Description of the dermatoscopic features observed in sporotrichosis and American cutaneous leishmaniasis in a reference center in Rio de Janeiro, Brazil

Abstract

Background: The evaluation of American cutaneous leishmaniasis (CL) and sporotrichosis (SP) with dermoscopy may improve the diagnosis accuracy and clinical monitoring.

Objectives: To describe the dermoscopic findings and patterns of skin lesions of patients with CL and SP followed up at the Laboratory of Clinical Research and Surveillance in Leishmaniasis (LaPClinVigiLeish), Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.

Methods: The authors included patients with a diagnosis of CL or SP, who attended at INI/ Fiocruz, between 2019‒2021. All patients had 3 dermoscopic examinations (DermLite DL4): before treatment (T₀), during treatment (T₁), and after healing (T₂). Up to three lesions per patient were evaluated.

Results: The authors studied 47 patients with CL (74 lesions), and 19 patients with SP (24 lesions). The authors described dermoscopic structures such as rosettes, white lines, white dots, brown focal structureless areas, brown lines and dots, white perilesional circles, perilesional hyperchromic circles, microulcerations and the rainbow patterns. The authors created specific patterns; in CL: CL-T₀ "central yellow scales with a white perilesional circle pattern", CL-T₁ "diffuse structureless white area pattern" and CL-T₂ "white and brown focal structureless areas pattern". In SP: SP-T₀ the "pustule with erythema pattern"; SP-T₁ the "focal structureless white areas with erythema pattern" and SP-T₂ the "white linear pattern".

Study limitations: This study does not correlate dermoscopic findings with time of disease evolution at the first medical examination.

Conclusions: The recognition of CL and SP dermoscopy patterns may be helpful tool for the differential diagnosis and monitoring of disease evolution.

Keywords: Cutaneous; Dermoscopy; Infectious diseases; Sporotrichosis; leishmaniasis.

Figure 1

Cutaneous leishmaniasis ulcer crustose lesion of patient (n = 29) on the arm, at the initial medical appointment. (A) Dermoscopy. (B) Illustration of the dermoscopic pattern: “central yellow scales with white perilesional circle”. The “central yellow scales with white perilesional circle pattern” is composed of general erythema, central ulcer with hyperkeratosis, microulcerations, focal structureless white areas, white lines, white dots, polymorphic vessels (mostly glomerular vessels, dotted vessels), surrounding by white perilesional circle

Figure 2

Cutaneous leishmaniasis epithelialized lesion of patient (n = 29), on the arm, thirty days after the beginning of the treatment. (A) Dermoscopy. (B) Illustration of the dermoscopic pattern: “diffuse structureless white area pattern”. The “diffuse structureless white area pattern” is composed of general erythema, focal structureless white area, white lines, white dots, microulcerations, polymorphic vessels and brown focal structureless areas

Figure 3

Cutaneous leishmaniasis dyschromic- atrophic cicatricial lesion of patient (n = 29) in the arm at cure. (A) Dermoscopy. (B) Illustration of the dermoscopic pattern “atrophic-hyperchromic”. The “white and brown focal structureless areas pattern” is composed of general erythema, focal structureless white area, white lines, white dots, polymorphic vessels (mostly linear irregular vessels), brown focal structureless areas, brown lines and black/brown dots

Figure 4

Sporotrichosis ulcerated plaque lesion of patient (n = 69) on the arm, at the initial medical appointment. (A) Dermoscopy. (B) Illustration of the dermoscopic pattern “pustule with erythema pattern”. The “pustule with erythema pattern” is composed of pustule, general erythema, central ulcer, microulcerations, focal structureless white areas, white lines, white dots, focal structureless yellow areas and polymorphic vessels (mostly linear irregular vessels and hairpin like vessels)

Figure 5

Sporotrichosis lesion of patient (n = 69) on the arm, thirty days after the beginning of the treatment. (A) Dermoscopy. (B) Illustration of the dermoscopic pattern “Focal structureless white areas with erythema pattern. The “Focal structureless white areas with erythema pattern” is composed of general erythema, focal structureless white areas, white lines, white dots, focal structureless yellow areas, polymorphic vessels (mostly glomerular vessels and doted vessels)

Figure 6

Sporotrichosis hypertrophic cicatricial lesion with central linear disposition of patient (n = 69) on the arm, at cure. (A) Dermoscopy. (B) Illustration of the dermoscopic pattern “white linear”. The “white linear pattern” is composed of general erythema, white lines, focal structureless white areas, white dots, black/brown dots, black lines, comedones and polymorphic vessels (mostly irregular linear vessels)

Figure 7

Sporotrichosis infiltrated plaque lesion on the face of patient (n = 21) at cure. (A) Dermoscopy. (B) Illustration of the dermoscopic pattern “strawberry”. The “strawberry pattern” is composed of general erythema with follicular plugs, white dots, and linear vessels