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.

Diagnostic accuracy of ultraviolet-induced fluorescence dermoscopy in non-neoplastic dermatoses (general dermatology): A multicentric retrospective comparative study.

BACKGROUND: Preliminary data support the possible use of ultraviolet-induced fluorescence (UVF) dermoscopy in general dermatology, yet no accuracy analysis has been performed so far. OBJECTIVE: To evaluate diagnostic accuracy of UVF dermoscopy in clinically similar non-neoplastic conditions as compared to polarized light-based dermoscopy. METHODS: Patients with dermatoses potentially showing UV-induced findings were considered; cases were grouped according to clinical patterns and controls were also included. Standardized evaluation of dermoscopic pictures of the target lesion along with comparative and accuracy analysis were performed for polarized and UVF dermoscopic findings. RESULTS: A total of 208 patients were included [31 foot intertrigo (7 due to Pseudomonas, 13 due to Corynebacterium and 11 due to dermatophytes); 57 intertrigo of major creases (18 inverse psoriasis, 13 erythrasma, 15 tinea infections and 11 candidiasis); 16 acne (papulopustular) and 13 Malassezia folliculitis; 46 papulosquamous dermatoses (14 guttate psoriasis, 11 lichen planus, 12 pityriasis rosea and 9 pityriasis lichenoide chronica); and 45 hypopigmented macular dermatoses of the trunk (9 progressive macular hypomelanosis, 9 idiopatic guttate hypomelanosis, 13 vitiligo and 14 achromic pityriasis versicolor)]. Significant (p < 0.01) UVF was seen in several conditions: green in Pseudomonas foot intertrigo; red in Corynebacterium foot intertrigo, inverse and guttate psoriasis (arranged around dermal papillae in the former), progressive macular hypomelanosis (folliculocentric distribution) and erythrasma (showing polygonal or structureless appearance); blue fluorescent concretions along hair shaft in erythrasma; light green in achromic pityriasis versicolor and tinea of major creases; and blue follicular in Malassezia folliculitis. Additionally, both acne and achromic pityriasis versicolor were also associated with interruption of uniform follicular red fluorescence. Notably, polarized and UVF dermoscopy were related to the most accurate feature in nine and eight analysed dermatoses, respectively. CONCLUSION: UVF dermoscopy improves recognition of non-neoplastic dermatoses, yet it should be considered complimentary to polarized light-based dermoscopy to increase diagnostic performance.

Porokeratoses-A Comprehensive Review on the Genetics and Metabolomics, Imaging Methods and Management of Common Clinical Variants.

Porokeratosis is a heterogeneous group of keratinising disorders characterised by the presence of particular microscopic structural changes, namely the presence of the cornoid lamella. This structure develops as a consequence of a defective isoprenoid pathway, critical for cholesterol synthesis. Commonly recognised variants include disseminated superficial actinic porokeratosis, disseminated superficial porokeratosis, porokeratosis of Mibelli, palmoplantar porokeratosis (including porokeratosis palmaris et plantaris disseminata and punctate porokeratosis), linear porokeratosis, verrucous porokeratosis (also known as genitogluteal porokeratosis), follicular porokeratosis and porokeratoma. Apart from the clinical presentation and epidemiology of each variant listed, this review aims at providing up-to-date information on the precise genetic background, introduces imaging methods facilitating the diagnosis (conventional and ultraviolet-induced fluorescence dermatoscopy, reflectance confocal microscopy and pathology), discusses their oncogenic potential and reviews the literature data on the efficacy of the treatment used, including the drugs directly targeting the isoprenoid-mevalonate pathway.

Dermoscopic Pattern of Basal Cell Carcinoma in H- and Non-H-zones.

INTRODUCTION: Basal cell carcinoma (BCC) localized in the H-zone, the region of fusion of embryonic masses, has been associated with a higher risk of deeper invasion and more frequent recurrence. OBJECTIVES: The aim of the study was to compare dermoscopic features of BCC in H and non-H zone that may most appropriately characterize those two locations. METHODS: Dermoscopy images of histopathologically confirmed BCCs from 120 patients were retro-spectively analyzed. Dermoscopy features of BCC in H- and non-H zone were described and a comparative study of the dermoscopic pattern of BCC between the two locations was performed. RESULTS: Of 120 BCC cases included in this study, 41 (34.2%) were located in the H-zone. The most frequent histological type was nodular (51.3% in H- zone and 61.6 % in non-H-zone) followed by superficial (5.1% and 19.8 % in H and non-H-zone respectively).In dermoscopy, there was a higher prevalence of ulceration (73.2% versus 43.6%, P < 0.001) in H-zone and a lower prevalence of brown globules (26.8% versus 53.2%; P = 0.01), when compared with the non-H-zone. CONCLUSIONS: Our results show that dermoscopic features of BCC on the face fulfill a typical pattern regardless of the region, except for the prevalence of the ulceration which is significantly more frequent in H-zone and the brown globules present significantly more often in the non-H-zone It can be hypothesized that H-zone might predispose to more aggressive course of BCC complicated by ulceration and consequently deeper tissue destruction.

Vascular pattern in dermoscopy of basal cell carcinoma in the H- and non-H-zone.

Introduction: Basal cell carcinoma (BCC) located on the face in the H-zone (nose, ears, eyes), the region corresponding to places of fusion of embryonic masses (EFP) has been associated with a higher risk of deeper invasion and more frequent recurrence. Aim: To characterize the dermoscopic image of the vessels of BCC in the H-zone and non-H-zone. Material and methods: A retrospective analysis of vessels in dermoscopic images of 120 BCC cases in the H-zone and non-H-zone (the rest of the face) was conducted. The H-zone consists of the nose, ears, eyes and the non-H-zone of the forehead, cheek, chin and the rest of the face and neck. Results: Of the 120 lesions analysed, there were 41 (34.2%) in the H-zone and 79 (65.8%) in the non-H-zone. Arborizing vessels, as well as the short-fine-telangiectasias were the most predominant types of vessels present, and their frequency in the H- and non-H-zone was comparable. Significant differences were observed for the occurrence of glomerular and comma vessels, both of which occurred less frequently in the H-zone than in the non-H-zone. Conclusions: The dermoscopic morphology of the vessels in BCC tumours in the H- and non-H-zones is generally similar, with differences in the presence of glomerular and comma vessels, which occur more frequently in the non-H-zone.

The efficacy of antimalarial drugs in the therapy of selected forms of cicatricial alopecia.

INTRODUCTION: Frontal fibrosing alopecia (FFA) is primary lymphocytic cicatricial alopecia with a clinically characteristic progressive recession of the frontotemporal hairline, perifollicular erythema, as well as symptoms of itching and burning. It occurs mainly in postmenopausal women. FFA is considered as a subtype of lichen planopilaris (LPP). The treatment of those diseases is presently empirical. AIM: To define the efficacy of treating FFA and LPP with hydroxychloroquine. MATERIAL AND METHODS: We performed a retrospective analysis of 95 women, including 35 with FFA and 60 with LPP. We collected the relevant demographic and clinical data. The response to treatment with hydroxychloroquine was assessed using LPPAI. Also, adverse events were monitored. RESULTS: Treatment with hydroxychloroquine has a statistically significant effect on decreasing the disease activity after 6 and 12 months of therapy. The results of statistical tests do not confirm the existence of a relationship between age range and treatment efficacy. However, there is a correlation between the duration and efficacy of treatment (p < 0.05). CONCLUSIONS: Administration of hydroxychloroquine can be considered as one of the treatment methods for FFA and LPP in everyday clinical practice. The presented study is the first attempt at using hydroxychloroquine to treat such large patient groups for FFA and LPP. Hydroxychloroquine efficaciously alleviates the symptoms in LPP patients and gives maximum benefits in long-term therapy (12 months). The preliminary results obtained in the presented retrospective analysis should be confirmed in a randomized prospective clinical trial, which remains a future challenge for researchers.

Variances in the mRNA expression profile of TGF-ß1-3 isoforms and its TGF-ßRI-III receptors during cyclosporin a treatment of psoriatic patients.

INTRODUCTION: Psoriasis is a chronic, immunologic, multi-factor inflammatory skin disease, strongly associated with a higher level of a number of cytokines, such as isoforms of transforming growth factor ß (TGF-ß1-3) and its receptors (TGF-ßRI-III). One of the most popular and important drugs used to treat this disease is cyclosporin A (CsA). AIM: The aim of this study was to investigate the expression of genes encoding the transforming growth factor (TGF)-ß isoforms and receptors of the cytokine TGF-ßRs in psoriatic patients during an 84-day long observation of the effects of cyclosporin A therapy. It made an attempt to determine the usefulness of testing mRNA expression of TGF-ß1-3 and its receptors TGF-ßRI-III as the supplementary molecular markers of lost sensitivity to the medicine. MATERIAL AND METHODS: The study group consisted of 32 patients with psoriasis (20 men and 12 women) treated with cyclosporin A. The changes in expression patterns of TGF-ß1-3 and TGF-ßRI-III were performed by real-time quantitative reverse transcription PCR (RTqPCR). RESULTS: The expression of TGF-ß1-3 and TGF-ßRI-III were detected in the whole period of therapy with CsA. Changes in transcriptional activities of TGF-ß1-3 and TGF-ßRI-III during pharmacotherapy were observed. Differences in the expression of these genes were found before and after 42 and 84 days of using CsA. CONCLUSIONS: The changes in expression profiles of TGF-ß1-3 and TGF-ßRI-III during CsA therapy can be a useful molecular marker of lost sensitivity to the medicine.

The correlation between serum E-selectin levels and soluble interleukin-2 receptors with relation to disease activity in localized scleroderma.

INTRODUCTION: Scleroderma is a chronic connective tissue disease resulting in fibrosis. AIM: The aim of the study was to determine the connection between sE-selectin and sIL-2R and the severity of skin lesions in various subtypes of LoS. Evaluation of disease severity, the location of skin lesions, the duration of symptoms and disease activity were assessed in relation to the three different LoS subtypes in patients with localized scleroderma. MATERIAL AND METHODS: The study included 42 patients with localized scleroderma and the control group consisted of 41 healthy subjects. All patients in the LoS study group had a confirmed diagnosis via skin biopsy and underwent serology testing for sE-selectin and sIL-2R concentrations by enzyme-linked immunosorbent assay (ELISA). RESULTS: Significantly higher levels of sE-selectin and sIL-2R were observed in the LoS study group when compared with the control group (p < 0.001). The analysis showed a result close to statistical significance (p = 0.058) between sE-selectin concentration during the time of active disease in the LoS study group. The highest concentrations of sE-selectin and sIL-2R were observed in patients with the generalized subtype of LoS. A positive, statistically significant, curvilinear relationship was shown amid the modified Localized Skin Severity Index (mLoSSI) and sE-selectin and sIL-2R concentrations in the LoS study group. CONCLUSIONS: Concentrations of the circulating form of sE-selectin appear to be an adequate marker of the endothelial function, positively correlating with the severity of the disease. The proven correlation of sIL-2R concentrations with the severity of the disease indicates that it is a valuable prognostic factor for predicting the impending course of the disease.

Primary Locations of Malignant Melanoma Lesions Depending on Patients' Gender and Age

Introduction: Location of malignant melanoma lesions depends on environmental, genetic, sociological and demographical factors. Available sources do not provide enough information on such dependencies in various populations. There is no data concerning the role of socio-demographic factors for the population of the Central and Eastern Europe. Aim: The aim of this work was to evaluate the anatomical location of the primary malignant melanoma lesion in correlation to patients' gender and age. Material and methods: A retrospective analysis of medical documentation of 363 patients has been performed. The patients had been diagnosed with malignant melanoma and were undergoing treatment in the years 2010-2014 in two Polish oncologic hospitals. The subject group consisted of 199 (55%) females and 164 (45%) males. The age varied between 19 - 90 years, with the median of 62 years. Results: In women, the melanoma lesions seem to appear more often in their lower extremities, while in case of men such lesions seem to be more often on their torsos. In both cases, the difference was statistically significant (p<0.01 When the specific locations are considered in women the lesions were more often located on their shins (p<0.01), whereas for men the lesions were located on their backs (p<0.01). It has been observed that there is dependency between lesion localization and age of patients. The lesions located on heads and necks were most common in older patients, and the lesions located in lower extremities were most common in younger ones. Conclusion: Differences in location of malignant melanoma lesions may be due to either genetic or environmental reasons. It is often emphasized in literature that correlation between the socio-demographic factors and the process of oncogenesis requires intensive research. In our work, we have tried to fill this gap for the population of Central and Eastern Europe to determine the exact epidemiology of this kind of cancer. This knowledge may be then used for developing cancer prevention methods specific to gender and age.

Pregnancy: a therapeutic dilemma.

Treatment during pregnancy is problematic. The Food and Drug Administration established drug categories to help in the treatment process. First-generation antihistamines are considered safe but they have sedative properties. Second-generation antihistamines cause less adverse reactions but besides cetirizine and loratadine they belong to category C. All retinoids should be avoided during pregnancy due to the risk of fetal malformations. Antimalarial drugs should be considered based on the clinical data. Sulfones can be considered as safe for use during pregnancy only with proper monitoring. Prednisone is administered in pregnancy. Other glucocorticosteroids have a different safety profile. Cyclosporine A treatment should be reserved as rescue therapy in severe stages of the disease. Treatment during pregnancy should be precise when it comes to pregnant woman and safe for the fetus.

Physiochemical properties and application of hyaluronic acid: a systematic review.

BACKGROUND: Hyaluronic acid is a widely available, biocompatible, polysaccharide with distinguishing physiochemical properties which inspire its application throughout several fields of medicine. OBJECTIVE: We aim to investigate the application of hyaluronic acid and its effectiveness throughout several fields of medicine, including several therapies administered and prescribed by general health practitioners. METHODS: We conducted a systematic review on randomized controlled trials about the physiochemical properties of hyaluronic acid and its application through primary care. Studies included in this review were peer reviewed and met our inclusion criteria. FINDINGS: Factors were clustered into the following: uses throughout several fields of medicine, physiochemical properties, bioavailability, tolerance, effectiveness, and adverse effects. Therapies with hyaluronic acid provided long-lasting, pain relieving, moisturizing, lubricating, and dermal filling effect. Tissue hydration, elasticity, and durability improved. CONCLUSIONS: Adjunct therapy with hyaluronic acid provides longer-lasting therapeutic effect when compared to the use of glucocorticosteroids and NSAIDs in osteoarthritic chronic diseases, is well-established in ophthalmology due to its lubricating properties for the corneal endothelium, and improves tissue hydration and cellular resistance to mechanical damage in aesthetic dermatology, and has marginal adverse effects. Several trials indicated its role in tumor markers, liver diseases, and in pharmaceuticals, but further research would be necessary to draw conclusive results in those fields.