients with BRAF V600 mutation positive metastatic melanoma were examined dermoscopically during vemurafenib treatment. All skin lesions occurring during therapy were assessed clinically and dermoscopically using a hand-held dermoscope with polarised and non-polarised light. Skin lesions suspected for malignancy appearing during therapy were totally surgically excised with consecutive histopathological examination.

Results

All 8 examined patients developed skin toxicity. The majority of patients (7/8) presented G1 skin toxicity according to CTCAE version 4.3. Only 1 of them had G2 skin toxicity. The most common dermoscopy findings in our study were hyperkeratotic verrucas in 5 patients (5/8) with structureless pattern. In some of them we also observed central dots, exophytic proliferation, hairpin vessels and homogeneous haemorrhage. Other findings were hyperkeratosis of the nipples (5/8) with brownish to yellowish, angular clods with a tendency to be more confluent in dermoscopy. Palmar plantar erythrodysaesthesia (3/8) showed dermoscopically a yellowish, homogeneous pattern. Four melanocytic skin lesions in 2 patients were surgically excised due to suspected malignant transformation. In most of them we observed an atypical pigmented network (abrupt cut-off, big holes), atypical globules and a homogeneous blue pattern; however, histopathological diagnosis excluded any malignancy.

Conclusions

Dermoscopy seems to be an easily performed and valuable method for assessment of skin toxicities during oncological therapy, at any time of the treatment.

[Dermoscopy of nails]

Pigmented and nonpigmented nail abnormalities often represent a challenge for clinicians because many, and sometimes potentially life-threatening differential diagnoses must be taken into consideration. Although many details of nail diseases can already be assessed with the naked eye, dermoscopy opens up a second microscopic level of inspection, which can be very useful for the diagnostic process. In the last 20 years dermoscopy has made rapid progress in the further development of criteria for the early recognition of melanoma. In addition, the use of dermoscopy has been extended to the examination of cutaneous adnexa, such as hairs (trichoscopy) and nails (onychoscopy). Many, sometimes highly specific criteria for the dermoscopic assessment of nail diseases have been described in a series of recently published articles. This review article provides important diagnostic aids for a well-founded dermoscopic assessment of nail diseases.

When all you have is a dermatoscope- start looking at the nails

Pigmented and non-pigmented nail alterations are a frequent challenge for dermatologists. A profound knowledge of clinical and dermatoscopic features of nail disorders is crucial because a range of differential diagnoses and even potentially life-threatening diseases are possible underlying causes. Nail matrix melanocytes of unaffected individuals are in a dormant state, and, therefore, fingernails and toenails physiologically are non-pigmented. The formation of continuous, longitudinal pigmented streaks (longitudinal melanonychia) may either be caused by a benign activation of matrix melanocytes (e.g., as a result of trauma, inflammation, or adverse drug reactions) or by a true melanocytic proliferation (e.g., in a nevus or melanoma). In general, non-continuous nail alterations, affecting only limited parts of the nail apparatus, are most frequently of non-melanocytic origin. Important and common differential diagnoses in these cases are subungual hemorrhage or onychomycosis. In addition, foreign bodies, bacterial infections, traumatic injuries, or artificial discolorations of the nail unit may less frequently cause non-continuous nail alterations. Many systemic diseases that may also show involvement of the nails (e.g., psoriasis, atopic dermatitis, lichen planus, alopecia areata) tend to induce alterations in numerous if not all nails of the hands and feet. A similar extensive and generalized alteration of nails has been reported after treatment with a number of systemic drugs, especially antibiotics and cytostatics. Benign or malignant neoplasms that may also affect the nail unit include glomus tumor, Bowen's disease, squamous cell carcinoma, and rare collision tumors. This review aims to assist clinicians in correctly evaluating and diagnosing nail disorders with the help of dermatoscopy.