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.

Evidence for the Clinical Association between Demodex and Rosacea: A Review.

BACKGROUND: Rosacea is a chronic inflammatory dermatological condition in humans, and its pathogenesis remains unclear. However, the development of rosacea is suspected to be related to Demodex, a microscopic commensal organism that resides in or near hair follicles and sebaceous glands. Although Demodex is known to be a host-specific, obligate commensal organism, it is currently difficult to be cultured in vitro to parasitize and infect other animal hosts. Therefore, direct evidence for a pathogenic role of Demodex in rosacea is currently lacking. SUMMARY: As circumstantial evidence, non-invasive skin-detecting techniques have shown abnormally elevated numbers of Demodex in rosacea patients. Increased cytokine levels such as IL-10, IL-8, and IL-12p70 have been observed in human sebocytes following the Demodex challenge, and acaricides have been found to be effective in rosacea therapy, all point to a close relationship between Demodex and rosacea. Based on these findings, we conducted a comprehensive literature review to summarize the current state of knowledge, research insights, and clinical treatment recommendations for Demodex-associated rosacea, with the ultimate goal of improving patient outcomes.

The dermatoscope in the hair clinic: Trichoscopy of scarring and nonscarring alopecia.

Trichoscopy is currently regarded as an essential part of the hair loss consultation. It allows visualization of morphologic structures that are not obvious to the naked eye, including peri- and interfollicular skin surface abnormalities and changes to hair shaft thickness and shape. In this paper, we aim to discuss current knowledge on trichoscopy of the most common forms of scarring and nonscarring alopecias.

In Vivo Observation of Cutaneous Larva Migrans by Fluorescence-Advanced Videodermatoscopy.

Fluorescence-advanced videodermatoscopy is not a widespread diagnostic technique. Its application in dermatology can facilitate the diagnosis of diseases such as cutaneous larva migrans by enabling us to recognize the precise position of larva in vivo on the skin. Using this noninvasive technique, we detected a case of cutaneous larva migrans in a patient.

In Vivo Observation of Trombiculosis with Fluorescence-Advanced Videodermatoscopy.

Trombiculosis is a skin infestation by larvae of mites of the Trombiculidae family. We used fluorescence-advanced videodermatoscopy to diagnose trombiculosis in a woman in Italy with targetoid patches. This method might be useful for identifying atypical manifestations of trombiculosis.

Patient Attitude towards Videodermatoscopy for the Detection of Skin Cancer: A Cross-Sectional Study.

BACKGROUND: Videodermatoscopy (VD) is a useful device for supporting dermatologists in the distinction between benign and malignant lesions. However, only few patients have access to VD in daily practice. OBJECTIVES: To investigate patient attitudes towards VD. METHOD: A cross-sectional study was conducted between May and June 2018. Patients were asked to complete a self-administered questionnaire on the popularity of VD. Descriptive analysis was performed including contingency tables and χ2 tests to investigate associations between sociodemographic data and the popularity of VD. RESULTS: A total of 61.2% (123/201) of the patients had not heard of VD at the time of assessment or were unsure. Of the 38.8% of patients (78/201) who already knew of VD, 64.1% (50/78) reported that they had already been investigated by VD; 57.5% (111/193) were willing to pay an extra fee for VD. A high level of education and private insurance status had a statistically significant association with the popularity of VD (p = 0.036 and p = 0.026, respectively). CONCLUSIONS: There was a strong information deficit, especially in patients with lower education and statutory health insurance. Nevertheless, the willingness to pay an extra fee for a VD-assisted skin examination was high. Dermatologists should actively offer and inform their patients about VD when performing skin cancer screening.

Dermatoscopy: Instrumental Update.

Dermatoscopy is a noninvasive technique that allows in vivo, magnified observation of skin details and structures not visible to the naked eye. It may be performed using handheld devices or computer-assisted digital systems or videodermatoscopes. The handheld dermatoscope is the most used device because it is user-friendly and relatively inexpensive. It is not a mere magnifying glass but a more complex instrument that allows the visualization of the cutaneous microstructures of the different skin layers. Videodermatoscopes are more expensive systems that allow higher magnifications and simplify the process of image viewing, storage, organization, analysis, and retrieval.

Dermatoscopy of Parasitic and Infectious Disorders.

The use of dermatoscopy in the diagnosis and management of parasitic and infectious skin disorders has been defined as entodermoscopy, and several studies have confirmed its advantages in dermatology. Dermatoscopic patterns of several parasitic, viral, and fungal skin infections have been identified and herein described. A noninvasive, fast, and accurate diagnosis plays an important role in containing the spread of contagious skin disorders.

Dermatoscopy of Common Lesions in Pediatric Dermatology.

The use of dermatoscopy to assist in the diagnosis of a variety of proliferative, pigmentary, inflammatory, infectious, congenital, and genetic cutaneous and skin appendage disorders is constantly increasing, as it is effective, affordable, noninvasive, and quick to perform.

Trichoscopy of alopecia areata: An update.

The diagnosis of alopecia areata is usually based on clinical manifestations. However, there are several hair and scalp disorders that share similar clinical features with alopecia areata, such as tinea capitis, trichotillomania or traction alopecia. Trichoscopy as a fast, non-invasive and easy-to-perform technique may help to identify subtle details and establish the correct diagnosis. The aim of this review is to present the spectrum of trichoscopic findings in alopecia areata. A systematic review of the published work was performed by searching the PubMed, Scopus and EBSCO databases, complemented by a thorough hand search of reference lists. Of 427 articles retrieved, 30 studies were eligible for quantitative analysis. The reported features of alopecia areata were: yellow dots (6-100% patients), short vellus hairs (34-100%), black dots (0-84%), broken hairs (0-71%) and exclamation mark hairs (12-71%). Tapered hairs (5-81%) were reported in few studies, but a relatively high frequency of this finding in alopecia areata may indicate their important role in the differential diagnosis of hair loss. Rarely reported features, which include upright regrowing hairs (11-96%), pigtail (circle) hairs (4-61%) and Pohl-Pinkus constrictions (2-10%), may also be helpful in the diagnosis of alopecia areata. There is no pathognomonic trichoscopic marker for alopecia areata and the most common trichoscopic features are not the most specific. Therefore, the diagnosis should be based on the coexistence of several trichoscopic findings, not on the presence of a single feature.

Clinical, ultrasound, and videodermatoscopy monitoring of psoriatic patients following biological treatment.

BACKGROUND AND PURPOSE: Effective non-invasive techniques to monitor plaque psoriasis progression and treatment are desirable. The aim of the study was to evaluate changes in vascular pattern using videodermatoscopy (VD) and in skin thickness by ultrasound (US), along with clinical observation, during treatment with biologicals. METHODS: Forty-two patients with moderate-to-severe plaque psoriasis treated with adalimumab, etanercept, or ustekinumab were evaluated. Following the identification of a 'target' plaque at baseline, lesion changes were monitored at 15, 30 and 60 days by clinical observation using a Target Lesion Score (TLS), and by VD and US. RESULTS: After 60 days, a significant improvement in all three parameters was observed. In adalimumab-treated patients mean values of TLS, VD, and US were reduced by 83.9%, 73.5%, and 90%, respectively; in etanercept-treated patients by 67.9%, 49.7%, and 79.3%; in ustekinumab-treated patients by 80.9%, 66.4%, and 80.1%. Skin thickness was the first parameter to improve. Vascular improvement was slower compared to clinical and US responses. CONCLUSION: VD and US may be useful to monitor psoriasis treatment. Further investigations are warranted to assess if the persistence of an altered vascular pattern despite clinical and US normalization, as observed in 22% of patients, may influence disease progression and/or correlate with rate and severity degree of relapse.

Evaluation and diagnosis of the hair loss patient: part II. Trichoscopic and laboratory evaluations.

The use of trichoscopy for evaluating a number of hair and scalp disorders is gaining popularity. It is a simple and noninvasive in vivo tool for visualizing hair shafts and the scalp. Recently, alopecias have been classified according to their trichoscopic findings. The second part of this 2-part continuing medical education article reviews recent advances in this field and describes a systematic approach for using the differential diagnostic findings of trichoscopy in alopecia.

Alopecia areata incógnita: casos clínicos y revisión de la literatura / Alopecia areata incognita: clinical cases and literature review

La alopecia areata incógnita es un tipo de alopecia no cicatricial, que ha sido considerada por algunos autores como parte del espectro de alopecia areata. Se presenta como caída difusa de cabello, con visualización variable de vellos cortos, puntos amarillos, puntos negros y pelos en signos de exclamación a la dermatoscopía, y hallazgos histológicos que, si bien varían de acuerdo al tiempo de evolución, son similares a lo encontrado en biopsias de pacientes con patrones clásicos de alopecia areata. Desde que Rebora et al. describe por primera vez su hipótesis de alopecia areata incógnita, se han publicado diversos estudios dirigidos a establecer criterios que permitan definir esta entidad. Sin embargo, aún no se ha llegado a consenso. A continuación, se describen los hallazgos clínicos, dermatoscópicos e histopatológicos de pacientes con alopecia difusa de difícil manejo vistos en el Departamento de Dermatología de la Pontificia Universidad Católica de Chile

Alopecia areata incognita, a type of non-scarring alopecia, has been considered by some authors as a subtype of alopecia areata. Clinically it is characterized by diffuse hair fall, with variable display of short hairs, yellow dots, black dots and exclamation mark hairs on dermoscopy. Its histological findings are similar to those found in biopsies of patients with classical pattern of alopecia areata, although substancial changes may be seen according to the evolution of the disease. Since Rebora et al. described his hypothesis of alopecia areata incognita, several studies have been published to establish a criteria in order to define this entity. However, still no consensus has been reached. In this review, we describe the clinical, dermoscopic and histopathologic features of patients seen at the Dermatology Department of the Pontificia Universidad Católica de Chile with the diagnosis of diffuse alopecia with difficult management.

Photoletter to the editor: Exogenous pigmentation of the sole mimicking in situ acral melanoma on dermoscopy.

The parallel ridge pattern, characterized by a parallel band-like pigmentation of the ridges of the surface skin markings, represents the most important dermoscopic feature of in situ acral melanoma. A case of a young girl who showed a plantar pigmented brown macule likely due to prolonged contact with black rubber shoes, revealing a parallel ridge pattern on dermoscopy, is reported and discussed. Although parallel ridge pattern is highly suspicious of early melanoma, exogenous pigmentation should be considered as differential diagnosis in case of rapid onset acral pigmented macules.