Dermatoscopy of Infections and Infestations

Abstract

Dermoscopy is a non-invasive tool for the diagnosis of skin diseases. Entomodermoscopy is a branch of dermoscopy that deals with infections and infestations. The use of dermoscopy for diagnosis of infections and infestations is rapidly increasing as it can provide useful clues related to diagnosis and effectiveness of treatment. It serves as a useful adjunct to microbiological and histopathological examination. In some cases, like scabies dermoscopy can even clinch the diagnosis.

Keywords: Dermoscopy; entomodermoscopy; infections and infestations; leishmaniasis; pediculosis; scabies.

Figure 1

Dermoscopy of scabies shows triangle or delta wing jet (blue arrow) which represents mite and contrail (orange arrow) representing burrow (Heine Delta20, polarized, X10)

Figure 2

Dermoscopy shows live head louse with blood meal (blue arrow) and presence of nits (Heine Delta 20, polarized, X 10)

Figure 3

Dermoscopy shows live nits which are brown colored (white circle) and translucent empty nits (orange circle) (Heine Delta 20, polarized, X 10)

Figure 4

Direct microscopy showing pubic louse and nits attached to hair shaft (X4) (Courtesy Dr Pradeesh Armugam, Base Hospital, Lucknow)

Figure 5

Dermoscopy showing pubic louse holding onto hair shaft and live nit attached to hair shaft (blue arrow) (Dinolite, polarized, X 50) (Courtesy Dr Hiral Shah, Assoc Prof, Medical college Baroda, SSG Hospital)

Figure 6

Dermoscopy of demodiciosis shows gelatinous filament-like structure emerging from hair follicle (blue circle), reticular pattern of pigment is seen (blue arrow) (Dermlite DL4, polarized, X10)

Figure 7

Dermoscopy of cutaneous larva migrans shows translucent light pink structureless area suggestive of body of larvae (Dermlite DL4, polarized, X10) (Courtesy: Dr Enzo Erichetti, Consultant Dermatologist, University Hospital “ Santa Maria della Misericordia”, Udine, Italy)

Figure 8

Dermoscopy shows tick as round shiny structure in external ear. It is surrounded by blood and crust (Dermlite DL4, polarized X10) Courtesy: Dr Biju vasudevan, Prof, Department of Dermatology, AFMC, Pune

Figure 9

Dermoscopy of common wart shows irregular white structures, red to black dots (blue circle) and hair pin vessels in the white structures (blue arrow) (Dermlite DL4, polarized X10)

Figure 10

Dermoscopy of flat wart shows well defined lesion with presence of regular red dots in white to pink background (blue arrow). The lesion does not respect anatomical structures (Dermlite DL4, polarized X10)

Figure 11

Dermoscopy of plantar wart shows white scales on background of yellow structureless area (blue arrow), red to black dots can be seen in the center (blue circle). The dermatoglyphics over the lesion is characteristically absent (Dermlite DL4, polarized X10)

Figure 12

Dermoscopy of genital wart shows presence of white to pink structures with dotted vessels in some area (blue circle) and linear vessels in other (blue arrow). The sessile part shows dotted vessels while pedunculated part shows linear vessels (Dermlite DL4, polarized X10)

Figure 13

Dermoscopy of pedunculated genital wart at higher magnification shows white finger like projections and presence of looped vessels in them (Dinolite Edge, polarized X100)

Figure 14

Dermoscopy of molluscum contagiosum shows yellow white clods (blue circle). Inset shows homogenous yellow white clods, rosette (four- clover leaf structure) and crown vessels (blue arrow) (Dermlite DL4, polarized X10)

Figure 15

Dermoscopy of tinea corporis shows background erythema and peripheral white scales. (Dermlite DL4, polarized X10)

Figure 16

Dermoscopy of tinea corporis shows vellus hair involvement which is seen as loss of vellus hairs, brown spots and surrounding white halo (blue circle) (Dermlite DL4, polarized X10)

Figure 17

Dermoscopy of steroid modified tinea shows erythema in periphery with relative lack of scaling (blue arrow), white scales are seen as trailing scales in the center of the lesion (red arrow) (Dermlite DL4, polarized X10)

Figure 18

Dermoscopy of tine mannum shows homogenous yellow background and white scales in the furrow (blue arrow) (Dermlite DL4, polarized X10)

Figure 19

Dermoscopy of pityriasis versicolor shows presence of white scales in furrows (blue arrow) (Dermlite DL4, polarized, X10)

Figure 20

Dermoscopy of pityriasis versicolor shows folliculotropism with scales around the hair follicle and reduced pigmentary network (blue circle) (Dermlite DL4, polarized, X10)

Figure 21

Dermoscopy of cutaneous candidiasis shows polycyclic erosions surrounded by yellow scales (blue arrows). These yellow scales give an appearance of cottage cheese like film (Dermlite DL4, polarised, X10) (Courtesy: Dr Balachandra Ankad, Prof and HOD, Department of Dermatology, S Nijalingappa medical college, Bagalkot)

Figure 22

Dermoscopy of eumycotic mycetoma shows yellow globules (blue star), red structureless areas, white scales (blue arrow) and erythema-dotted vessels (orange star) (Dermlite DL4, polarized, X10) (Courtesy: Dr Anwita Sinha, MD, Military Hospital, Kirkee)

Figure 23

Dermoscopy of sporotrichosis shows yellow structureless areas (blue arrow), peripheral rim of erythema and red dots (orange arrow) and central ulceration (blue circle) (Dermlite DL4, polarised, X10) (Courtesy: Dr Enzo Erichetti, Consultant Dermatologist, University Hospital “Santa Maria della Misericordia”, Udine, Italy)

Figure 24

Dermoscopy of folliculitis shows central pustule around the follicle (blue arrow) and surrounding red dots and clods (blue circle) (Dermlite DL4, polarized, X10) (Courtesy: Dr Enzo Erichetti, Consultant Dermatologist, University Hospital “Santa Maria della Misericordia”, Udine, Italy)

Figure 25

Dermoscopy of pitted keratolysis shows shallow, irregular pits, and absence of dermatoglyphics (Heine Delta 20, polarized, X 10)

Figure 26

Dermoscopy of Trichomycosis axillaris shows yellowish masses around hair follicle (blue arrow) (Dermlite DL4, polarized, X10) (Courtesy: Dr Enzo Erichetti, Consultant Dermatologist, University Hospital “Santa Maria della Misericordia”, Udine, Italy)

Figure 27

Dermoscopy of cutaneous leishmaniasis shows erosion (blue star), crust, white scale (blue arrow), and yellow tears (blue circle) on background of erythema (Dermlite DL4, polarized, X10)