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Alorainy M, Buchanan K, Nussinow T, Rabinowitz JB, Cyr P, Seiverling EV. A Systematic Review of Diagnoses with Rosettes Under Dermoscopy. Dermatol Pract Concept 2024; 14:dpc.1402a125. [PMID: 38810026 PMCID: PMC11135967 DOI: 10.5826/dpc.1402a125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Rosettes are a cluster of shiny white dots in the shape of a four-leaf clover seen under polarized dermoscopic light. Historically, rosettes were primarily reported in actinic keratoses and squamous cell carcinoma. However, rosettes have also been reported in other conditions. OBJECTIVES The objective of this systematic review to elucidate the breadth of diagnoses exhibiting this unique dermoscopic phenomenon. METHODS A review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Literature searches were performed in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science, as well as a manual search of the reference lists of screened articles. RESULTS A total of 73 articles met the inclusion criteria. Out of these, 47 distinct diagnoses with rosette were identified. Among neoplastic conditions, keratinizing neoplasms had the highest number of articles reported (N = 19). Discoid lupus was the most commonly reported diagnosis within the inflammatory category (N = 6). Molluscum contagiosum was the predominant diagnosis among infectious entities (N = 3), while acroangiodermatitis was the sole diagnosis reported in the vascular category (N = 1). CONCLUSIONS These findings confirm rosettes are not specific to keratinocytic growths and are observed in a wide range of conditions. Knowledge of the breadth of conditions with rosettes may aid clinicians when developing a differential diagnosis of a growth or an eruption with rosettes under dermoscopy.
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Affiliation(s)
- May Alorainy
- Tufts University School of Medicine, Department of Dermatology, Boston, Massachusetts, USA
| | - Kendall Buchanan
- Medical College of Georgia at Augusta University, Department of Dermatology, Augusta, Georgia, USA
| | - Tyler Nussinow
- University of New England College of Osteopathic Medicine, Biddeford, Maine, USA
| | - Judy B. Rabinowitz
- Hirsh Health Science Library, Tufts University, Boston, Massachusetts, USA
| | - Peggy Cyr
- Maine Medical Center, Department of Family Medicine, Boston, Massachusetts, USA
- Tufts University School of Medicine, Department of Family Medicine, Boston, Massachusetts, USA
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Maya Betancourth JG, Rojas Cuervo MM, Castellanos Lorduy H, Gonzalez Gonzalez F. Reticular Erythematous Mucinosis as Differential Diagnosis of the Apple-Jelly Pattern on Dermoscopy: A Case Report. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00052-8. [PMID: 38311221 DOI: 10.1016/j.ad.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/22/2023] [Accepted: 08/07/2023] [Indexed: 02/10/2024] Open
Affiliation(s)
- J G Maya Betancourth
- Dermatología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - M M Rojas Cuervo
- Dermatología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - H Castellanos Lorduy
- Dermatología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - F Gonzalez Gonzalez
- Dermatología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
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Żychowska M, Kołcz K. Dermoscopy for the Differentiation of Subacute Cutaneous Lupus Erythematosus from Other Erythematous Desquamative Dermatoses-Psoriasis, Nummular Eczema, Mycosis Fungoides and Pityriasis Rosea. J Clin Med 2024; 13:577. [PMID: 38276083 PMCID: PMC10816082 DOI: 10.3390/jcm13020577] [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: 12/19/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Subacute cutaneous lupus erythematosus (SCLE) is a condition that might pose a diagnostic challenge. The aim of this study was to assess the usefulness of videodermoscopy in the differentiation of SCLE from other erythematous-desquamative dermatoses. Consecutive patients with SCLE (n = 27), psoriasis (n = 36), nummular eczema (n = 30), mycosis fungoides (n = 26), and pityriasis rosea (n = 20) referred to our Department of Dermatology were recruited for this study. A representative lesion was visualized using a Canfield D200EVO Videodermatoscope (Canfield Scientific GmbH, Bielefeld, Germany) and evaluated for the following parameters: vessels (morphology and distribution), scales (color and distribution), follicular findings, colors and morphologies, and presence of specific clues. SCLE was predominantly characterized by a polymorphous vascular pattern (92.6%) of unspecific distribution (92.6%) over a pink-red background (74.1%). Gray-brown dots were present in 10 (37.0%) cases, and pigmentation was noted in 15 (55.6%) patients, including peripheral pigmentation in 7 (25.9%) patients. Videodermoscopic evaluation showed significant differences between SCLE and psoriasis, which was characterized by regularly distributed dotted vessels. Although some common dermoscopic features with MF were noted, the presence of yellow structureless areas and red dots/globules favored the diagnosis of MF. In conclusion, a polymorphic vascular pattern, especially in association with gray-brown dots and/or peripheral pigmentation, is a valuable clue for the differentiation of SCLE from other erythematous-desquamative dermatoses.
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Affiliation(s)
- Magdalena Żychowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland
| | - Kinga Kołcz
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland
- The Doctoral School, University of Rzeszow, 35-959 Rzeszow, Poland
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Garcia B, Hasnaoui A, Ramdass PV. Lupus Erythematosus Tumidus Misdiagnosed as Erythema Nodosum from Coccidioidomycosis. Case Rep Dermatol 2024; 16:128-132. [PMID: 39015404 PMCID: PMC11250662 DOI: 10.1159/000538737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/03/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction Lupus erythematosus tumidus (LET) is a rare photosensitive dermatosis that is categorized as intermittent cutaneous lupus erythematosus. It shares clinical similarities and histopathological features with other skin disorders, such as erythema nodosum, lymphocytic infiltrate of Jessner, and reticular erythematous mucinosis, thus making diagnosis quite challenging. We present a patient with LET whose diagnosis was confirmed after seeing several doctors. Case Presentation A 52-year-old Hispanic female presented with tender erythematous nodules on her thighs for approximately 1 month. She was suspected of having erythema nodosum secondary to coccidioidomycosis and was prescribed fluconazole 200 mg for 30 days but showed no improvement. However, histopathological and direct immunofluorescence tests later confirmed a diagnosis of LET. The patient was treated with hydroxychloroquine, and the lesions improved remarkably after 2 weeks. Conclusion LET is a rare dermatosis that closely resembles other dermatologic conditions such as erythema nodosum, lymphocytic infiltrate of Jessner, and reticular erythematous mucinosis. Diagnosis based on clinical features alone should be avoided, and ideally, treatment should only be initiated after confirmatory histopathological testing.
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Affiliation(s)
- Brianae Garcia
- Department of Public Health and Preventive Medicine, St. George’s University School of Medicine, St. George, Grenada
| | - Anis Hasnaoui
- Visceral and Digestive Surgery, Medical School of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Prakash V.A.K. Ramdass
- Department of Public Health and Preventive Medicine, St. George’s University School of Medicine, St. George, Grenada
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Ürün YG, Ürün M, Danişman MŞ. Dermoscopic Characteristics of Cutaneous Lupus Erythematosus According to Subtype, Lesion Location, Lesion Duration, and CLASI Score. Dermatol Pract Concept 2024; 14:dpc.1401a40. [PMID: 38364410 PMCID: PMC10868886 DOI: 10.5826/dpc.1401a40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Dermoscopic findings are used to diagnose and evaluate disease activity in patients with cutaneous lupus erythematosus (CLE). OBJECTIVES This study aimed to characterize the dermoscopic features of discoid LE (DLE) and LE tumidus (LET) by lesion duration and CLE Disease Area and Severity Index (CLASI) scores and to examine the dermoscopic findings of lesions in different locations in DLE patients. METHODS Dermoscopic findings (follicular features, perifollicular surface, interfollicular features, and vessel pattern) were assessed and lesion duration (≤12 and >12 months) and CLASI scores (grouped as mild or moderate) were calculated. DLE lesion locations were categorized as, non-scalp, scalp and lip. RESULTS Forty-eight dermoscopic images from 35 DLE and 4 LET patients were analyzed. The most common dermoscopic findings in non-scalp DLE were follicular keratotic plugs (82.8%) and white scales (69%). In scalp DLE (n=9), the most common findings were absent follicular openings (77.8%), white structureless areas (77.8%), and perifollicular scaling (66.7%). All LET patients had pink-white background and linear vessels. Follicular plugs, peripheral pigmentation, and polymorphous vessels were lower in patients with mild CLASI activity than moderate activity (P = 0.036, 0.039, and 0.019, respectively). Fibrotic white dots, honeycomb pigment pattern, and blue-gray dots/globules were lower in those with mild CLASI damage scores than moderate damage (P = 0.010, 0.010, and 0.020, respectively). Peripheral pigmentation was more common in patients with lesion duration ≤12 months, while blue-gray dots/globules were more common with lesion durations >12 months. CONCLUSIONS Certain dermoscopic features may facilitate the differential diagnosis of DLE and LET.
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Affiliation(s)
- Yıldız Gürsel Ürün
- Departments of Dermatology and Venereology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Mustafa Ürün
- Departments of Dermatology and Venereology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Mehmet Şerif Danişman
- Departments of Dermatology and Venereology, Faculty of Medicine, Trakya University, Edirne, Turkey
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Sonego B, Sola S, Biondo G, Massone C. Two cases of granuloma faciale showing rosettes. Dermatol Reports 2023; 15:9696. [PMID: 37908606 PMCID: PMC10614554 DOI: 10.4081/dr.2023.9696] [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: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 11/02/2023] Open
Abstract
Granuloma faciale (GF) is a rare benign chronic inflammatory dermatosis often difficult to distinguish clinically from other diseases, both inflammatory and neoplastic. Dermoscopy can be a helpful diagnostic tool and indeed several dermoscopic criteria observed in GF have been described in literature. We present two patients affected by GF in which we have observed rosettes.
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Affiliation(s)
- Benedetta Sonego
- Dermatology Unit and Scientific Directorate, Galliera Hospital, Genoa
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste
| | - Simona Sola
- Surgical Pathology, Galliera Hospital, Genoa
| | - Giovanni Biondo
- Istituto Clinico Sant’Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Cesare Massone
- Dermatology Unit and Scientific Directorate, Galliera Hospital, Genoa
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Arasiewicz H, Kamińska-Winciorek G, Dec M, Leśniak-Jakubiec L. Successful treatment of a child's lupus erythematosus tumidus with antimalarials. Postepy Dermatol Alergol 2023; 40:581-583. [PMID: 37692277 PMCID: PMC10485747 DOI: 10.5114/ada.2023.130475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/24/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Hubert Arasiewicz
- Department of Dermatology and Vascular Anomalies, John Paul II Center of Pediatrics, Sosnowiec, Poland
| | - Grażyna Kamińska-Winciorek
- Department of Bone Marrow Transplantation and Onco-Hematology; Skin Cancer and Melanoma Team, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Michał Dec
- Department of Dermatology and Vascular Anomalies, John Paul II Center of Pediatrics, Sosnowiec, Poland
| | - Lilianna Leśniak-Jakubiec
- Department of Dermatology and Vascular Anomalies, John Paul II Center of Pediatrics, Sosnowiec, Poland
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Király Z, Róbert L, Joura MI, Hidvégi B. [Dermoscopy of granulomatous and autoimmune skin diseases]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:243-249. [PMID: 36881125 PMCID: PMC10049958 DOI: 10.1007/s00105-023-05123-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 03/08/2023]
Abstract
Dermoscopy is an easily accessible, noninvasive diagnostic tool, originally used in the differentiation of benign and malignant skin tumors. Other structures beside pigment content observed by dermoscopy, e.g., scaling, follicles, or vessels, may present in a specific pattern in different dermatoses. Recognition of these patterns may aid the diagnosis of inflammatory and infectious dermatological conditions. The aim of this article is to review the distinct dermoscopic features of granulomatous and autoimmune skin diseases. Diagnosis of granulomatous skin disorders is based on the histopathological examination. The dermoscopic picture of these diseases (cutaneous sarcoidosis, granuloma annulare, necrobiosis lipoidica, and granulomatous rosacea) show many similarities; however, there are some differences to note between the dermatoses, mainly in granuloma annulare. The cornerstones of the diagnostic process of autoimmune skin diseases (morphea, systemic sclerosis, dermatomyositis, cutaneous lupus erythematosus) include the clinical picture, immunoserology, and histology; however, dermoscopy may aid the diagnostic process and follow-up of the patients. For those diseases, where vascular abnormalities play an important role in the pathogenesis, videocapillaroscopy is used for examination of the microcirculation at the nailfold capillaries. Dermoscopy can be an easy-to-use everyday diagnostic tool in clinical practice regarding granulomatous and autoimmune skin diseases. Although punch biopsy is inevitable in many cases, the distinct dermoscopic structures can aid the diagnostic process.
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Affiliation(s)
- Zsófia Király
- Klinik für Dermatologie, Venerologie und Dermatoonkologie, Semmelweis Universität, Mária Straße 41, 1085, Budapest, Ungarn.
| | - Lili Róbert
- Klinik für Dermatologie, Venerologie und Dermatoonkologie, Semmelweis Universität, Mária Straße 41, 1085, Budapest, Ungarn
| | - Marie Isolde Joura
- Klinik für Dermatologie, Venerologie und Dermatoonkologie, Semmelweis Universität, Mária Straße 41, 1085, Budapest, Ungarn
| | - Bernadett Hidvégi
- Klinik für Dermatologie, Venerologie und Dermatoonkologie, Semmelweis Universität, Mária Straße 41, 1085, Budapest, Ungarn
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