Hair and scalp dermatoscopy

Dermatoscopy is a noninvasive diagnostic tool that allows the recognition of morphologic structures not visible by the naked eye. Trichoscopy (scalp dermatoscopy and videodermatoscopy) is useful for the diagnosis and follow-up of hair and scalp disorders. However, it is not widely used in the management of hair disorders. This review provides updated information from the literature and our experience on the dermoscopic features of the most common hair and scalp disorders. This will enable dermatologists to make fast diagnoses of tinea capitis and alopecia areata, distinguish early androgenetic alopecia from telogen effluvium, and differentiate scarring from nonscarring alopecia.     

Diagnostic pearl: bright field globe magnifier diascopy for large pigmented skin lesions: a practical approach to epiluminescence microscopy

Papular and nodular mucinosis is a distinct form of cutaneous mucinosis associated with systemic lupus erythematosis. We report a case in which papular and nodular mucinosis predated early findings of progressive systemic sclerosis.     

Significance of dermatoscopy in genital dermatoses

Dermatoscopy as a non-invasive technique has become an integrative part in the evaluation of pigmented and non-pigmented skin lesions, particularly for the early detections of melanoma. Although dermatoscopy improves diagnosis of pigmented and nonpigmented lesions of the skin, it is unknown if dermatoscopy improves the diagnostic accuracy of pigmented mucosal lesions. The “entodermatoscopy” is used for the dermatoscopy of skin infections and infestations and revised as entomodermatoscopy, as it connects the research fields of dermatology and entomology, with its roots being found in these two words. In genital dermatology along with the clinical examination, dermatoscopy is also used for the diagnosis and treatment follow-up of pediculosis pubis, genital warts, molluscum contagiosum, and scabies.     

Principles of dermatoscopy of pigmented skin lesions

There has been a dramatic increase in the incidence of malignant melanoma in most parts of the world. Because the tumor thickness is the most important prognostic factor for the prognosis of the malignant melanoma, the early detection of thin melanomas is essential. Dermatoscopy allows the physician to discriminate between melanocytic and nonmelanocytic lesions with high diagnostic accuracy and to detect initial malignant melanomas. We review the principles of dermatoscopy and the differential diagnosis of pigmented skin lesions. Before using the ABCD rule of dermatoscopy to classify melanocytic lesions into benign, suspicious, or malignant, the distinction between melanocytic and nonmelanocytic lesions is necessary. An essential prerequisite for the usefulness of this technique is adequate training.     

Hair diagnoses and signs: the use of dermatoscopy

Background.  Hair-shaft examination is diagnostically useful in a range of adult and paediatric conditions.
Objective.  To evaluate the usefulness of dermatoscopy in hair-shaft microscopy.
Methods.  Typical examples of selected conditions from an extensive collection of scalp hair were examined using a dermatoscope and a light microscope with paired cross-polarizing filters. Hair-shaft characteristics were photographed using a digital camera.
Results.  Dermatoscopy was helpful in detecting tapered hairs, weathering, monilethrix, pediculosis capitis, peripilar casts, 'exclamation-mark' hairs of alopecia areata, bubble hair and pili torti. It was less helpful in pili annulati and unhelpful in detecting 'tiger-tail' banding in trichothiodystrophy. Light microscopy provided greater detail in almost all cases; it was necessary for detection of cuticle changes and added significant information in detecting characteristic features of trichothiodystrophy, pili annulati, bubble hair and pili torti.
Conclusions.  Dermatoscopy is most revealing in conditions resulting in gross changes in shaft outline and colour, where reflected light is valuable. It is unhelpful for detection of features within the shaft or at higher levels of resolution. When added to its ability to aid evaluation of scalp surface characteristics, dermatoscopy provides an excellent first-line method of assessment in clinics. In vivo it may aid screening and selection of hairs of greatest diagnostic yield for further assessment. In some instances, it may obviate the need for obtaining hair specimens and have implications for public health screening. Where detailed or cortical hair-shaft features need assessment, transmitted light microscopy remains the standard tool.     

Use of dermatoscopy and videodermatoscopy in therapeutic follow-up: a review

Dermatoscopy (DE) is a noninvasive technique that allows a rapid and magnified in vivo observation of the skin surface with the visualization of morphologic features invisible to the naked eye. It is performed using manual devices without computer assistance, which generally allows ×10 magnifications. Videodermatoscopy (VD) represents the evolution of DE and is performed using a video camera equipped with optic fibers and lenses that currently allow magnifications ranging from ×10 to ×1000. Both DE and VD have been demonstrated to have further applications in dermatology apart from their use in differential diagnosis of pigmented skin lesions. In several disorders, they may be useful in differential diagnosis, prognostic evaluation, and in evaluating the response to treatment. This article focuses on the use of DE and VD in therapeutic follow-up. Although VD systems using high magnifications may not be cost-effective in all cases, VD represents a more reliable noninvasive and easy-to-use tool in therapeutic follow-up both for in-office dermatology as well as for clinical investigations.     

Two controversies confronting dermoscopy or dermatoscopy: nomenclature and results

Dermatoscopy is a noninvasive diagnostic technique that was used mostly for diagnosing pigmented lesions,[1], [2] but more recently, it has been employed in the diagnosis of infectious and inflammatory skin lesions, also known as entomodermoscopy and inflammoscopy,³ as well as for hair⁴ and scalp disorders, called trichoscopy.⁵ The initial name of epiluminescence microscopy has evolved into dermatoscopy and dermoscopy but not without controversy.     

Preoperative assessment of melanoma thickness by ABCD score of dermatoscopy

BACKGROUND: Epiluminescence microscopy is a useful tool for the noninvasive diagnosis of malignant melanoma based on criteria that have been correlated with specific histologic characteristics. Previous studies have also shown a good correlation between the frequency of some dermatoscopic criteria based on pattern analysis (pigment network, blue-gray areas, vascular pattern) and tumor thickness. This technique could be useful in the preoperative assessment of tumor thickness as an indication for sentinel node biopsy. OBJECTIVE: Our purpose was to evaluate the possible role of the total dermatoscopy score (TDS) assigned to a series of lesions in accordance with the ABCD rule of dermatoscopy as a preoperative predictor of melanoma thickness. METHODS: For 84 cutaneous melanomas (17 were in situ melanomas; 67 invasive cases with mean thickness 0. 93 mm; range, 0.2-3.9 mm; standard deviation, 0.63) consecutively excised at the Department of Dermatology of Florence, TDS was established by two observers blinded as to the tumor thickness. The performance of different cut-off points of TDS in the diagnosis of melanoma with Breslow's thickness more than 0.75 or 1.00 mm was investigated by receiver operating characteristic (ROC) analysis. Accuracy of classification was evaluated in terms of sensitivity, specificity, and area under ROC curves (AUC). RESULTS: The TDS assigned to cutaneous melanomas by the ABCD rule increased with the thickness of the lesions from in situ melanomas to melanomas of intermediate thickness (0.75-1.50 mm). As a preoperative method for the detection of melanomas with a Breslow thickness greater than 0. 75 mm, a TDS cut-off point of 6.80 showed 80% sensitivity, 84% specificity, and 82% diagnostic accuracy (AUC value, 0.90). TDS performed better in the diagnosis of a thickness threshold of 0.75 than 1.00 mm (higher AUC value). CONCLUSION: The TDS calculated by the ABCD rule of dermatoscopy-a simplified approach to dermatoscopic diagnosis of melanoma-provides useful information for the preoperative assessment of melanoma thickness greater than 0.75 mm.