Fungal Melanonychia: A Systematic Review.

Fungal melanonychia is an uncommon condition, most typically caused by opportunistic melanin-producing pigmented filamentous fungi in the nail plate. In the present study, the clinical characteristics of patients diagnosed with fungal melanonychia were analyzed through a systematic review of cases reported in the literature. The MESH terms used for the search were "melanonychia" AND "fungal" OR "fungi" through four databases: PubMed, SciELO, Google scholar and SCOPUS. After discarding inadequate articles using the exclusion criteria, 33 articles with 133 cases were analyzed, of which 44% were women, 56% were men and the age range was between 9 and 87 years. The majority of cases were reported in Turkey followed by Korea and Italy. Frequent causal agents detected were Trichophyton rubrum as non-dematiaceous in 55% and Neoscytalidium dimidiatum as dematiaceous in 8%. Predisposing factors included nail trauma, migration history, employment and/or outdoor activities. Involvement in a single nail was presented in 45% of the cases, while more than one affected nail was identified in 21%, with a range of 2 to 10 nails. Regarding the clinical classification, 41% evidenced more than one type of melanonychia, 21% corresponded to the longitudinal pattern and 13% was of total diffuse type. Likewise, the usual dermoscopic pattern was multicolor pigmentation. It is concluded that fungal melanonychia is an uncommon variant of onychomycosis and the differential diagnosis is broad, which highlights the complexity of this disease.

Multicentric reticulohistiocytosis revealing a ductal breast cancer in situ: A case report with dermoscopic and histopathological findings. / Reticulohistiocitosis multicéntrica reveladora de cáncer de mama ductal in situ: reporte de caso con aspectos dermatoscópicos e histopatológicos.

Multicentric reticulohistiocytosis is a rare non-Langerhans cell histiocytosis of unknown etiology. It is classified as multicentric because of multisystem involvement. The disease predominantly affects the skin and joints, but visceral involvement is possible. Multiple erythematous-brownish, pruritic nodules and papules on the face, hands, neck, and trunk are characteristic. It is associated with autoimmune diseases, or malignant neoplasms are seen in 20% to 30% of patients with multicentric reticulohistiocytosis. The diagnosis is based on histopathology of affected tissues. As it is an underreported disease, there is no standardized treatment. A case of multicentric reticulohistiocytosis is reported as a paraneoplastic manifestation of ductal breast cancer, being successfully treated with no recurrence after two years of follow-up. Few cases of multicentric reticulohistiocytosis associated with breast cancer have been reported in the literature.

La reticulohistiocitosis multicéntrica es una enfermedad inflamatoria, una histiocitosis de células no Langerhans, poco frecuente y de etiología desconocida. Se clasifica como multicéntrica al presentar compromiso multisistémico. La enfermedad afecta predominantemente a la piel y las articulaciones, pero es posible la afectación visceral. Las manifestaciones cutáneas se caracterizan por múltiples nódulos y pápulas de color eritemato-marronáceas, pruriginosas en la cara, manos, cuello y tronco. Se asocia a enfermedades autoinmunes y neoplasias malignas, observándose entre el 20 y el 30% de los pacientes con reticulohistiocitosis multicéntrica. Su diagnóstico se realiza sobre la base de la histopatología de tejidos afectados. Al ser una enfermedad poco reportada, no existe tratamiento estandarizado. Se reporta un caso de reticulohistiocitosis multicéntrica como manifestación paraneoplásica a un cáncer ductal de mama, siendo tratadas con éxito, sin recidivas luego de dos años de seguimiento. Pocos casos se han reportado en la literatura de reticulohistiocitosis multicéntrica asociado a cáncer mamario.

Terra Firma-Forme Dermatosis: A Heart-Shaped Dark Lesion in a Boy.

Terra firma-forme dermatosis is an acquired and idiopathic disorder with an underestimated incidence. It is characterized by brownish skin pigmentation, forming asymptomatic plaques that give a soiled skin appearance. Soap and water have a minor effect; however, friction with 70% ethyl or isopropyl alcohol immediately eliminates plaques to a normal skin appearance, thus being the ideal method for diagnosis and treatment. The lack of familiarity with this disease possibly contributes to an alarming underdiagnosis. In this report, the authors present a case of terra firma-forme occurring in a 14-year-old Mexican patient who presented with a heart-shaped pigmented lesion in the pubic area.

Gamification of dermatoscopy education using a smartphone mobile platform: A pilot study.

Background: Dermatoscopy is a noninvasive method of examining skin lesions under high magnification, gradually replacing the need for invasive biopsies. Training is required to gain clinical competency. Gamification employs game-like elements to enhance education engagement and is an engaging means of delivering medical education. We sought to use gamification and a mobile-based platform to deliver dermatoscopy education to physicians. Methods: We developed SKIN@GoPRIME, an interactive smartphone platform. Thirty physician participants were randomly assigned to watch an online dermatoscopy lecture or to use SKIN@GoPRIME. Twenty-eight participants completed prelearning and postlearning quizzes and provided feedback on SKIN@GoPRIME. Results: Users of SKIN@GoPRIME demonstrated a significant 1.71-point mean score improvement (P = .0018). The group that watched the online dermatoscopy lecture had a higher 2.36-point mean score improvement (P = .00021). Both family medicine and internal medicine physicians demonstrated a significant mean score increase of 1.29 (P = .049) and 2.14 (P = .023), respectively, after using SKIN@GoPRIME. Based on feedback, 83% believed that SKIN@GoPRIME can be used to acquire the applied competencies required for their job scope. Discussion and Conclusion: SKIN@GoPRIME, a novel learning tool via gamification effectively delivers dermatoscopy education, although it is not shown to be more effective than lectures. Larger studies are required to further validate the effectiveness of gamified learning techniques in dermatoscopy education. Future studies should involve the optimization of SKIN@GoPRIME to more effectively deliver dermatoscopy education.

Imaging Approach in the Diagnostics and Evaluation of the Psoriasis Plaque: A Preliminary Study and Literature Review.

(1) Background: the aim of the study was to demonstrate its usefulness in the field of imaging evaluation of plaque morphology in psoriasis vulgaris, with an emphasis on the use of confocal microscopy and other advanced skin-imaging techniques. (2) Methods: we conducted a prospective study over two years (July 2022-April 2024), on patients diagnosed with moderate or severe psoriasis vulgaris, treated in the dermatology department of our institution. We selected 30 patients, of whom 15 became eligible according to the inclusion and the exclusion criteria. A total of 60 psoriasis plaques were analyzed by dermatoscopy using a Delta 30 dermatoscope and Vidix 4.0 videodermoscope (VD), by cutaneous ultrasound (US) using a high-resolution 20 MHz linear probe, and by confocal microscopy, along with histopathological analysis. (3) Results: the study included fifteen patients with vulgar psoriasis, diagnosed histopathologically, of whom six were women and nine were men, with an average age of 55. Between two and six plaques per patient were selected and a total of sixty psoriasis plaques were analyzed by non-invasive imaging techniques. Twelve lesions were analyzed with ex vivo fluorescence confocal microscopy (FCM), compared to histology. US showed that the hyperechoic band and the lack of damage to the subcutaneous tissue were the most common criteria. The epidermis and dermis were found to be thicker in the area of psoriasis plaques compared to healthy skin. Dermatoscopy showed that the specific aspect of psoriasis plaques localized on the limbs and trunk was a lesion with an erythematous background, with dotted vessels with regular distribution on the surface and covered by white scales with diffuse distribution. The presence of bushy vessels with medium condensation was the most frequently identified pattern on VD. Good correlations were identified between the histological criteria and those obtained through confocal microscopy. (4) Conclusions: the assessment and monitoring of patients with psoriasis vulgaris can be conducted in a more complete and all-encompassing manner by incorporating dermatoscopy, ultrasonography, and confocal microscopy in clinical practice.

Efficacy and safety of spironolactone versus bicalutamide in female pattern hair loss: A retrospective comparative study.

BACKGROUND: Female-pattern hair loss (FPHL) is characterized by decreased scalp hair density, thinning of hair shafts, and progressive miniaturization of hair follicles. OBJECTIVE: To compare the safety and efficacy of spironolactone versus bicalutamide in female pattern hair loss [FPHL]. METHODS: The study design was retrospective, and all eligible females aged between 18 years and 50 years with FPHL were included. We identified 120 patients from our database who fulfilled the inclusion and exclusion criteria, and patients were then categorized into two groups, Group A comprising patients who were taking 100 mg of spironolactone once daily and Group B comprising patients who were taking 50 mg of bicalutamide once daily along with topical minoxidil 2% in both groups. Patient were analysed at approximately at 24 weeks from the commencement of the treatment. RESULTS: Mean reduction in hair loss severity score on Sinclair scale was 19.51% in spironolactone group compared to 28.20% in bicalutamide group at 24 weeks, which was statistically significant. On global photographic assessment, marked improvement was seen in bicalutamide group compared to spironolactone group (p = 0.139). CONCLUSIONS: Our study, though limited by its retrospective design and small sample size, showed that bicalutamide has greater efficacy and better safety profile in comparison to spironolactone in the treatment of FPHL.

Matching between ctlinical examination and dermoscopy in patients with nail psoriasis: Should dermoscopy be used instead of clinical examination?

Background: Dermoscopy has emerged as a useful diagnostic tool to evaluate skin lesions, including psoriasis. We aimed to compare the clinical examination and digital dermoscopy findings of nail involvement in patients with psoriatic nails. Methods: This study included 60 patients with clinically diagnosed psoriasis. The nail findings and NAPSI were evaluated clinically and via dermoscopy, and then the severity of the disease was calculated using PASI criteria. Results: About 32 patients were males, with a median PASI score of 4.4, and pitting and subungual hyperkeratosis were the most common findings. The clinical and dermoscopic examination had a moderate diagnostic resemblance regarding onycholysis, subungual hyperkeratosis, and leukonychia. The resemblance between the two methods for the diagnosis of leukonychia in patients with a duration of disease <2 years (Kappa = 0.59) and 2-6 years was moderate (Kappa = 0.48), and for 6 years< was perfect (Kappa = 0.62). The resemblance for the diagnosis of subungual hyperkeratosis and onycholysis in subjects with a duration of disease <2 years was slight, and for 2-6 years and 6 years< were moderate. The resemblance between the NAPSI score by the two methods was also moderate (95%CI -0.89-0.81, P < 0.001). Conclusion: Dermoscopy is an efficient, supportive, and non-invasive method providing a better diagnosis of nail psoriasis.

Dermoscopy as a Tool for Identifying Potentially Metastatic Thin Melanoma: A Clinical-Dermoscopic and Histopathological Case-Control Study.

Despite being early-stage tumors, thin cutaneous melanomas contribute significantly to mortality and have a rising incidence. A retrospective case-control study was performed to identify clinical-dermoscopic and histopathological variables linked to local and distant metastases in melanomas ≤0.8 mm. Data from 1 January 2000 to 22 June 2022 were analyzed from two Italian skin cancer referral centers. Sixteen patients with ≤0.8 mm melanomas developing metastases were studied compared to controls without metastases over 5 years. Statistical analysis involved Pearson's chi-squared test or Fisher's exact test. Of the 1396 cases, 1.1% progressed. The median diagnosis age was 49 (range 28-83), with 56.3% men and 43.7% women. The torso was the primary tumor site (43.7%). Clinically, lesions were pigmented (>10 mm diameter: 73.3%, ≥3 colors: 80%). Dermoscopically, the common features were white patches (73.3%), atypical vascular patterns (66.5%), blue-gray areas (60%) and absent pigment networks (60%). Histopathologically, all cases had adverse features like regression (87.4%), dermal mitoses (50%), a vertical growth phase (62.5%) and ulceration (12.5%). These findings were statistically significant compared to controls (p < 0.05). In ≤0.8 mm melanomas, specific clinical-dermoscopic traits might indicate higher metastatic potential when paired with adverse histopathological features.

Dermatoscopic evaluation of leprosy: A multi-centre cross-sectional study.

Background Leprosy is known to be a great mimicker. Its dermatoscopic evaluation may be of value in establishing diagnosis. Objective To study the dermatoscopic findings encountered across the leprosy spectrum. Methods This was a multi-centre cross-sectional study of leprosy patients, where after a thorough cutaneous and neurological evaluation, representative skin lesions from the study patients were photographed in standard settings, and the most representative skin lesions were chosen for dermatoscopic evaluation. Data was entered in a structured proforma and a descriptive analysis of dermatoscopic patterns was carried out. Results A total of 53 cases of ages between 14 and 80 years, ranging from tuberculoid to the lepromatous spectrum of disease, with active skin lesions in the form of patches and plaques were included. The spectrum of leprosy as per Ridley-Jopling classification at diagnosis was indeterminate in 1 (1.9%), tuberculoid in 1 (1.9%), borderline tuberculoid in 25 (21.5%), borderline lepromatous in 9 (17%), lepromatous in 14 (26.4%) and histoid in 3 (5.7%). Dermatoscopic features included distorted pigment network in 48 (90.6%), focal white areas in 40 (75.5%), reduced eccrine and follicular openings in 43 (81.1%), widened skin lines in 28 (52.8%), circle hairs in 15 (28.3%) and white shiny streaks in 17 (32.1%). Conclusion Dermatoscopy is a practical, non-invasive device to assess skin lesions of leprosy and provide cues to its diagnosis, spectral classification and differentiating it from other granulomatous disorders. However, dermatoscopy alone cannot reliably differentiate between the various types of leprosy and future large-scale studies are required. Limitations of the study The numbers for each subtype were variable and few in some spectrum of leprosy patients. A dermatoscopic-histologic correlation was not done.

Assessing field cancerization and actinic keratosis using ultraviolet-induced fluorescence dermatoscopy after the application of 5-aminolevulinic acid - An observational study.

BACKGROUND: Actinic keratoses (AK) are one of the most frequent reasons for consultations in dermatology. Ultraviolet-induced fluorescence dermatoscopy (UVFD) is a new method that allows the assessment of lesions in a spectrum of light that originates from the fluorochromes emitting UV-excited luminescence. The aim of this study was to assess the UVFD features of AKs before PDT and their intensity in field cancerization and single lesions. METHODS: This retrospective study was conducted from June to November 2023. Lesions were assessed with the Olsen scale clinically and dermatoscopically (DermLite DL5, 10x magnification) and photographed. UVFD fluorescence was categorized as 'none', 'weak', 'moderate', and 'intense'. A 1-mm thick layer of 10 % 5-ALA gel was applied to single lesions or cancerization field (depending on the patient) and covered with an occlusive dressing for 3 h. Prior the application of 10 % 5-ALA gel, the lesions were degreased with an alcoholic solution. The occlusion was removed, and the field was cleaned with a 0,9 % saline solution. Afterward, each lesion was photographed in polarized light and UVFD mode. RESULTS: A total of 194 dermatoscopic images were analyzed, 111 corresponded to field cancerization and 81 to single AKs. Overall, weak fluorescence was noticed in 22 of them (11,3 %), moderate in 107 (55,15 %), and intense in 65 (33,5 %). Amongst field cancerization (111 images), weak fluorescence was seen in 11 (9.9 %), moderate in 68 (61,26 %), and intense in 32 (28,82 %). In single lesions (81 images), weak fluorescence was detected in 11 (13,2 %), moderate in 39 (46,99 %), and intense in 33 (28.83 %) of the lesions. Slightly more intense fluorescence was noticed in higher Olsen grade (p = 0.04). CONCLUSIONS: UVFD can enhance our efficacy of pre-procedural examination and might arise as a useful device to predict the therapeutic effect of PDT.

Effective Treatment of Rosacea and Other Vascular Lesions Using Intense Pulsed Light System Emitting Vascular Chromophore-Specific Wavelengths: A Clinical and Dermoscopical Analysis.

Background: Facial telangiectasias is a prevalent cosmetic disorder that can be associated with several conditions such as rosacea. IPL (intensity pulsed light) therapy is commonly used for the treatment of vascular lesions. This study tested the efficacy of an IPL system emitting selected vascular chromophore-specific wavelengths in the range of 500-1200 nm for the treatment of vascular lesions. Materials and Methods: A total of 39 patients affected by different vascular lesions on their face were enrolled. The procedure consisted of three treatment sessions, spaced 1 month apart, using the IPL system with a 500-677 and 854-1200 nm filter. Follow-up was performed at 21-90 days (3 weeks-3 months) after the last IPL session. Three-dimensional and dermoscopic clinical photographs were captured and evaluated using a five-point scale. Adverse events were checked. Results: In total, 21 patients achieved excellent improvement, 13 patients achieved good improvement, 3 patients achieved moderate improvement, 2 patients achieved mild improvement, and 0 patients achieved no improvement, with an overall good response to treatment. The photographic evaluation showed good results as soon as 3 days after the last IPL session. Relevant side effects were absent. Conclusions: The study device may represent a successful treatment to improve vascular lesions that are resistant to laser therapy.

Dermoscopy of Umbilical Lesions-A Systematic Review.

Background: The umbilicus is a fibrous remnant located in the centre of the abdomen. Various entities may be encountered in this special anatomical location; however, little is known about their dermoscopic presentation. The aim of this study was to provide a comprehensive summary of existing evidence on dermoscopic features of umbilical lesions. Methods: Studies assessing dermoscopic images of umbilical lesions were included in this study. No age, ethnicity or skin phototype restrictions were applied. Papers assessing lesions outside of the umbilical area, lacking dermoscopic images and/or dermoscopic description and not related to the topic were excluded. Embase, Medline and Cochrane Library were searched from inception to the end of May 2023. The Joanna Briggs Institute critical appraisal tools were used to evaluate the risk of bias of the selected studies. The quality and the level of evidence of included studies were assessed according to the Oxford 2011 Levels of Evidence. Thirty-four studies reporting a total of 39 lesions met the inclusion criteria and were included in qualitative analysis. Results: A qualitative synthesis of the following entities was performed: melanoma, nevi, basal cell carcinoma, fibroepithelioma of Pinkus, Sister Mary Joseph nodule, mycosis fungoides, dermatofibroma, endometriosis, epidermal cyst, granuloma, intravascular papillary endothelial hyperplasia, lichen planus, omphalolith, seborrheic keratosis, and syringoma. Conclusions: Dermoscopy is a non-invasive technique that may be useful in the differential diagnosis of umbilical lesions. The main limitations of this study were lack of a high level of evidence in the studies and the lack of uniformity in applied dermoscopic terminology between included studies.

Use of Dermoscopy among Greek Dermatologists in Everyday Clinical Practice: A National Questionnaire-Based Study.

Background: Dermatoscopy has been established as an important diagnostic tool for a wide range of skin diseases. This study aims to evaluate the use of dermatoscopy in clinical practice among Greek dermatologists. Methods: A nationwide questionnaire-based survey was conducted collecting data on the frequency of dermatoscopic examinations, the types of lesions examined, training and educational resources, as well as factors influencing the choice to incorporate dermatoscopy into daily clinical routines. Results: A total of 366 Greek dermatologists participated in the survey. Most of the respondents reported the daily use of dermatoscopy in their practice. Pigmented and non-pigmented lesions, inflammatory diseases, cutaneous infectious, hair disorders, and nail lesions were the most common indications for dermatoscopy. Factors influencing the utilization of dermatoscopy included increased diagnostic accuracy, enhanced patient care, better patient communication and general compliance, and improved satisfaction among dermatologists. Conclusions: This national questionnaire-based study demonstrates that dermatoscopy has become an integral part of daily dermatological practice in Greece. The findings highlight the significance of structured training and education to promote dermoscopy's effective and routine use. Incorporating dermatoscopy into clinical practice not only improves diagnostic precision but also enhances patient care, contributing to the overall quality of dermatological services in Greece.

Applications of Ultraviolet and Sub-ultraviolet Dermatoscopy in Neoplastic and Non-neoplastic Dermatoses: A Systematic Review.

Dermatoscopy is a non-invasive and cost-efficient imaging technique augmenting clinical examination in neoplastic and non-neoplastic dermatoses. Recently, novel dermatoscopic techniques based on principles of reflectance/absorption and excited fluorescence have been developed. However, comprehensive data on their applications are sparse, and terminology is inconsistent. In this systematic review, we addressed the principles of ultraviolet (UV) imaging and proposed categorization based on spectral characteristics and signal acquisition, as well as discussed documented and potential clinical applications, safety measures during examination, and limitations associated with reflectance and fluorescence dermatoscopy. A literature search was conducted in the PubMed medical database until 2 December 2023 according to PRISMA guidelines, and 28 papers fit the scope of this review, whereas additional relevant articles were included to provide broader context regarding the chosen terminology, chromophores described, safety of sub-UV/UV, and regulations for light-emitting devices. UV and sub-UV dermatoscopy, categorized into different methods on the basis of the emitted wavelength and signal acquisition process (reflectance versus fluorescence), augment conventional dermatoscopy by optimizing safety margins in melanoma, facilitating early detection of tumor recurrence, and enhancing visualization in non-neoplastic conditions, including pigmentation disorders, intertrigo, papulo-desquamative dermatoses, and beyond. The review highlights the limitations of these techniques, including difficulty in differentiating melanin from hemoglobin, challenges in evaluating uneven surfaces, and artifacts. Although UV dermatoscopy complements conventional dermatoscopy, clinicians should be aware of their peculiarities, artifacts, limitations, and safety concerns to optimize their diagnostic accuracy and ensure patient's safety.

Dermatoscopy and reflectance confocal microscopy for basal cell carcinoma diagnosis and diagnosis prediction score: A prospective and multicenter study on 1005 lesions.

BACKGROUND: Basal cell carcinoma (BCC) is usually diagnosed by clinical and dermatoscopy examination, but diagnostic accuracy may be suboptimal. Reflectance confocal microscopy (RCM) imaging increases skin cancer diagnostic accuracy. OBJECTIVE: To evaluate additional benefit in diagnostic accuracy of handheld RCM in a prospective controlled clinical setting. METHODS: A prospective, multicenter study in 3 skin cancer reference centers in Italy enrolling consecutive lesions with clinical-dermatoscopic suspicion of BCC (ClinicalTrials.gov: NCT04789421). RESULTS: A total of 1005 lesions were included, of which 474 histopathologically confirmed versus 531 diagnosed by clinical-dermatoscopic-RCM correlation, confirmed with 2 years of follow-up. Specifically, 740 were confirmed BCCs. Sensitivity and specificity for dermatoscopy alone was 93.2% (95% CI, 91.2-94.9) and 51.7% (95% CI, 45.5-57.9); positive predictive value was 84.4 (95% CI, 81.7-86.8) and negative predictive value 73.3 (95% CI, 66.3-79.5). Adjunctive RCM reported higher rates: 97.8 (95% CI, 96.5-98.8) sensitivity and 86.8 (95% CI, 82.1-90.6) specificity, with positive predictive value of 95.4 (95% CI, 93.6-96.8) and negative predictive value 93.5 (95% CI, 89.7-96.2). LIMITATIONS: Study conducted in a single country. CONCLUSIONS: Adjunctive handheld RCM assessment of lesions clinically suspicious for BCC permits higher diagnostic accuracy with minimal false negative lesions.

Microvascular changes on nailfold capillaroscopy in acute stage of Kawasaki disease: a new diagnostic paradigm for an enigmatic condition.

OBJECTIVES: Kawasaki disease (KD) is a medium vessel vasculitis with a predilection to involve coronary arteries. However, there is a paucity of literature on microvascular changes in patients with KD. METHODS: Children diagnosed with KD based on American Heart Association guidelines 2017 were enrolled prospectively. Demographic details and echocardiographic changes in coronaries were recorded. Nailfold capillaries were assessed using Optilia Video capillaroscopy and data were analysed using Optilia Optiflix Capillaroscopy software at acute (prior to IVIG administration) and subacute/convalescent phase. RESULTS: We enrolled 32 children with KD (17 boys) with a median age of 3 years. Nailfold capillaroscopy (NFC) was performed in 32 patients in the acute phase (compared with 32 controls) and in 17 during the subacute/convalescent phase at a median follow-up of 15 (15-90) days after IVIG treatment. The following findings were seen in NFC in the acute phase of KD: reduced capillary density (n = 12, 38.6%), dilated capillaries (n = 3, 9.3%), ramifications (n = 3, 9.3%) and capillary haemorrhages (n = 2, 6.2%). Capillary density was reduced significantly in the acute phase of KD (38.6%) as compared with the subacute/convalescent phase (25.4%) (P-value <0.001) and controls (0%) (P-value = 0.03). We observed no correlation between coronary artery involvement and mean capillary density (P = 0.870). CONCLUSION: Results show that patients with KD have significant nailfold capillary changes in the acute phase. These findings may provide a new diagnostic paradigm for KD and a window to predict coronary artery abnormalities.