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Dermoscopy in General Dermatology: A Practical Overview

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).

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Dermoscopic examination of a case of active alopecia areata shows black dots and micro-exclamation mark hairs; regular yellow dots are also evident (a), while dermoscopy of trichotillomania reveals a chaotic pattern of diverse findings related to hair fracturing, including (in this case) hairs broken at different lengths, black dots, flame-like hairs (white arrow), tulip-like hairs (short hairs with darker, tulip-shaped ends white arrowhead) and V-sign (two or more hairs emerging from one follicular unit that are broken at the same level black arrowhead) (b). Dermoscopy of androgenetic alopecia typically shows hair shaft thickness heterogeneity, a large number of follicular units with only one emerging hair shaft, and an increased proportion of thin and vellus hairs (>10% of the hairs); wavy hairs are also visible (black arrowhead) (c). The most indicative dermoscopic clue of telogen effluvium is the lack of features typical of other diseases; empty hair follicles and follicular units with only one hair are also evident in this case of chronic telogen effluvium (d)
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Fig11: Dermoscopic examination of a case of active alopecia areata shows black dots and micro-exclamation mark hairs; regular yellow dots are also evident (a), while dermoscopy of trichotillomania reveals a chaotic pattern of diverse findings related to hair fracturing, including (in this case) hairs broken at different lengths, black dots, flame-like hairs (white arrow), tulip-like hairs (short hairs with darker, tulip-shaped ends white arrowhead) and V-sign (two or more hairs emerging from one follicular unit that are broken at the same level black arrowhead) (b). Dermoscopy of androgenetic alopecia typically shows hair shaft thickness heterogeneity, a large number of follicular units with only one emerging hair shaft, and an increased proportion of thin and vellus hairs (>10% of the hairs); wavy hairs are also visible (black arrowhead) (c). The most indicative dermoscopic clue of telogen effluvium is the lack of features typical of other diseases; empty hair follicles and follicular units with only one hair are also evident in this case of chronic telogen effluvium (d)

Mentions: The most characteristic findings of active alopecia areata include black dots, micro-exclamation mark hairs, broken hairs, tapered hairs, monilethrix-like hairs and trichorrhexis nodosa, while long-standing inactive disease is mainly characterised by yellow dots and vellus hairs (Fig. 11a) [131, 139, 151–158]. The main signs of regrowing consist of upright and regularly coiled (circle and/or pigtail) hairs [131, 139, 151–158]. Less specific/less common features of active stages include tulip hairs and zigzag hairs [151, 152].Fig. 11


Dermoscopy in General Dermatology: A Practical Overview
Dermoscopic examination of a case of active alopecia areata shows black dots and micro-exclamation mark hairs; regular yellow dots are also evident (a), while dermoscopy of trichotillomania reveals a chaotic pattern of diverse findings related to hair fracturing, including (in this case) hairs broken at different lengths, black dots, flame-like hairs (white arrow), tulip-like hairs (short hairs with darker, tulip-shaped ends white arrowhead) and V-sign (two or more hairs emerging from one follicular unit that are broken at the same level black arrowhead) (b). Dermoscopy of androgenetic alopecia typically shows hair shaft thickness heterogeneity, a large number of follicular units with only one emerging hair shaft, and an increased proportion of thin and vellus hairs (>10% of the hairs); wavy hairs are also visible (black arrowhead) (c). The most indicative dermoscopic clue of telogen effluvium is the lack of features typical of other diseases; empty hair follicles and follicular units with only one hair are also evident in this case of chronic telogen effluvium (d)
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5120630&req=5

Fig11: Dermoscopic examination of a case of active alopecia areata shows black dots and micro-exclamation mark hairs; regular yellow dots are also evident (a), while dermoscopy of trichotillomania reveals a chaotic pattern of diverse findings related to hair fracturing, including (in this case) hairs broken at different lengths, black dots, flame-like hairs (white arrow), tulip-like hairs (short hairs with darker, tulip-shaped ends white arrowhead) and V-sign (two or more hairs emerging from one follicular unit that are broken at the same level black arrowhead) (b). Dermoscopy of androgenetic alopecia typically shows hair shaft thickness heterogeneity, a large number of follicular units with only one emerging hair shaft, and an increased proportion of thin and vellus hairs (>10% of the hairs); wavy hairs are also visible (black arrowhead) (c). The most indicative dermoscopic clue of telogen effluvium is the lack of features typical of other diseases; empty hair follicles and follicular units with only one hair are also evident in this case of chronic telogen effluvium (d)
Mentions: The most characteristic findings of active alopecia areata include black dots, micro-exclamation mark hairs, broken hairs, tapered hairs, monilethrix-like hairs and trichorrhexis nodosa, while long-standing inactive disease is mainly characterised by yellow dots and vellus hairs (Fig. 11a) [131, 139, 151–158]. The main signs of regrowing consist of upright and regularly coiled (circle and/or pigtail) hairs [131, 139, 151–158]. Less specific/less common features of active stages include tulip hairs and zigzag hairs [151, 152].Fig. 11

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