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CORRESPONDENCE
Year : 2021  |  Volume : 66  |  Issue : 4  |  Page : 421-424
A Pilot Study to Evaluate Dermoscopic Patterns in Eczema at Rural Based Tertiary Care Centre


Department of Dermatology and Venereology, Pramukhswami Medical College, Karamsad, Gujarat, India

Date of Web Publication17-Sep-2021

Correspondence Address:
Pragya A Nair
Department of Dermatology and Venereology, Pramukhswami Medical College, Karamsad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_223_19

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How to cite this article:
Nair PA, Bhavsar N, Patel D. A Pilot Study to Evaluate Dermoscopic Patterns in Eczema at Rural Based Tertiary Care Centre. Indian J Dermatol 2021;66:421-4

How to cite this URL:
Nair PA, Bhavsar N, Patel D. A Pilot Study to Evaluate Dermoscopic Patterns in Eczema at Rural Based Tertiary Care Centre. Indian J Dermatol [serial online] 2021 [cited 2021 Dec 3];66:421-4. Available from: https://www.e-ijd.org/text.asp?2021/66/4/421/326113




Sir,

This is a prospective study conducted in the Department of Dermatology for 6 months after obtaining approval from the Ethics committee for Human Research (HREC). Patients with a clinical diagnosis of chronic plaque psoriasis, eczema (subacute and chronic), or lichen planus (LP) affecting the trunk, upper and lower extremities were included. Lesions located on the scalp, palms, soles, intertriginous or genitals were excluded from the study.

Informed written consent of all the participating patients was taken. A pre-structured proforma was filled to collect the data. Clinical details in the form of size, number, site, and morphology of the lesions were recorded. Dermatoscopic evaluation was done in all the cases with contact polarized dermatoscope FireflyPro DE300. Photographs were stored in a laptop and findings recorded in the proforma.

Well-developed lesions were examined dermoscopically with special emphasis on variables such as vascular morphology and arrangement, background color, distribution with the color of scale, and presence of Wickham striae.

Descriptive statistics were presented using frequency for clinical profile of patients. Analysis comparing the clinical features and dermatoscopic features was done using the Chi-square method.

Out of 60 patients, 35 were of eczema, 15 were of psoriasis, and 10 of LP [Table 1].
Table 1: Demographic details of patients

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The mean age of the patients presenting with eczema was 35.86 ± 12.67 (range, 16–66) years with duration of lesions ranging from 5 days to 15 years (median 36 months) and lower extremities as the most commonly involved site.

The dermoscopic patterns observed were as follows [Table 2]:
Table 2: Dermoscopic changes in eczema, psoriasis, and lichen planus

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   Subacute Eczema Top


Distribution of dotted vessels (60%, n = 5) with dull red background (60%, n = 5) and yellow scales (80%, n = 5) in a patchy arrangement [Figure 1]a
Figure 1: (a) Patchy distribution of dotted vessels (red arrow) with dull red background (green arrow) and yellow scales (yellow arrow) in a patchy arrangement in subacute eczema. (b) Dotted vessels (red arrow) with patchy distribution of yellow and white scales (yellow arrow) in chronic eczema. (c) Violaceous background (violet arrow) along with scaling on skin creases (yellow arrow) in chronic eczema. (d) Dotted vessels in a patchy distribution (red arrow) with yellow scales (yellow arrow) in chronic eczema

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   Chronic Eczema Top


Distribution (83%, n = 30) of dotted vessels (63%, n = 30) with violaceous background (96%, n = 30) [Figure 1]b and scales of both yellow and white color (40%, n = 30) in a patchy arrangement. Psoriasis: Regular distribution of dotted vessels (100%, n = 15) on a light red background (73%, n = 15) [Figure 2]a with diffusely arranged white scales (54%, n = 15) [Figure 2]b
Figure 2: (a) Regular distribution of dotted vessels (red arrow) on a light red background (green arrow) in psoriasis. (b) Diffusely arranged white scales (yellow arrow) with dotted regularly arranged vessels (red arrow) in psoriasis. (c) Dotted plus linear vessels (red arrow) in a peripheral distribution with central scale (yellow arrow) in lichen planus. (d) Violaceous background (violet arrow) with peripheral scaling (green arrow) and Wickham striae (pink arrow) in lichen planus

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   Lichen Planus Top


Violaceous background with dotted and linear vessels at the periphery [Figure 2]c. Wickham striae were seen exclusively in LP [Figure 2]d

Clinically, eczema or dermatitis appears many times similar to psoriasis and LP. This poses a diagnostic challenge necessitating skin biopsy for an accurate diagnosis.[1]

Some dermoscopic patterns are observed consistently with certain diseases which can be used for their diagnosis that will obviate the need for skin biopsy for diagnosis as well as for follow-up.

Very few studies of dermatoscopy on dermatitis have been done especially in India,[2] So this pilot study was done with the objective of evaluating the dermoscopic patterns in eczema particularly subacute and chronic, and to differentiate it from psoriasis and LP.

The reported dermoscopic findings of our study in eczema were red dots in a patchy distribution with yellow scales which were consistent with the previously reported studies.[2],[3],[4] The red dots are identical to the vessels in psoriatic lesions, but unlike psoriasis, their distribution is not homogenous and regular, but rather clustered, generating an irregular "patchy" pattern.[2]

Besides vascular morphology, the vascular arrangement and specific dermoscopic clues have been judged to be of equal importance in the differential diagnosis of nonpigmented skin lesions.[4]

Superficial scaling is a common clinical observation in eczema but opposed to psoriasis and other papulosquamous diseases. The scales on dermoscopy of eczema reveal a yellow color either alone, or in combination with white.[2] Scales in a combination of yellow and white color were seen in 40% (n = 30) of our patients with chronic eczema while 80% (n = 5) of the patients with subacute eczema showed yellow scales.

Yellow serocrusts have recently been described as dermoscopic finding in two cases of nummular eczema with characteristic yellow scales known as "yellow clod sign."[5] We also observe the same finding in our cases of subacute eczema.

Violaceous background was observed in a majority of our cases of chronic eczema which was probably because of the Indian population having Fitzpatrick skin type 3–5. Nayak SS, et al.[3] in their study found (53%, n = 15) patients with brown-black background while (47%, n = 15) patients with red to pinkish background. To the best of our knowledge, violaceous background in cases of eczema has not yet been reported in the literature.

Xu C, et al. observed dotted vessels in a regular arrangement over a light red background with white scales on dermoscopy in plaques of psoriasis.[6] They also reported vascular structures of hairpin vessels and red loops for the diagnosis of psoriasis.[5] Thus, dermoscopic patterns of red dots or globules arranged in a homogeneous, regular, or ring-like fashion are a common finding in plaque psoriasis.[6] Lallas et al.[2] reported that red dots, globules, homogeneous vascular area, and light red background aided in the diagnosis of psoriasis. Histopathologically, red dots correspond to loops of vertically arranged dilated dermal capillaries within the elongated dermal papillae.

Errichetti E, et al.[7] in their study found the presence of diffuse white scales in palmar psoriasis and yellowish scales, brownish-orange dots/globules, and yellowish-orange crusts in chronic hand eczema.

Sporadic cases of dermatitis reportedly show dermoscopic patterns similar to those found in psoriasis—predominantly red dots in a patchy distribution with yellow scales.[7]

A specific feature for the diagnosis of psoriasis is the sign of red globular rings described by Vazquez-Lopez et al.[8] Only one-third of our patients had dermoscopic findings of red globules in irregular circles or rings.

Wickham striae, clinically appreciated as white streaks in a reticular pattern, are the hallmark of LP not only in the clinical examination but also on dermoscopy.[2],[9] Wickham striae with dotted and linear vessels in patchy and peripheral distribution were seen in 80% of our patients.

Besides its diagnostic values, dermoscopy might provide a useful tool for the evaluation of therapeutic outcomes and can highlight unwarranted side effects caused by drugs.

Limitations of the study included a relatively small sample size and lack of histopathological correlation.

Thus, plaque psoriasis, dermatitis, and LP reveal specific dermoscopic patterns that may aid in the clinical diagnosis. Violaceous background was observed in a majority of our cases of chronic eczema with yellow and white scales, distributed diffusely, and lack of Wickham striae, which will help to differentiate it from LP.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
McKee PH, Brenn T, Calonje JE, Granter SR, Lazar AJ. Spongiotic, psoriasiform and pustulardermatoses. Pathology of the Skin with Clinical Correlations. 3rd ed. St Louis: Elsevier Mosby; 2005. p. 171-216.  Back to cited text no. 1
    
2.
Lallas A, Kyrgidis A, Tzellos TG, Apalla Z, Karakyriou E, Karatolias A, et al. Accuracy of dermoscopic criteria for the diagnosis of psoriasis, dermatitis, lichen planus and pityriasisrosea. Br J Dermatol 2012;166:1198-205.  Back to cited text no. 2
    
3.
Nayak SS, Mehta HH, Gajjar PC, Nimbark VN. Dermoscopy of general dermatological conditions in Indian population: A descriptive study. Clin Dermatol Rev 2017;1:41-51.  Back to cited text no. 3
  [Full text]  
4.
Nischal KC, Khopkar U. Dermoscope. Indian J Dermatol Venereol Leprol 2005;71:300-3.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Zalaudek I, Argenziano G. Dermoscopysub patterns of inflammatory skin disorders. Arch Dermatol 2006;142:808.  Back to cited text no. 5
    
6.
Navarini AA, Feldmeyer L, Töndury B, Fritsche P, Kamarashev J, French LE, et al. The yellow clod sign. Arch Dermatol 2011;147:1350.  Back to cited text no. 6
    
7.
Errichetti E, Stinco G. Dermoscopy in differential diagnosis of palmar psoriasis and chronic hand eczema. J Dermatol 2016;43:423-5.  Back to cited text no. 7
    
8.
Xu C, Liu J, Chen D, Liu Y, Sun Q. [Roles of dermoscopy in differential diagnosis of psoriasis and eczema]. Zhonghua Yi Xue Za Zhi 2014;94:2833-7.  Back to cited text no. 8
    
9.
Vázquez-López F, Zaballos P, Fueyo-Casado A, Sánchez-Martín J. A dermoscopy sub pattern of plaque-type psoriasis: Red globular rings. Arch Dermatol 2007;143:1612.  Back to cited text no. 9
    


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