Dermoscopy in the Diagnosis of Cutaneous Leishmaniasis

Abstract

Background: Cutaneous leishmaniasis (CL) is a protozoan infectious disease. Dermoscopy is a noninvasive diagnostic tool that has been applied to several skin diseases, including infestations.

Objectives: To determine the dermoscopic patterns of CL lesions and to investigate whether a relationship exists between dermoscopic characteristics and the disease duration, localization, and type of CL lesions.

Methods: Seventy-nine patients (48 male, 31 female) from Hatay, Turkey, were enrolled in the study and a dermoscopic evaluation was performed on 139 lesions. Images of CL lesions were taken via polarized light contact dermoscopy. Chi-square and Fisher exact tests were used for statistical analyses and P values <0.05 were considered significant.

Results: Generalized erythema was seen in all CL lesions. Vascular structures (94.2%), yellow tears (75.5%), and a white starburst-like pattern (58.3%) were the other most common dermoscopic features. Hyperkeratosis (P = 0.001) and white starburst-like pattern (P < 0.001) were more prevalent in the extremities than elsewhere. Among vascular structures, linear irregular (45.8%), hairpin (43.5%), and comma-shaped (25.9%) patterns were the most common dermoscopic findings. Linear irregular (P = 0.023) and arborizing vessels (P = 0.001) were observed in the head-neck region. Dotted (P = 0.009), hairpin (P < 0.001), and glomerular-like (P = 0.016) morphological findings were more prevalent in the extremities. Statistical significances in disease duration were detected in microarborizing (P = 0.027) and arborizing (P = 0.004) vessels and were most prevalent with a disease duration of >6 months. Hairpin vessels were prevalent in the plaque and nodulo-ulcerative type of lesions. Dotted vessels were most commonly seen in the plaque type (47.4%) of lesions.

Conclusions: Generalized erythema, yellow tears, and starburst-like patterns, as well as linear irregular, hairpin, comma-shaped, and arborizing vessels, were the most commonly detected dermoscopic features of CL lesions. We suggest that the presence of these features can be helpful when diagnosing CL lesions by dermoscopy.

Keywords: cutaneous; dermoscopy; leishmaniasis; vascular.

Figure 1

Examples of background color with polarized light contact dermoscopy (PlCD). (A) Dusky red (PlCD × 20). (B) Light red (PlCD × 40). (C) Yellowish red (PlCD × 30). [Copyright: ©2019 Serarslan et al.]

Figure 2

(A,C) Clinical picture of CL lesion. (B) Dermoscopically lesion reveals yellow tears (PlCD × 30). (D) Yellow tears with central crust (PlCD × 30). [Copyright: ©2019 Serarslan et al.]

Figure 3

(A,C) Clinical features of leishmaniasis. (B,D) Examples of starburst-like pattern (PlCD × 20 and × 30). [Copyright: ©2019 Serarslan et al.]

Figure 4

Vascular structures of CL lesions (PlCD × 40). (A) Arborizing vessels with peripheral distribution. (B) Regularly distributed hairpin vessels. (C) Microarborizing vessels. [Copyright: ©2019 Serarslan et al.]