[Multiple verruca plantaris treated with modified fire-needle technique and herbal bathing-repairing therapy of TCM: a randomized controlled trial].

OBJECTIVE: To observe the clinical effect of modified fire-needle technique and herbal bathing-repairing therapy of TCM on multiple verruca plantaris. METHODS: Seventy patients with multiple verruca plantaris were randomly divided into an observation group (35 cases, 1 case was eliminated) and a control group (35 cases, 2 cases dropped out). In the control group, the herbal bathing-repairing therapy of TCM was adopted. In the observation group, besides the treatment as the control group, fire needling and cauterization were delivered on the base of skin lesion or the sites with rich blood vessels under the dermoscope. The intervention was provided once a week, one course of treatment was composed of 3 weeks, and two courses were required in each group. The score of the self-designed symptom scale, the score of dermatology life quality index (DLQI) and the area of typical skin lesion were observed before and after treatment. The clinical effect was evaluated after treatment and the recurrence was assessed 2 months after treatment completion in the two groups. RESULTS: After treatment, the scores of the self-designed symptom scale and DLQI were lower and the area of typical skin lesion was smaller compared with those before treatment in the two groups (P<0.05). The scores of the self-designed symptom score and DLQI in the observation group were reduced (P<0.05), and the area of typical lesion was smaller (P<0.05) in comparison with those in the control group. The total effective rate was 91.2% (31/34) in the observation group, higher than that in the control group (60.6%, 20/33, P<0.05). The recurrence rate was 6.5% (2/31) in the observation group, lower than that in the control group (35.0%, 7/20, P<0.05). CONCLUSION: Modified fire-needle technique combined with herbal bathing-repairing therapy ameliorates clinical symptoms and the quality of life in the patients with multiple verruca plantaris and reduces the recurrence of the disease.

Challenging Diagnosis of Basal Cell Carcinoma: A Case Report Emphasizing the Clinical Utility of Dermoscopy.

Dermatological conditions often present diagnostic challenges due to their diverse manifestations and overlapping clinical features. In such cases, dermoscopy, a non-invasive imaging technique, has emerged as a valuable tool to enhance diagnostic accuracy and guide clinicians in reaching an appropriate differential diagnosis. By visualizing subsurface skin structures and microvascular patterns, dermoscopy provides additional information that complements clinical examination, aiding in the recognition of specific dermatoses and the differentiation between benign and malignant skin lesions. Herein, we present a case that demonstrates the utility of dermoscopy in distinguishing between an initial broad list of differential diagnoses, namely, basal cell carcinoma, squamous cell carcinoma in situ, and other inflammatory dermatitides, such as psoriasis and atopic dermatitis, and narrowing down the differential diagnosis to just one likely diagnosis, which was basal cell carcinoma in our case.

A Clinical and Dermatoscopic Perspective of the Efficacy and Safety of Erbium: YAG Laser Ablation Versus 50% Trichloroacetic Acid for the Management of Xanthelasma Palpebrarum.

Xanthelasma palpebrarum (XP) is a benign cosmetic condition. Although the role of CO2 laser is well described, there are only a few studies on Erbium: YAG in XP. Similarly, trichloroacetic acid (TCA) is commonly used in XP. However, there are only a few studies comparing these modalities in the treatment of XP. Aim: To evaluate the effectiveness and safety of Erbium: YAG laser and 50% TCA in the treatment of XP with the role of dermoscope in the evaluation of lesions. Materials and Methods: A total of 20 subjects were randomly allocated into two groups: group A (TCA) and group B (laser). All patients were subcategorized into three grades viz. I (mild), II (moderate), and III (severe) using a self-devised scoring system. Results: About 25% and 70% of patients achieved complete clearance in groups A and B, respectively (P = 0.017). The rate of recurrence was 40% and 15% in groups A and B. Dyspigmentation and erythema were the most common side effects. Pretreatment dermoscopic evaluation of the lesion showed a network of brown streaks on a background of a yellowish structureless area and was used to assess the area and margins of the lesion where the adipose tissue was found during the procedure and serial assessment of the lesion.

The correlation between dermoscopy and clinical and pathological tests in the evaluation of skin photoaging.

BACKGROUND: There are no standards for evaluating skin photoaging. Dermoscopy is a non-invasive detection method that might be useful for evaluating photoaging. OBJECTIVE: To assess the correlation between the dermoscopic evaluation of photoaging and clinical and pathological evaluations. METHODS: The age, clinical evaluation (Fitzpatrick classification, Glogau Photoaging Classification, and Chung's standardized image ruler), histopathology (Masson staining and MMP-1 immunohistochemistry), and dermoscopy (Hu's and Isik's) of 40 donor skin samples were analyzed statistically, and Spearman rank correlation analysis was performed. RESULTS: There was a robust correlation between the total Hu scores and Isik dermoscopy. The correlation of dermoscopy with histopathology was higher than that of clinical evaluation methods. There is a strong correlation between telangiectases and lentigo. Xerosis, superficial wrinkle, diffuse erythema, telangiectases, and reticular pigmentation were significantly correlated with the three clinical evaluation methods. Superficial wrinkles were correlated with Masson, MMP-1, various clinical indicators, and other dermoscopic items. CONCLUSION: There is a good correlation between dermoscopy and clinical and histopathological examination. Dermoscopy might help evaluate skin photoaging.

Diagnostic Utility of Nailfold Capillaroscopy using Hand-held Dermoscope in Systemic Sclerosis.

Introduction: The pathogenesis in systemic sclerosis (SSc) mainly involves vascular injury, fibrosis, and immune activation. Visualization of these microvascular changes by nailfold capillaroscopy (NFC) can help in the early diagnosis of the disease. Even though the gold standard for NFC is a videodermoscope, the ease, practicality, and accessibility make the hand-held dermoscope a more versatile and suitable device in the hands of the dermatologists in the busy outpatient department. Aim: To study the pattern of nail fold capillaries using hand-held dermoscope in the patients of SSc and correlate the findings with disease severity. Materials and Methods: An observational, cross-sectional hospital-based study was carried out over a span of 2 years, from January 2020 till December 2021, in 50 patients of SSc. NFC using DermLite DL4 was performed in all the patients and distribution, morphology, density of capillaries, and nail fold capillary pattern were observed. Results: Out of 50 patients, 38 patients had diffuse type of disease, and 12 had limited type of disease. The mean capillary density in our patients was 4.7 ± 0.81/mm. Dilated capillaries was the most common NFC finding (80%), whereas active scleroderma pattern was the most common pattern (56%). A significant association was found between the type of capillary pattern and duration of disease, type of disease, and cutaneous manifestations. Conclusion: Hand-held dermoscope is reliable, practical, and assessable tool that aids in early diagnosis of the disease and also helps in assessing the severity and prognosis of SSc.

Efficacy of Jessener solution versus intralesional steroid in treatment of alopecia areata.

BACKGROUND: Alopecia areata is an autoimmune condition that causes non-scarring hair loss. To date, there is no single cure and treatment remains challenging. OBJECTIVES: To evaluate the efficacy of Jessener solution versus intralesional steroid in treatment of Alopecia Areata. METHODS: This study included 40 patients who presented with multifocal patchy alopecia areata (AA). For each patient, three patches were randomly selected to be treated one with intralesional steroid, another with topical Jessner solution and the third with normal saline. Three sessions were done 3 weeks apart and were followed up for 3 months. Response was assessed clinically and by trichoscope. RESULTS: Fifteen percent of patches coated with Jessner or injected with steroids showed an excellent response while 20% of patches coated with Jessner and 32.5% patches injected with steroids showed a good response. A significant difference was observed between the three modalities of treatment regarding the prognostic score for response (p < 0.001) as patches coated with Jessner and those steroid injected showed a significant higher response rate than patches injected with saline (p < 0.001) while no significant difference was reported between patches either treated with Jessner or steroids (p > 0.05). CONCLUSION: Jessners solution can be a novel and feasible and well tolerated modality of treatment for patients suffering from alopecia areata.

Trichoscopic Diagnosis of Structural Hair Defects in a Clinical Setting: A Cross-Sectional Analytical Study.

BACKGROUND: Trichoscopy is a simple, noninvasive procedure practiced in the diagnosis of a multitude of scalp and hair disorders. Hair shaft abnormalities usually represent a diagnostic challenge to dermatologists. OBJECTIVES: The aim of the study was to determine the practicality, versatility, and value of using the handheld dermoscope in the assessment of hair shaft abnormalities and the diagnosis of different hair/scalp disorders. METHODS: Eight hundred and seven patients of both sexes, aged from 1 to 76 years, with complaints pertaining to scalp and hair, were the subjects of the study. All patients were examined by the handheld dermoscope, and 400 were additionally examined by the folliscope, digital dermoscope, or their hairs mounted for light microscopy. RESULTS: Based on trichoscopic findings, more than half the patients demonstrated thinned terminal hairs and a predominance of single-haired scalp pilosebaceous units (57% and 55.5%, respectively). Over a quarter of the patients showed hair diameter heterogeneity, upright regrowing hairs, and increased vellus hairs (37%, 31%, and 25%, respectively). Other trichoscopic findings included scalp scaling (19%), hair weathering (12%), thinned wavy hairs (10.5%), brush-like hair fractures (9%), exclamation mark hairs (9%), and longitudinal cleavage (trichoptilosis) (8%). The clinical diagnostic spectrum was topped by the following diagnoses in order of frequency: female pattern hair loss, telogen effluvium, traction alopecia, and trichotillomania. Trichodynia appeared to be significantly associated with numerous hair shaft abnormalities. CONCLUSION: Most hair shaft abnormalities can be reliably diagnosed with high accuracy using a handheld dermoscope in an office setting. Skillful knowledge of dermoscopy is an important aid in the diagnosis of hair and scalp disorders.

Linear porokeratosis of the foot with dermoscopic manifestations: A case report.

BACKGROUND: Porokeratosis (PK) is a common autosomal dominant chronic progressive dyskeratosis with various clinical manifestations. Based on clinical manifestations, porokeratosis can be classified as porokeratosis of mibelli, disseminated superficial porokeratosis, disseminated superficial actinic porokeratosis, linear porokeratosis (LP), porokeratosis palmaris et plantaris disseminata, porokeratosis punctata, popular PK, hyperkeratosis PK, inflammatory PK, verrucous PK, and mixed types. We report a case of LP in a child and describe its dermoscopic findings. CASE SUMMARY: Linear porokeratosis is a rare PK. The patient presented with unilateral keratinizing maculopapular rash of the foot in childhood. The patient underwent skin pathology and dermoscopy, and was treated with liquid nitrogen freezing and topical drugs. CONCLUSION: From this case we take-away that LP is a rare disease, by the dermoscopic we can identify it.

MobileSkin: Classification of Skin Lesion Images Acquired Using Mobile Phone-Attached Hand-Held Dermoscopes.

Dermoscopy is the visual examination of the skin under a polarized or non-polarized light source. By using dermoscopic equipment, many lesion patterns that are invisible under visible light can be clearly distinguished. Thus, more accurate decisions can be made regarding the treatment of skin lesions. The use of images collected from a dermoscope has both increased the performance of human examiners and allowed the development of deep learning models. The availability of large-scale dermoscopic datasets has allowed the development of deep learning models that can classify skin lesions with high accuracy. However, most dermoscopic datasets contain images that were collected from digital dermoscopic devices, as these devices are frequently used for clinical examination. However, dermatologists also often use non-digital hand-held (optomechanical) dermoscopes. This study presents a dataset consisting of dermoscopic images taken using a mobile phone-attached hand-held dermoscope. Four deep learning models based on the MobileNetV1, MobileNetV2, NASNetMobile, and Xception architectures have been developed to classify eight different lesion types using this dataset. The number of images in the dataset was increased with different data augmentation methods. The models were initialized with weights that were pre-trained on the ImageNet dataset, and then they were further fine-tuned using the presented dataset. The most successful models on the unseen test data, MobileNetV2 and Xception, had performances of 89.18% and 89.64%. The results were evaluated with the 5-fold cross-validation method and compared. Our method allows for automated examination of dermoscopic images taken with mobile phone-attached hand-held dermoscopes.

Evaluation of efficacy of follicular unit extraction versus follicular unit extraction with platelet rich plasma in treatment of cicatricial alopecia.

BACKGROUND: Follicular unit extraction (FUE) is a minimally invasive surgery that is becoming popular in hair restoration in cicatricial alopecia (CA). AIM: Evaluation of FUE with or without platelet rich plasma (PRP) in scarring alopecia. PATIENTS AND METHODS: Twenty patients with CA were randomized into two groups. Group A (10 patients) underwent FUE, group B (10 patients) underwent FUE + PRP. PRP was injected 1 week before surgery, then monthly after surgery for 3 months. Follow up was done after 3, 6 and 12 months by calculating the density of surviving follicular units and the survival rate. RESULTS: In group A, there was statistically significant increase in mean survival rate which was 30.30%. At 3 months, 67.26% at 6 months and 78.15% at 12 months. In group B, there was a significant increase in mean survival rate being 30.14% at 3 months, 58.75% at 6 months and 69.74% at 12 months. There was no significant difference between both groups at anytime during follow up period. CONCLUSION: Follicular unit extraction is a preferred procedure for hair restoration in CA with few side effects. The role of PRP in HT is controversial. In the present study, PRP does not significantly affect the survival rate of hair grafts.

Quantitative and Anatomical Imaging of Human Skin by Noninvasive Photoacoustic Dermoscopy.

Imaging plays a vital role in the diagnosis and treatment of skin diseases. However, pure optical imaging technique is limited to the visualization of superficial skin tissues. Ultrasonic imaging technique can detect deep tissues, but it lacks detailed information on microscopic pathological structures. Photoacoustic imaging is an advanced technology that bridges the spatial-resolution gap between optical and ultrasonic techniques, by the modes of optical excitation and acoustic detection. Photoacoustic dermoscopy (PAD), based on photoacoustic technology, can noninvasively obtain high-resolution anatomical structures by endogenous absorbers, such as melanin, hemoglobin, lipids, etc. In the past years, PAD has gradually been developed in clinical dermatology for the diagnosis of melanoma, psoriasis, port-wine stains, dermatitis, skin grafting, and testing the efficacy of cosmetics. This protocol provides detailed procedures for PAD construction, including component selection, equipment setup, and system calibration. A step-by-step guide for human skin imaging is provided as an example application. Image reconstruction and troubleshooting procedures are also elaborated. PAD offers the 3D volumetric images of human skin, and quantitatively analyzes the vascular morphology in the dermis. The protocol will provide clinicians with standardized and reasonable guidance in dermatological imaging.

Pulsed-dye Laser Versus Intralesional Steroid in the Management of Nail Psoriasis: A Randomized, Intra-patient, Comparative, Controlled Study.

BACKGROUND: Intralesional injection of corticosteroid (ILIS) and pulsed-dye laser (PDL) have been used in nail psoriasis treatment with variable outcomes. OBJECTIVE: We sought to compare the efficacy of ILIS to PDL for the treatment of psoriatic fingernails using a dermoscope in the assessment and follow-up. METHODS: This study included 30 patients with bilateral nail psoriasis. The fingernails of one hand were treated with PDL, whereas ILIS was used to treat the fingernails of the other hand. One psoriatic nail was left alone as a control. Every patient received four treatment sessions once every month. Efficacy was recorded clinically using the Nail Psoriasis Severity Index (NAPSI) and by a dermoscope before treatment (baseline) and at eight, 24, and 36 weeks after treatment. RESULTS: The assessment by NAPSI revealed improvements of 22.24% and 24.11% occurred in the laser group and the intralesional steroid group, respectively. Also, the dermoscopic assessments revealed an improvement of 18.33% in the laser group versus that of 21.69% in the ILES. No significant difference was found between the two groups. CONCLUSION: Both PDL and ILIS are considered safe treatments for nail psoriasis, yielding nearly equal results. The dermoscope is a reliable tool for the diagnosis and follow-up of nail psoriasis treatment.

Nail Changes in Leprosy: Onychoscopy Evaluation.

CONTEXT: Repeated trauma involving extremities (in the setting of peripheral neuropathy) and poor vascularity that impairs wound healing are important causes of disability and deformity in leprosy patients. Nail changes can serve as indicators of trophic changes due to leprosy. AIMS: To describe the onychoscopy findings in leprosy cases and to identify any specific findings in leprosy patients in comparison to controls. SETTINGS AND DESIGN: The first 30 leprosy patients and 30 age and sex-matched controls who attended our tertiary care center from 1 August 2018 were included in this cross-sectional study. MATERIALS AND METHODS: Onychoscopy examination of all fingernails was performed at 50× magnification using dinolite dermoscope AM4113ZT under non-polarizing light to document surface changes and under polarizing light to document pigmentation and vascular changes. STATISTICAL ANALYSIS: The observed nail changes in cases and controls were compared using Pearson's Chi-square test. RESULTS: Statistically significant association with leprosy was found for pitting, onycholysis, melanonychia, transverse lines, nail pallor, and onychauxis. Nail pallor was unique to leprosy patients. LIMITATIONS: Small sample size and not evaluating toenails were the major limitations of the study. CONCLUSIONS: Studies with large sample size are needed to assess the significance of nail pallor as a specific onychoscopy finding in leprosy.

The Role of Dermoscopy in Severity Assessment of Alopecia Areata: A Tertiary Care Center Study.

OBJECTIVE: To evaluate the dermoscopic features of alopecia areata (AA) and correlate these features with patterns and severity. DESIGN AND SETTING: The present study was performed over a period of six months, from September 2018 to February 2019, in a tertiary care hospital where clinically diagnosed patients with AA were enrolled. A thorough clinical examination followed by dermoscopy was performed. The results were tabulated and then analyzed statistically. PARTICIPANTS: The study included 52 patients with AA of either sex and all age groups. Patients whose diagnosis was unclear and those who received treatment for their AA in the month prior to the study were excluded. RESULTS: The mean age of presentation was 22.8±12.1 years. The most common dermoscopic finding was presence of black dots (BD) seen in 82.7 percent of patients; the least common was tulip hairs (TH), seen in 9.6 percent. Significant associations between yellow dots (YD) and broken hair (BH) and severity of alopecia was observed. There was a significant correlation of alopecia areata disease pattern with YD and BH (p<0.05). CONCLUSION: This study highlights the potential use of dermoscopy in AA as a means to understand various disease characteristics that can act as predictors of severe disease or poor prognosis.

Intralesional vitamin D3 versus new topical photodynamic therapy in recalcitrant palmoplanter warts Randomized comparative controlled study.

BACKGROUND: Recalcitrant palmoplanter warts represent a therapeutic challenge. Side effects of local destructive methods necessitates the need for other less morbid modalities. Recently immunotherapy as well as light based devices and lasers have emerged as therapeutic approaches. AIM OF THE STUDY: To compare between the safety and efficacy of intralesional vitamin D3 injection and photodynamic therapy (PDT) using eosin in treatment of recalcitrant palmoplanter warts. PATIENTS AND METHODS: Prospective, randomized, controlled comparative study. Fifty -six patients with recalcitrant palmoplanter warts were randomly divided into 3 groups. Group A was injected with intralesional vitamin D3. Group B was subjected to PDT using eosin loaded in trasferosomes as a photosensitizer. Group C is the control group. Clinical improvement was assessed by photographic records and dermoscopic assessment, at baseline, before each session and after completion of treatment. Patients were followed up for 6 months after cure to detect recurrence. RESULTS: Group A and B showed complete clearance in 88.89 % and 86.36 % respectively compared to 18.75 % in the control group. These results were statistically significant (P value<0.001). No side effects were reported except for pain during injection in group A. CONCLUSION: In the current study, both vitamin D3 and PDT using Eosin are safe, highly effective and well tolerated modalities in treatment of viral warts.

Intra-Operative Dermoscopy in Assessment of Melanonychia and as a Guide for Biopsy.

BACKGROUND AND AIMS: Melanonychia can be a manifestation of benign or malignant pathology and often poses a diagnostic challenge on clinical examination. Even with distinguishing dermoscopic features (nail plate), it can be quite difficult to determine the nature of pigmentation as complete assessment of nail bed and matrix is still not possible. Intraoperative dermoscopy (IOD) can serve as a useful tool to appreciate the bed and matrix changes. The aim here is to study the intraoperative dermoscopic features in patients with melanonychia and correlate with histopathology. METHODS: 20 consecutive patients with melanonychia were recruited. Inclusion criteria was melanonychia of sudden onset, progressive nature, irregular width/color/symmetry on dermoscopy, positive Hutchinson sign, solitary nail involvement or associated nail dystrophy. Preoperative dermoscopy was performed and recorded. Patients were planned for nail matrix biopsy, during which IOD was performed over nail matrix and bed after removal of the nail plate. Images were recorded and analyzed and correlated with the histopathology. RESULTS: Out of 20 patients, 12 were females and 8 males. On IOD-histopathological correlation, 2 patients were found to have melanoma of the nail unit, 5had nail lichen planus, 9 had benign melanocytic nevi, and 4 had fungal melanonychia. IOD revealed fine, parallel and regular lines of pigmentation localized to proximal nail bed and matrix in all patients with benign melanonychia, while dark thick bands with irregular borders, dots, globules, streaks and structureless areas in the two patients with melanoma. Fungal melanonychia revealed an unremarkable nail bed and matrix on IOD. CONCLUSION: Intraoperative dermoscopycan help in determining the nature of melanonychia and obviate the need to perform biopsy in certain cases. It can also aid in delineating the most suitable site for biopsy, along with grossly assessing the extent of involvement in case of malignancy.

Utility of trichoscopy to diagnose early female pattern hair loss in resource-poor setting: A cross-sectional study.

BACKGROUND: Trichoscopy is a reliable instrument for diagnosis and for tracking therapy-related changes in female pattern hair loss (FPHL). Videodermoscopic diagnosis of FPHL has been established, which requires fine measurements of hair-related parameters; the method requires an expensive equipment/digital program. AIM: To determine whether a low-cost, simple USB dermoscope can ascertain the hair-related changes in early FPHL. METHODS: An age-matched, cross-sectional study was performed over 3 years on subjects with less than 6-month history of hair loss and without an obvious broadening of midline hair parting. Trichoscopic analysis of the frontal and occipital scalp of the study subjects were performed, using a USB-connected dermoscope. The subjects were analyzed for the presence of microscopic hair changes in the form of anisotrichosis, vellus-like hair, single hair follicle unit, peri-pilar sign and yellow dots. RESULTS: A total of 230 cases and 230 controls were analyzed. The dermoscopic hair changes were found to be significantly associated with the frontal scalp zone of cases. LIMITATIONS: Histopathological evaluation of the cases was not done. CONCLUSION: Microscopic changes recorded with the help of a simple USB dermoscope are helpful in establishing a diagnosis of FPHL even in early disease.