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Dermoscopy in General Dermatology: A Practical Overview

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ABSTRACT

Over the last few years, dermoscopy has been shown to be a useful tool in assisting the noninvasive diagnosis of various general dermatological disorders. In this article, we sought to provide an up-to-date practical overview on the use of dermoscopy in general dermatology by analysing the dermoscopic differential diagnosis of relatively common dermatological disorders grouped according to their clinical presentation, i.e. dermatoses presenting with erythematous-desquamative patches/plaques (plaque psoriasis, eczematous dermatitis, pityriasis rosea, mycosis fungoides and subacute cutaneous lupus erythematosus), papulosquamous/papulokeratotic dermatoses (lichen planus, pityriasis rosea, papulosquamous sarcoidosis, guttate psoriasis, pityriasis lichenoides chronica, classical pityriasis rubra pilaris, porokeratosis, lymphomatoid papulosis, papulosquamous chronic GVHD, parakeratosis variegata, Grover disease, Darier disease and BRAF-inhibitor-induced acantholytic dyskeratosis), facial inflammatory skin diseases (rosacea, seborrheic dermatitis, discoid lupus erythematosus, sarcoidosis, cutaneous leishmaniasis, lupus vulgaris, granuloma faciale and demodicidosis), acquired keratodermas (chronic hand eczema, palmar psoriasis, keratoderma due to mycosis fungoides, keratoderma resulting from pityriasis rubra pilaris, tinea manuum, palmar lichen planus and aquagenic palmar keratoderma), sclero-atrophic dermatoses (necrobiosis lipoidica, morphea and cutaneous lichen sclerosus), hypopigmented macular diseases (extragenital guttate lichen sclerosus, achromic pityriasis versicolor, guttate vitiligo, idiopathic guttate hypomelanosis, progressive macular hypomelanosis and postinflammatory hypopigmentations), hyperpigmented maculopapular diseases (pityriasis versicolor, lichen planus pigmentosus, Gougerot-Carteaud syndrome, Dowling-Degos disease, erythema ab igne, macular amyloidosis, lichen amyloidosus, friction melanosis, terra firma-forme dermatosis, urticaria pigmentosa and telangiectasia macularis eruptiva perstans), itchy papulonodular dermatoses (hypertrophic lichen planus, prurigo nodularis, nodular scabies and acquired perforating dermatosis), erythrodermas (due to psoriasis, atopic dermatitis, mycosis fungoides, pityriasis rubra pilaris and scabies), noninfectious balanitis (Zoon’s plasma cell balanitis, psoriatic balanitis, seborrheic dermatitis and non-specific balanitis) and erythroplasia of Queyrat, inflammatory cicatricial alopecias (scalp discoid lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia and folliculitis decalvans), nonscarring alopecias (alopecia areata, trichotillomania, androgenetic alopecia and telogen effluvium) and scaling disorders of the scalp (tinea capitis, scalp psoriasis, seborrheic dermatitis and pityriasis amiantacea).

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Dermoscopy of discoid lupus erythematosus of the scalp varies according to the disease stage: active lesions may be mainly characterised by red dots (a) or follicular keratotic plugs (quite large yellowish/whitish dots) and thick arborising vessels (b), while long-lasting lesions commonly display loss of follicular openings, white areas and thin vessels (c). The main dermoscopic hallmarks of active lichen planopilaris are perifollicular scales; characteristic (but not pathognomonic) white dots (fibrotic white dots) (black arrowheads) and a reddish background are also present in less active areas in this case (d). Dermoscopic examination of a case of frontal fibrosing alopecia reveals minor perifollicular scaling with an aflegmasic (ivory white to ivory beige) surrounding background; follicular openings with only one hair at the hair-bearing margin (black arrows) and lonely hair (black arrowhead) are also visible (e). Classic dermoscopic appearance of active folliculitis decalvans showing follicular pustules, yellow discharge, crusts and characteristic hair tufts that contain >10 hair shafts (white arrowhead); unspecific vessels and erythema are also evident in the picture (f)
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Fig10: Dermoscopy of discoid lupus erythematosus of the scalp varies according to the disease stage: active lesions may be mainly characterised by red dots (a) or follicular keratotic plugs (quite large yellowish/whitish dots) and thick arborising vessels (b), while long-lasting lesions commonly display loss of follicular openings, white areas and thin vessels (c). The main dermoscopic hallmarks of active lichen planopilaris are perifollicular scales; characteristic (but not pathognomonic) white dots (fibrotic white dots) (black arrowheads) and a reddish background are also present in less active areas in this case (d). Dermoscopic examination of a case of frontal fibrosing alopecia reveals minor perifollicular scaling with an aflegmasic (ivory white to ivory beige) surrounding background; follicular openings with only one hair at the hair-bearing margin (black arrows) and lonely hair (black arrowhead) are also visible (e). Classic dermoscopic appearance of active folliculitis decalvans showing follicular pustules, yellow discharge, crusts and characteristic hair tufts that contain >10 hair shafts (white arrowhead); unspecific vessels and erythema are also evident in the picture (f)

Mentions: The dermoscopic hallmarks of active discoid lupus erythematosus of the scalp are represented by follicular keratotic plugs (quite large yellowish/whitish dots) and thick arborising vessels (Fig. 10a, b) [131–137]; additional findings include fine interfollicular scaling, blue-grey dots, scattered brown discolouration and red dots (Fig. 10a) [131–137]. Thin arborising vessels emerging from the yellow dots (“red spider in a yellow dot”) are considered peculiar of late, prefibrotic lesions [133], while pink areas, loss of follicular openings, white areas and branching vessels are typical of long-lasting lesions (Fig. 10c) [131, 133–137].Fig. 10


Dermoscopy in General Dermatology: A Practical Overview
Dermoscopy of discoid lupus erythematosus of the scalp varies according to the disease stage: active lesions may be mainly characterised by red dots (a) or follicular keratotic plugs (quite large yellowish/whitish dots) and thick arborising vessels (b), while long-lasting lesions commonly display loss of follicular openings, white areas and thin vessels (c). The main dermoscopic hallmarks of active lichen planopilaris are perifollicular scales; characteristic (but not pathognomonic) white dots (fibrotic white dots) (black arrowheads) and a reddish background are also present in less active areas in this case (d). Dermoscopic examination of a case of frontal fibrosing alopecia reveals minor perifollicular scaling with an aflegmasic (ivory white to ivory beige) surrounding background; follicular openings with only one hair at the hair-bearing margin (black arrows) and lonely hair (black arrowhead) are also visible (e). Classic dermoscopic appearance of active folliculitis decalvans showing follicular pustules, yellow discharge, crusts and characteristic hair tufts that contain >10 hair shafts (white arrowhead); unspecific vessels and erythema are also evident in the picture (f)
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Related In: Results  -  Collection

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Fig10: Dermoscopy of discoid lupus erythematosus of the scalp varies according to the disease stage: active lesions may be mainly characterised by red dots (a) or follicular keratotic plugs (quite large yellowish/whitish dots) and thick arborising vessels (b), while long-lasting lesions commonly display loss of follicular openings, white areas and thin vessels (c). The main dermoscopic hallmarks of active lichen planopilaris are perifollicular scales; characteristic (but not pathognomonic) white dots (fibrotic white dots) (black arrowheads) and a reddish background are also present in less active areas in this case (d). Dermoscopic examination of a case of frontal fibrosing alopecia reveals minor perifollicular scaling with an aflegmasic (ivory white to ivory beige) surrounding background; follicular openings with only one hair at the hair-bearing margin (black arrows) and lonely hair (black arrowhead) are also visible (e). Classic dermoscopic appearance of active folliculitis decalvans showing follicular pustules, yellow discharge, crusts and characteristic hair tufts that contain >10 hair shafts (white arrowhead); unspecific vessels and erythema are also evident in the picture (f)
Mentions: The dermoscopic hallmarks of active discoid lupus erythematosus of the scalp are represented by follicular keratotic plugs (quite large yellowish/whitish dots) and thick arborising vessels (Fig. 10a, b) [131–137]; additional findings include fine interfollicular scaling, blue-grey dots, scattered brown discolouration and red dots (Fig. 10a) [131–137]. Thin arborising vessels emerging from the yellow dots (“red spider in a yellow dot”) are considered peculiar of late, prefibrotic lesions [133], while pink areas, loss of follicular openings, white areas and branching vessels are typical of long-lasting lesions (Fig. 10c) [131, 133–137].Fig. 10

View Article: PubMed Central - PubMed

ABSTRACT

Over the last few years, dermoscopy has been shown to be a useful tool in assisting the noninvasive diagnosis of various general dermatological disorders. In this article, we sought to provide an up-to-date practical overview on the use of dermoscopy in general dermatology by analysing the dermoscopic differential diagnosis of relatively common dermatological disorders grouped according to their clinical presentation, i.e. dermatoses presenting with erythematous-desquamative patches/plaques (plaque psoriasis, eczematous dermatitis, pityriasis rosea, mycosis fungoides and subacute cutaneous lupus erythematosus), papulosquamous/papulokeratotic dermatoses (lichen planus, pityriasis rosea, papulosquamous sarcoidosis, guttate psoriasis, pityriasis lichenoides chronica, classical pityriasis rubra pilaris, porokeratosis, lymphomatoid papulosis, papulosquamous chronic GVHD, parakeratosis variegata, Grover disease, Darier disease and BRAF-inhibitor-induced acantholytic dyskeratosis), facial inflammatory skin diseases (rosacea, seborrheic dermatitis, discoid lupus erythematosus, sarcoidosis, cutaneous leishmaniasis, lupus vulgaris, granuloma faciale and demodicidosis), acquired keratodermas (chronic hand eczema, palmar psoriasis, keratoderma due to mycosis fungoides, keratoderma resulting from pityriasis rubra pilaris, tinea manuum, palmar lichen planus and aquagenic palmar keratoderma), sclero-atrophic dermatoses (necrobiosis lipoidica, morphea and cutaneous lichen sclerosus), hypopigmented macular diseases (extragenital guttate lichen sclerosus, achromic pityriasis versicolor, guttate vitiligo, idiopathic guttate hypomelanosis, progressive macular hypomelanosis and postinflammatory hypopigmentations), hyperpigmented maculopapular diseases (pityriasis versicolor, lichen planus pigmentosus, Gougerot-Carteaud syndrome, Dowling-Degos disease, erythema ab igne, macular amyloidosis, lichen amyloidosus, friction melanosis, terra firma-forme dermatosis, urticaria pigmentosa and telangiectasia macularis eruptiva perstans), itchy papulonodular dermatoses (hypertrophic lichen planus, prurigo nodularis, nodular scabies and acquired perforating dermatosis), erythrodermas (due to psoriasis, atopic dermatitis, mycosis fungoides, pityriasis rubra pilaris and scabies), noninfectious balanitis (Zoon’s plasma cell balanitis, psoriatic balanitis, seborrheic dermatitis and non-specific balanitis) and erythroplasia of Queyrat, inflammatory cicatricial alopecias (scalp discoid lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia and folliculitis decalvans), nonscarring alopecias (alopecia areata, trichotillomania, androgenetic alopecia and telogen effluvium) and scaling disorders of the scalp (tinea capitis, scalp psoriasis, seborrheic dermatitis and pityriasis amiantacea).

No MeSH data available.


Related in: MedlinePlus