Review
Dermatoscopy: Alternative uses in daily clinical practice

https://doi.org/10.1016/j.jaad.2010.03.010Get rights and content

Dermatoscopy, also known as dermoscopy, epiluminescence microscopy, or surface microscopy, is a noninvasive technique allowing rapid and magnified (×10) in vivo observation of the skin with the visualization of morphologic features often imperceptible to the naked eye. Videodermatoscopy (VD) represents the evolution of dermatoscopy and is performed with a video camera equipped with lenses providing higher magnification (×10 to ×1000). Over the past few years, both dermatoscopy and VD have been demonstrated to be useful in a wide variety of cutaneous disorders, including ectoparasitic infestations, cutaneous/mucosal infections, hair and nail abnormalities, psoriasis, and other dermatologic as well as cosmetologic conditions. Depending on the skin disorder, both dermatoscopy and VD may be useful for differential diagnosis, prognostic evaluation, and monitoring response to treatment. Nowadays, it represents an important and relatively simple aid in daily clinical practice.

Introduction

Capsule Summary

  • Dermatoscopy and videodermatoscopy are noninvasive techniques allowing magnified in vivo skin observation, which have demonstrated to be useful in a wide variety of cutaneous disorders (including ectoparasitic infestations, cutaneous/mucosal infections, hair and nail abnormalities, psoriasis and other dermatological as well as some cosmetological conditions) beyond the traditional indication for pigmented lesions of the skin.

  • Dermatoscopy and videodermatoscopy may be useful for differential diagnosis, prognostic evaluation, and monitoring response to treatment.

  • The aim of this article is to advance knowledge about and update the alternative uses of dermatoscopy and videodermatoscopy by reviewing existing papers and presenting our experience.

Dermatoscopy, also known as dermoscopy, epiluminescence microscopy, or surface microscopy, is a noninvasive technique allowing rapid and magnified in vivo observation of the skin with the visualization of morphologic features often imperceptible to the naked eye. It is performed with manual devices which do not require any computer “assistance” and generally employs ×10 magnifications (Table I). Videodermatoscopy (VD) represents the evolution of dermatoscopy and is performed with a video-camera equipped with lenses providing magnification ranging from ×10 to ×1000.1, 2 The images obtained are visualized on a monitor and stored on a personal computer in order to process them and compare any possible changes over time (Table II).

Both dermatoscopy and VD have greatly improved the diagnostic accuracy of pigmented skin lesions and, more recently, the evaluation of nonpigmented skin disorders. They are usually performed according to an epiluminescence microscopy technique facilitated by the application of a liquid (oil, alcohol, or water) to the skin to eliminate light reflection. However, this method has been recently replaced by new systems involving polarized light instead of liquids, with comparable results.2, 3 Over the past few years, both dermatoscopy and VD have been demonstrated to be useful in a wide variety of cutaneous disorders, including ectoparasitic infestations, cutaneous/mucosal infections, hair and nail abnormalities, psoriasis, and other dermatological as well as cosmetologic conditions.

Section snippets

Scabies

Both dermatoscopy and VD represent promising and useful diagnostic tools for scabies. Their effectiveness has been confirmed by numerous studies.1, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 In particular, the accuracy of VD has been demonstrated to be comparable to that of scraping.11

Dermatoscopic examination of active lesions shows, at low magnifications (up to ×40), the presence of a small dark brown triangular structure, corresponding to the pigmented anterior part of the mite, located at the end of

Molluscum contagiosum

Clinical diagnosis of molluscum contagiosum, a common skin infection caused by a poxvirus, is in general not difficult, although in some doubtful cases dermatoscopic examination may be helpful.14, 32, 33, 34 Molluscum contagiosum shows a characteristic pattern (Fig 2), consisting of a central polylobular white to yellow amorphous structure with a peripheral crown of reddish, linear or branched vessels, which do not usually cross the center of the lesion (‘red corona').14, 32, 33

Human papillomavirus infections

Dermatoscopy has

Hair disorders

In the past few years VD has been increasingly and successfully employed in the evaluation of different hair disorders either as a diagnostic device or as a useful instrument for a better insight into their pathogenesis.

Nail diseases

Dermatoscopic examination has been recently utilized in the study of some nonpigmented lesions and diseases of the nails.61, 62 Dermatoscopy can analyze the nail in various anatomic aspects, such as nail plate, hyponychium, distal edge of the nail plate, proximal nailfold, nail bed, and matrix and generally requires the use of immersion gel or oil.61, 62 The evaluation of nailfold capillaroscopic abnormalities, widely utilized in the diagnosis of collagen tissue disorders (systemic sclerosis

Psoriasis

Evaluation of microvascular alterations is relevant to investigate the pathogenesis of as well as to enhance the diagnosis of psoriasis.69 Over the years, the role of VD in the study of psoriatic lesions has gained increasing importance because of the identification of a peculiar vascular pattern.70, 71, 72 VD at low magnifications (×10 to ×50) of the psoriatic microcirculation in lesional skin provides a global vision of the vascular configuration characterized by a dotted pattern. Higher

Clear cell acanthoma

Dermatoscopy of clear cell acanthoma, a benign epidermal tumor clinically characterized by a well-circumscribed, pink reddish papule, shows at low magnification (×20 to ×50) homogeneous, symmetrical, dotted vessels throughout the entire nodule, arranged either in a net-like pattern or as pearls on a line.80, 81, 82, 83 At higher magnification (×200), the dotted vessels display a bush-like aspect.82 Thus dermatoscopy can be a useful diagnostic tool.

Port-wine stains

The use of dermatoscopy has been proposed for

Cosmetologic applications

VD can be of value in a variety of cosmetologic disorders. It may enhance the visualization of xerosis, through the identification of lifted keratinocyte edges and skin flakes, which cause the skin to appear whitish.54, 117

In pseudofolliculitis barbae, VD displays the course of sharp-pointed ingrown hairs on individual papules responsible for extrafollicular and transfollicular penetration. It has also been recommended to evaluate the efficacy of therapy and to enhance its compliance.54, 118

Conclusions

Alternative uses of dermatoscopy and VD have been described in recent years in steadily increasing numbers. Depending on the skin disorder, both dermatoscopy and VD may be useful for differential diagnosis, prognostic evaluation, and monitoring response to treatment. Nowadays, they represent an important and relatively simple aid in daily clinical practice.

References (118)

  • N. Okada et al.

    Video macroscopic study of psoriasis

    J Am Acad Dermatol

    (1991)
  • F. Lacarrubba et al.

    Videodermatoscopy enhances diagnostic capability in psoriatic balanitis

    J Am Acad Dermatol

    (2009)
  • F. Vázquez-López et al.

    The hand-held dermatoscope improves the clinical evaluation of port-wine stains

    J Am Acad Dermatol

    (2003)
  • L.E. Eubanks et al.

    Videomicroscopy of port-wine stains: correlation of location and depth of lesion

    J Am Acad Dermatol

    (2001)
  • G. Micali et al.

    Possible applications of videodermatoscopy beyond pigmented lesions

    Int J Dermatol

    (2003)
  • I. Zalaudek et al.

    Dermoscopy in general dermatology

    Dermatology

    (2006)
  • G. Argenziano et al.

    Epiluminescence microscopy. A new approach to in vivo detection of Sarcoptes scabiei

    Arch Dermatol

    (1997)
  • J. Bauer et al.

    Nodular scabies detected by computed dermatoscopy

    Dermatology

    (2001)
  • B. Brunetti et al.

    Findings in vivo of Sarcoptes scabiei with incident light microscopy

    Eur J Dermatol

    (1998)
  • N. Ishii

    Guideline for the diagnosis and treatment of scabies in Japan (2nd ed)

    J Dermatol

    (2008)
  • J. Kreusch

    Incident light microscopy: reflection on microscopy of the living skin

    Int J Dermatol

    (1992)
  • F. Lacarrubba et al.

    High-magnification videodermatoscopy: a new noninvasive diagnostic tool for scabies in children

    Pediatr Dermatol

    (2001)
  • G. Micali et al.

    Scraping versus videodermatoscopy for the diagnosis of scabies: a comparative study

    Acta Derm Venereol

    (2000)
  • S. Neynaber et al.

    Diagnosis of scabies with dermoscopy

    CMAJ

    (2008)
  • C. Prins et al.

    Dermoscopy for the in vivo detection of Sarcoptes scabiei

    Dermatology

    (2004)
  • I. Zalaudek et al.

    Entodermoscopy: a new tool for diagnosing skin infections and infestations

    Dermatology

    (2008)
  • K.Y. Mumcuoglu et al.

    Louse comb versus direct visual examination for the diagnosis of head louse infestations

    Pediatr Dermatol

    (2001)
  • J. De Maeseneer et al.

    Wet combing versus traditional scalp inspection to detect head lice in schoolchildren: observational study

    BMJ

    (2000)
  • A. Chuh et al.

    Diagnosis of Pediculosis pubis: a novel application of digital epiluminescence dermatoscopy

    J Eur Acad Dermatol Venereol

    (2007)
  • G. Micali et al.

    Videodermatoscopy enhances the ability to monitor efficacy of scabies treatment and allows optimal timing of drug application

    J Eur Acad Dermatol

    (2004)
  • F. Lacarrubba et al.

    Head lice: ex vivo videodermatoscopy evaluation of the pediculocidal activity of two different topical products

    G Ital Dermatol Venereol

    (2006)
  • K.C. Yoon et al.

    Mechanical treatment of phthiriasis palpebrarum

    Korean J Ophthalmol

    (2003)
  • J. Bauer et al.

    Dermoscopy of tungiasis

    Arch Dermatol

    (2004)
  • A. Di Stefani et al.

    An additional dermoscopic feature of tungiasis

    Arch Dermatol

    (2005)
  • J. Bauer et al.

    Variability of dermoscopic features of tungiasis

    Arch Dermatol

    (2005)
  • R. Cabrera et al.

    Tungiasis: eggs seen with dermoscopy

    Br J Dermatol

    (2008)
  • R.M. Bakos et al.

    “Whitish chains”: a remarkable in vivo dermoscopic finding of tungiasis

    B J Dermatol

    (2008)
  • R. Cabrera et al.

    Dermoscopy in the diagnosis of tungiasis

    Br J Dermatol

    (2009)
  • E. Moscarella et al.

    Tungiasis

  • A. Llambrich et al.

    Dermoscopy of cutaneous leishmaniasis

    Br J Dermatol

    (2009)
  • A. Morales et al.

    Dermoscopy of molluscum contagiosum

    Arch Dermatol

    (2005)
  • P. Zaballos et al.

    Dermoscopy of molluscum contagiosum: a useful tool for clinical diagnosis in adulthood

    J Eur Acad Dermatol Venereol

    (2006)
  • P. Zaballos

    Molluscum contagiosum

  • J.M. Bae et al.

    Differential diagnosis of plantar wart from corn, callus and healed wart with the aid of dermoscopy

    Br J Dermatol

    (2009)
  • D.Y. Lee et al.

    The use of dermoscopy for the diagnosis of plantar wart

    J Eur Acad Dermatol Venereol

    (2009)
  • M. Ozeki et al.

    Dermoscopic features of pearly penile papules

    Dermatology

    (2008)
  • M. Brasiello et al.

    Lupus vulgaris: a new look at an old symptom—the lupoma observed with dermoscopy

    Dermatology

    (2009)
  • A. Tosti

    Dermoscopy of hair and scalp disorders with clinical and pathological correlations

    (2007)
  • L. Rudnika et al.

    Trichoscopy: a new method for diagnosis of hair loss

    J Drugs Dermatol

    (2008)
  • Cited by (0)

    Funding sources: None.

    Conflicts of interest: None declared.

    View full text