Dermoscopy in General Dermatology: Practical Tips
Dermoscopy in General Dermatology: Practical Tips
A recent study described the dermoscopic criteria observed in different stages of discoid lupus erythematosus (DLE). Perifollicular whitish halos, follicular plugging and white scales were the predominant features of early lesions (Fig. 5a), while telangiectatic vessels, pigmentation structures and whitish structureless areas characterized longer-standing lesions.
White-yellowish structureless areas represent the predominant dermoscopic feature of lichen sclerosus. Linear and dotted vessels are common additional findings in the genital area and late extragenital lesions, while early extragenital lesions commonly exhibit keratotic plugs (Figure 6a). Morphoea was reported dermoscopically to exhibit linear vessels within a lilac ring or 'fibrotic beams', corresponding histopathologically to dermal sclerosis (Figure 6b).
(Enlarge Image)
Figure 6.
Dermoscopy of extragenital lichen sclerosus (a) usually reveals whitish structureless areas and keratotic plugs, whereas morphoea (b) frequently exhibits whitish fibrotic beams (arrows) in combination with linear vessels.
Diagnosis. Dermoscopy is useful for discriminating DLE from lupus pernio or lupus vulgaris, which lack the predominant follicular abnormalities of DLE and display yellowish patches and linear or branching vessels (Figure 4 and Figure 5).
Dermoscopy may facilitate the differential diagnosis between early DLE and actinic keratosis by disclosing different patterns. In detail, the dermoscopic aspect of red follicular plugs over a white background of DLE can be considered the negative or inverse pattern of the white to yellow targetoid follicles and red pseudonetwork of actinic keratosis.
Dermoscopy might facilitate the clinical discrimination between lichen sclerosus and morphoea, by revealing whitish structureless areas and keratotic plugs in the former and fibrotic beams in the latter (Figure 6).
Autoimmune Diseases
Discoid Lupus Erythematosus
A recent study described the dermoscopic criteria observed in different stages of discoid lupus erythematosus (DLE). Perifollicular whitish halos, follicular plugging and white scales were the predominant features of early lesions (Fig. 5a), while telangiectatic vessels, pigmentation structures and whitish structureless areas characterized longer-standing lesions.
Lichen Sclerosus and Morphoea
White-yellowish structureless areas represent the predominant dermoscopic feature of lichen sclerosus. Linear and dotted vessels are common additional findings in the genital area and late extragenital lesions, while early extragenital lesions commonly exhibit keratotic plugs (Figure 6a). Morphoea was reported dermoscopically to exhibit linear vessels within a lilac ring or 'fibrotic beams', corresponding histopathologically to dermal sclerosis (Figure 6b).
(Enlarge Image)
Figure 6.
Dermoscopy of extragenital lichen sclerosus (a) usually reveals whitish structureless areas and keratotic plugs, whereas morphoea (b) frequently exhibits whitish fibrotic beams (arrows) in combination with linear vessels.
Practical Tips
Diagnosis. Dermoscopy is useful for discriminating DLE from lupus pernio or lupus vulgaris, which lack the predominant follicular abnormalities of DLE and display yellowish patches and linear or branching vessels (Figure 4 and Figure 5).
Dermoscopy may facilitate the differential diagnosis between early DLE and actinic keratosis by disclosing different patterns. In detail, the dermoscopic aspect of red follicular plugs over a white background of DLE can be considered the negative or inverse pattern of the white to yellow targetoid follicles and red pseudonetwork of actinic keratosis.
Dermoscopy might facilitate the clinical discrimination between lichen sclerosus and morphoea, by revealing whitish structureless areas and keratotic plugs in the former and fibrotic beams in the latter (Figure 6).
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