RESUMO
Dermoscopy can be an important help for the diagnosis of skin cancers and inflammatory cutaneous diseases. The list of the dermoscopic features reported in granuloma faciale is wide and includes vascular and non-vascular features. We report here three cases of diffuse flat facial and extrafacial granuloma faciale that exhibited elongated linear vessels simulating branching vessels and diffuse structureless orange areas. The differential diagnosis between flat-type granuloma faciale, basal cell carcinoma and cutaneous sarcoidosis can be extremely difficult, making histology mandatory before any treatment.
Assuntos
Dermoscopia , Granuloma , Humanos , Masculino , Feminino , Diagnóstico Diferencial , Pessoa de Meia-Idade , Granuloma/patologia , Granuloma/diagnóstico por imagem , Dermatoses Faciais/patologia , Dermatoses Faciais/diagnóstico por imagem , Sarcoidose/patologia , Sarcoidose/diagnóstico por imagem , Carcinoma Basocelular/patologia , Carcinoma Basocelular/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/diagnóstico por imagem , Idoso , AdultoRESUMO
BACKGROUND: The dermoscopic findings of papulopustular rosacea include tiny papules and pustules, follicular plugs and follicular dilatation. Demodex tails and Demodex follicular openings are dermoscopic indicators that are mainly found in primary demodicosis and, less frequently, in rosacea. AIM: To describe the dermoscopic features of papulopustular rosacea and to investigate the differential dermoscopic features between patients with and without concomitant Demodex infestation. METHODS: We conducted a prospective study of patients with almost-clear, mild or moderate papulopustular rosacea. For each patient, dermoscopic images were taken and a standardized skin surface biopsy was performed. RESULTS: In this group of 60 patients, the most frequent dermoscopic findings were yellow dots, vascular polygons and follicular scales. Patients with moderate rosacea had more Demodex follicular openings compared with patients with mild rosacea (P = 0.02), while patients with mild rosacea had a higher frequency of follicular scales than did patients with almost-clear rosacea (P = 0.01). Patients with moderate rosacea had higher rates of Demodex follicular openings (P = 0.02), follicular scales (P < 0.001), follicular annular pigmentation (P = 0.001) and follicular pustules (P < 0.001) compared with patients with almost-clear rosacea. No significant dermoscopic differences were observed between patients with and without concomitant Demodex infestation. CONCLUSIONS: Papulopustular rosacea has specific dermoscopic findings. In our opinion, dermoscopy is not sufficient by itself for the diagnosis of Demodex proliferation in rosacea.
Assuntos
Dermoscopia , Infestações por Ácaros/patologia , Rosácea/microbiologia , Rosácea/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Dermatoses Faciais/diagnóstico por imagem , Dermatoses Faciais/microbiologia , Dermatoses Faciais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infestações por Ácaros/diagnóstico por imagem , Estudos Prospectivos , Rosácea/diagnóstico por imagem , Índice de Gravidade de Doença , Pele/diagnóstico por imagem , Pele/microbiologia , Pele/patologia , TrombiculidaeAssuntos
Dermatoses Faciais/parasitologia , Melanose/parasitologia , Infestações por Ácaros/complicações , Anti-Infecciosos/uso terapêutico , Antiparasitários/uso terapêutico , Quimioterapia Combinada , Dermatoses Faciais/diagnóstico por imagem , Dermatoses Faciais/patologia , Feminino , Fricção , Humanos , Ivermectina/uso terapêutico , Masculino , Melanose/diagnóstico por imagem , Melanose/patologia , Metronidazol/uso terapêutico , Infestações por Ácaros/tratamento farmacológico , Prurido/parasitologiaRESUMO
BACKGROUND: Redness is the most common symptom among many facial dermatoses. With the rapid development of optical instruments, spectral imaging, and image processing technology, there appear varieties of skin color analysis methods and instruments. The aim of this study is to reveal the differences and correlations in measuring the facial redness between CSKIN® and VISIA® , as well as the relevance between the instrument parameters and clinical evaluation. MATERIALS & METHODS: Forty-three Chinese patients were enrolled. Images were taken and analyzed by VISIA® from Canfield and CSKIN® from Yanyun Technology, and the facial erythema was graded by the dermatologists. RESULTS: Feature counts within the red areas measured by VISIA® were found to have significantly positive correlations with red pixels and percent which were measured by CSKIN® on both sides of the face (r = .45 ~ .566, P < .01). The parameters analyzed by CSKIN® and VISIA® feature counts were correlated with visual scores graded by the dermatologists, VISIA® presented with a weak correlation (r = .213, P < .05), while CSKIN® had a moderate correlation with the visual scores (r = .472 ~ .492, P < .001). CONCLUSION: CSKIN® may be another alternative option when encountering with measurement and follow-up of facial erythema.
Assuntos
Eritema , Dermatoses Faciais , Processamento de Imagem Assistida por Computador , Eritema/diagnóstico por imagem , Dermatoses Faciais/diagnóstico por imagem , Humanos , Pigmentação da Pele , TecnologiaRESUMO
Lupus panniculitis (LP), also referred to as lupus erythematosus profundus (LEP), is a chronic recurrent inflammation condition of the subcutaneous fat. It occurs in 1 to 3% of patients with systemic lupus erythematosus (SLE) and in 10% of patients with discoid lupus erythematosus (DLE), but can also occur as an entity of its own. Patients with lupus panniculitis usually present with persistent, often tender and painful skin lesions, or subcutaneous nodules, that range from 1 to 5â¯cm in diameter. The overlying skin may appear erythematous; lesions may become ulcerated, and heal with atrophy, skin depression, dimpling and scaring. Lesions tend to resolve spontaneously and may follow a chronic course of remission and exacerbation that persists for months to years. The imaging features of facial LP are extremely scarce in the literature. We present a case of facial lupus panniculitis and describe the associated characteristic ultrasound, CT, and MR imaging findings along with histopathologic correlation.
Assuntos
Dermatoses Faciais/patologia , Lúpus Eritematoso Discoide/patologia , Paniculite de Lúpus Eritematoso/patologia , Adulto , Dermatoses Faciais/diagnóstico por imagem , Feminino , Humanos , Lúpus Eritematoso Discoide/diagnóstico por imagem , Imageamento por Ressonância Magnética , Paniculite de Lúpus Eritematoso/diagnóstico por imagem , Pele/patologia , Tomografia Computadorizada por Raios XRESUMO
An unusual case is presented of a 29 year-old Caucasian woman with a granuloma in an old scar in the right periocular region as a first clinical sign of a systemic sarcoidosis. An excisional biopsy was performed, for which the histological diagnosis was a chronic non-necrotising granulomatous inflammation, suggestive of scar sarcoidosis. The lesion re-appeared one year after initial treatment, and was treated with intralesional depot steroids, showing adequate progression. This disease occurs more frequently in wound areas where there are foreign bodies and could be the first sign of systemic sarcoidosis.
Assuntos
Cicatriz/patologia , Dermatoses Faciais/diagnóstico , Granuloma de Corpo Estranho/patologia , Sarcoidose/diagnóstico , Adulto , Anti-Inflamatórios/uso terapêutico , Biópsia , Dermatoses Faciais/diagnóstico por imagem , Dermatoses Faciais/patologia , Traumatismos Faciais/complicações , Traumatismos Faciais/patologia , Feminino , Granuloma de Corpo Estranho/diagnóstico por imagem , Granuloma de Corpo Estranho/etiologia , Humanos , Imageamento por Ressonância Magnética , Recidiva , Sarcoidose/tratamento farmacológico , Sarcoidose/patologia , Sarcoidose Pulmonar/complicações , Sarcoidose Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Triancinolona Acetonida/uso terapêutico , CicatrizaçãoRESUMO
BACKGROUND AND OBJECTIVE: Benign and malignant facial skin lesions may be difficult to differentiate clinically and with dermoscopy. The present study aimed to evaluate the potential utility of in vivo reflectance confocal microscopy (RCM) as a second-level examination for facial skin neoplasms. PATIENTS AND METHODS: Retrospective and blinded evaluation of 160 consecutive facial lesions was carried out in two separate steps. Clinical and dermoscopic images were assessed first, followed by combined evaluation of clinical/dermoscopic and RCM images. Our study included 60 % malignant lesions, comprising 43 % melanomas, 9 % basal cell carcinomas, 5 % in situ squamous cell carcinomas and 3 % lymphomas. RESULTS: Ancillary RCM significantly improved diagnostic specificity for the detection of malignancy compared to clinical/dermoscopic evaluation alone (58 % vs 28 %). However, sensitivity was slightly lower for RCM-based image evaluation (93 % vs 95 %) due to misclassification of one in situ SCC and one lymphoma. In terms of melanoma diagnosis, RCM-based image evaluation was generally superior; sensitivity was only slightly increased (88 % vs 87 %), but melanoma specificity was significantly higher (84 % vs 58 %). CONCLUSION: RCM is a valuable diagnostic adjunct for facial skin lesions; unnecessary biopsies in this cosmetically sensitive area could be reduced by one third without missing a melanoma.
Assuntos
Dermatoses Faciais/diagnóstico por imagem , Neoplasias Faciais/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Dermoscopia/métodos , Dermatoses Faciais/patologia , Neoplasias Faciais/patologia , Feminino , Humanos , Hiperpigmentação/diagnóstico por imagem , Hiperpigmentação/patologia , Ceratose Seborreica/diagnóstico por imagem , Ceratose Seborreica/patologia , Masculino , Microscopia Confocal/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemAssuntos
Carcinoma Basocelular/diagnóstico por imagem , Dermatoses Faciais/diagnóstico por imagem , Neoplasias Faciais/diagnóstico por imagem , Transtornos de Fotossensibilidade/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Dermoscopia , Diagnóstico Diferencial , Dermatoses Faciais/etiologia , Dermatoses Faciais/patologia , Neoplasias Faciais/patologia , Feminino , Humanos , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Transtornos de Fotossensibilidade/etiologia , Transtornos de Fotossensibilidade/patologia , Estudos Retrospectivos , Pele/diagnóstico por imagem , Pele/patologia , Pele/efeitos da radiação , Neoplasias Cutâneas/patologia , Luz Solar/efeitos adversosRESUMO
Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign vascular proliferation characterized by solitary or multiple angiomatous lesions. It is most common in young or middle-aged women, and the lesions typically affect the head and neck, showing a particular predilection for the periauricular region. The differential diagnosis in patients with ALHE is broad and includes both benign and malignant conditions. We report on a series of cases of periauricular ALHE in which ultrasound imaging revealed an hypervascular, pseudonodular and plaque-like morphology with clinical and histologic correlations. It also evidenced vascular communication between lesions that appeared to be separate on clinical examination. Familiarity with such ultrasound presentations could help to improve diagnostic accuracy and facilitate disease monitoring in patients with ALHE.
Assuntos
Hiperplasia Angiolinfoide com Eosinofilia/diagnóstico por imagem , Dermatoses Faciais/diagnóstico por imagem , Ultrassonografia/métodos , Hiperplasia Angiolinfoide com Eosinofilia/epidemiologia , Hiperplasia Angiolinfoide com Eosinofilia/patologia , Orelha , Dermatoses Faciais/epidemiologia , Dermatoses Faciais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Pele/irrigação sanguínea , Ultrassonografia Doppler em Cores/métodos , Adulto JovemRESUMO
INTRODUCTION: The evaluation of Acne using ordinal scales reflects the clinical perception of severity but has shown low reproducibility both intra- and inter-rater. In this study, we investigated if Artificial Intelligence trained on images of Acne patients could perform acne grading with high accuracy and reliabilities superior to those of expert physicians. METHODS: 479 patients with acne grading ranging from clear to severe and sampled from three ethnic groups participated in this study. Multi-polarization images of facial skin of each patient were acquired from five different angles using the visible spectrum. An Artificial Intelligence was trained using the acquired images to output automatically a measure of Acne severity in the 0-4 numerical range of the Investigator Global Assessment (IGA). RESULTS: The Artificial Intelligence recognized the IGA of a patient with an accuracy of 0.854 and a correlation between manual and automatized evaluation of r=0.958 (P less than .001). DISCUSSION: This is the first work where an Artificial Intelligence was able to directly classify acne patients according to an IGA ordinal scale with high accuracy, no human intervention and no need to count lesions. J Drugs Dermatol. 2018;17(9):1006-1009.
Assuntos
Acne Vulgar/diagnóstico por imagem , Inteligência Artificial , Dermatoses Faciais/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador , Índice de Gravidade de Doença , Acne Vulgar/patologia , Adolescente , Adulto , Criança , Dermatoses Faciais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Adulto JovemAssuntos
Dermatoses Faciais/diagnóstico , Hemiatrofia Facial/diagnóstico , Esclerodermia Localizada/diagnóstico , Adolescente , Adulto , Idoso , Anticorpos Antinucleares/sangue , Anticorpos Antinucleares/imunologia , Biomarcadores/sangue , Criança , Pré-Escolar , Estudos Transversais , Progressão da Doença , Dermatoses Faciais/diagnóstico por imagem , Dermatoses Faciais/imunologia , Dermatoses Faciais/patologia , Hemiatrofia Facial/diagnóstico por imagem , Hemiatrofia Facial/imunologia , Hemiatrofia Facial/patologia , Feminino , Alemanha , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esclerodermia Localizada/diagnóstico por imagem , Esclerodermia Localizada/imunologia , Esclerodermia Localizada/patologia , Testes Sorológicos , Pele/patologia , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
BACKGROUND: Acne is an inflammatory disease of the pilosebaceous follicle, affecting 41-54% of adult women, with a particular form that involves the mandible. METHODS: We characterized infundibulum morphology in two groups of adult women using reflectance confocal microscopy. First, we investigated acne visually "healthy zones" on the forehead in 15 adult women with diffuse acne and compared with acne-free controls. We then compared healthy forehead and affected mandibular zone in 15 acne patients with mandibular involvement. Exposed results had a P < 0.05. RESULTS: Seven hundred and ninety-one follicles were observed on apparently healthy skin of 15 adult women with acne, with a larger diameter, thicker (68%), and hyper keratinized (65%) follicle border, and more keratin plugs (44%) than in controls. In the second group of 15 adult women with mandibular acne, we compared 569 follicles in the mandibular zone and 475 on forehead. In the mandibular area, follicles were significantly larger, thicker (76%), more hyper keratinized (72%), with more keratin plugs (47%) and increased inflammation (23%) compared with the forehead area. In the mandibular area, 0.2% of follicles showed isolated inflammation without hyper keratinization, and 15.3% had both thickened borders with an onion-like appearance and keratin plugs associated with inflammation. CONCLUSIONS: Hyper keratinization was higher in healthy skin of adult women with acne compared with controls, confirming that microcomedo is crucial in the development of acne lesions. We also demonstrate that the repartition of comedones and microcomedones is inhomogeneous with a great number in the mandibular area where acne lesions are located.
Assuntos
Acne Vulgar/diagnóstico por imagem , Dermatoses Faciais/diagnóstico por imagem , Folículo Piloso/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Bochecha , Queixo , Feminino , Testa , Humanos , Microscopia Confocal , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Ingenol mebutate (IngMeb) 0.015% gel is an approved field treatment option for non-hyperkeratotic non-hypertrophic actinic keratosis (AK) of face and scalp. Efficacy of IngMeb has been assessed only on a clinical ground, in the majority of studies. Dermoscopy is a pivotal tool for the diagnosis of AK, while its role in evaluating the response to non-surgical therapies for AK has not been fully defined. OBJECTIVES: Our study aims to determine whether some dermoscopic features of AK of the face and scalp areas may independently predict the response to IngMeb therapy. METHODS: Clinical and dermoscopic responses, 1 month after 0.015% IngMeb therapy, were retrospectively evaluated using a per-patient and per-lesion approach. Safety was evaluated through local skin reaction composite score calculation. Demographic, clinical and dermoscopic factors were then evaluated via univariate and multivariate logistic regression analysis to assess independent predictors of response. RESULTS: Fifty-five patients with 245 AKs were enrolled. Clinically, per-patient response evaluation identified 25 (45.4%) poor/partial and 30 (54.5%) complete responders, corresponding on a per-lesion approach to 66 (26.9%) and 179 (73.1%) AKs, respectively. Dermoscopy reclassified 14 patients in the per-patient and 48 AKs in the per-lesion analysis from complete to poor/partial responders. Multivariate logistic regression analysis showed that AKs dermoscopically characterized by red pseudonetwork and located on the face were independently associated with a complete dermoscopic response to 0.015% IngMeb therapy, while microerosions were negative predictors. CONCLUSION: Specific dermoscopic features of AK may predict the response to 0.015% IngMeb therapy, together with the location on the face.
Assuntos
Antineoplásicos/uso terapêutico , Dermoscopia , Diterpenos/uso terapêutico , Ceratose Actínica/diagnóstico por imagem , Ceratose Actínica/tratamento farmacológico , Administração Cutânea , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/administração & dosagem , Diterpenos/administração & dosagem , Eritema/induzido quimicamente , Dermatoses Faciais/diagnóstico por imagem , Dermatoses Faciais/tratamento farmacológico , Feminino , Géis , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Dermatoses do Couro Cabeludo/diagnóstico por imagem , Dermatoses do Couro Cabeludo/tratamento farmacológico , Resultado do TratamentoRESUMO
Idiopathic facial aseptic granuloma is a typical childhood disease characterized by the presence of one or more asymptomatic nodules on the cheek. Although pathogenesis remains unclear, the disease is thought to be a type of childhood rosacea. It resolves spontaneously, yet it could be confused with other lesions that require treatment. We present clinical and ultrasound findings and outcome from 3 new cases. In 2 cases, the lesion presented as childhood rosacea. Ultrasound revealed a characteristic pattern, with variations depending on the stage of development. High-frequency ultrasound can facilitate the differential diagnosis and thus obviate unnecessary biopsy or excision.