Dermatoscopy of Inflammatory Diseases in Skin of Color

Pityriasis rosea: dermoscopic features in Uganda

PURPOSE

The study aimed to describe the dermoscopic features of pityriasis rosea among patients attending the skin clinic at Mbarara Regional Referral Hospital.

PATIENTS AND METHODS

A hospital-based cross-sectional descriptive study conducted for a 6-month period in the skin clinic of MRRH in Southwestern Uganda. Data were collected from consecutively recruited patients using structured questionnaires. Patients with a clinical diagnosis of pityriasis rosea were examined using a dermoscope and subsequently sent for KOH and TPHA tests to rule out fungal skin infection and secondary syphilis, respectively, and then received routine care at the skin clinic.

RESULTS

There were 54 patients with pityriasis rosea seen. Dermoscopy was done on a total of 162 lesions of which 19 were herald patches, 51 were truncal lesions, 52 on the extremities while 40 were on the face and neck regions. Common dermoscopic features consisted of a violaceous background noted in 145 (89.51%), white scales in 161 (99.38%), diffuse scale distribution in 57 (35.19%), perifollicular scale type in 61 (37.65%), and brown-dotted pigmentary changes in 66 (40.74%). Other unique findings noted in a few lesions were cloudy structures, petechial spots, erosions, and punched out pits.

CONCLUSION

Most prevalent dermoscopic features included: a violaceous background, white scales, diffuse scale distribution, perifollicular scale type, brown-dotted pigmentary changes with no visible blood vessels nor follicular changes. Other unique less frequently seen findings were cloudy structures, petechial spots, erosions, and punched out pits.

Dermoscopy of Inflammatory Dermatoses (Inflammoscopy) in Skin of Color - A Systematic Review by the International Dermoscopy Society "Imaging in Skin of Color" Task Force

Dermoscopic patterns of inflammatory dermatoses (inflammoscopy) have been extensively studied in the recent years, though data on patients with darker phototypes (IV-VI) are sparse. The aims of this systematic review were to summarize the current state of knowledge on inflammoscopy applied to skin of color and provide a standardized nomenclature of reported findings. Besides dermoscopic features, type of setting and magnification, number of cases, and histopathological correlation were analyzed. Eighty-five papers addressing 78 different dermatoses (25 papulosquamous dermatoses, 19 hyperpigmented dermatoses, eight hypopigmented dermatoses, four granulomatous dermatoses, two sclerotic dermatoses, five facial inflammatory dermatoses, and 15 miscellaneous conditions) for a total of 2073 instances were retrieved. Only one study showed a level of evidence of III (cross-sectional study), whereas 10 and 74 displayed a level of evidence of IV (case-control studies) and V (case-series and case-reports), respectively. Moreover, our analysis also highlighted that most of papers focalized on a limited number of dermatoses, with several conditions having only single dermoscopic descriptions. Additionally, few studies compared findings among phototypes belonging to the "skin of color" spectrum. Further studies designed according to a systematic approach and considering the above-mentioned issues are therefore needed.

[Dermoscopy of nonneoplastic diseases in dark skin]

BACKGROUND

Dermoscopy is an important tool in general dermatology.

OBJECTIVES

To show differences of light and dark skin in nonneoplastic diseases with focus on dermoscopy.

MATERIALS AND METHODS

Using previously published studies, dermoscopic differences of various skin types as well as features of inflammatory diseases and pigmentary changes are illustrated.

RESULTS

Certain structures are more difficult to assess in dermoscopy of dark skin (e.g., vessels), while other structures (e.g., follicular openings) are more prominent.

CONCLUSIONS

The majority of studies on dermoscopy are from studies that predominantly included individuals with fair skin types. Further studies of individuals with skin type IV or higher are needed to improve diagnosis in these patients.

International Dermoscopy Society criteria for non-neoplastic dermatoses (general dermatology): validation for skin of color through a Delphi expert consensus

BACKGROUND

The International Dermoscopy Society (IDS) recently released a set of five basic dermoscopic parameters (vessels, scales, follicular findings, "other structures," and specific clues) encompassing a total of 31 subitems to standardize the use of dermoscopy in non-neoplastic dermatoses, yet they have been developed taking into account Caucasian/Asian skin, with consequent possible limitations if used in dark skin.

OBJECTIVES

To validate the abovementioned criteria for the use in dark-skinned patients (phototypes IV-VI) through an expert consensus.

METHODS

The two-round Delphi method was adopted, with an iterative process consisting of two rounds of email questionnaires. Potential panelists were recruited via e-mail from all over the world based on their expertise on dermoscopy of non-neoplastic dermatoses in skin of color.

RESULTS

Twenty-two panelists took part in the validation process. All of the five originally proposed parameters and subitems reached agreement during the first round, aside from "follicular red dots." Additionally, during round 1, five new subitems were proposed (perifollicular scales distribution, follicular openings obliteration, broken hairs, eccrine pigmentation, and eccrine ostia obliteration), along with the possibility to change the denomination of parameter 3 (from "follicular findings" to "follicular/eccrine findings") and split it into two subparameters ("follicular findings" and "eccrine findings"). All such proposals reached agreement during the second round and therefore were included in the final list, for a total of 37 items.

CONCLUSIONS

Although nearly all the dermoscopic criteria originally proposed by the IDS are applicable even to darker phototypes, several additional variables need to be assessed.