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Acta Dermato-venereologica Oct 2021Trichotillomania is formally classified as a mental health disorder, but it is commonly diagnosed by dermatologists. The aim of this systematic review is to assess the...
Trichotillomania is formally classified as a mental health disorder, but it is commonly diagnosed by dermatologists. The aim of this systematic review is to assess the diagnostic value of trichoscopy in diagnosing trichotillomania. The analysis identified the 7 most specific trichoscopic features in trichotillomania. These features had the following prevalence and specificity: trichoptilosis (57.5%; 73/127 and 97.5%, respectively), v-sign (50.4%; 63/125 and 99%), hook hairs (43.1%; 28/65 and 100%), flame hairs (37.1%; 52/140 and 96.5%), coiled hairs (36.8%; 46/125 and 99.6%), tulip hairs (36.4%; 28/77 and 89.6%), and hair powder (35.6%; 42/118 and 97.9%). The 2 most common, but least specific, features were broken hairs and black dots. In conclusion, trichoscopy is a reliable new diagnostic method for hair loss caused by hair pulling. Trichoscopy should be included as a standard procedure in the differential diagnosis of trichotillomania in clinical practice.
Topics: Alopecia; Dermoscopy; Diagnosis, Differential; Hair; Humans; Trichotillomania
PubMed: 34184065
DOI: 10.2340/00015555-3859 -
Frontiers in Medicine 2021Melanoma has the highest mortality rate among skin cancers, and early-diagnosis is essential to maximize survival rate. The current procedure for melanoma diagnosis is...
Melanoma has the highest mortality rate among skin cancers, and early-diagnosis is essential to maximize survival rate. The current procedure for melanoma diagnosis is based on dermoscopy, i.e., a qualitative visual inspection of lesions with intrinsic limited diagnostic reliability and reproducibility. Other non-invasive diagnostic techniques may represent valuable solutions to retrieve additional objective information of a lesion. This review aims to compare the diagnostic performance of non-invasive techniques, alternative to dermoscopy, for melanoma detection in clinical settings. A systematic review of the available literature was performed using PubMed, Scopus and Google scholar databases (2010-September 2020). All human, , non-invasive studies using techniques, alternative to dermoscopy, for melanoma diagnosis were included with no restriction on the recruited population. The reference standard was histology but dermoscopy was accepted only in case of benign lesions. Attributes of the analyzed studies were compared, and the quality was evaluated using CASP Checklist. For studies in which the investigated technique was implemented as a diagnostic tool (DTA studies), the QUADAS-2 tool was applied. For DTA studies that implemented a melanoma vs. other skin lesions classification task, a meta-analysis was performed reporting the SROC curves. Sixty-two references were included in the review, of which thirty-eight were analyzed using QUADAS-2. Study designs were: clinical trials (13), retrospective studies (10), prospective studies (8), pilot studies (10), multitiered study (1); the remain studies were proof of concept or had undefined study type. Studies were divided in categories based on the physical principle employed by each diagnostic technique. Twenty-nine out of thirty-eight DTA studies were included in the meta-analysis. Heterogeneity of studies' types, testing strategy, and diagnostic task limited the systematic comparison of the techniques. Based on the SROC curves, spectroscopy achieved the best performance in terms of sensitivity (93%, 95% CI 92.8-93.2%) and specificity (85.2%, 95%CI 84.9-85.5%), even though there was high concern regarding robustness of metrics. Reflectance-confocal-microscopy, instead, demonstrated higher robustness and a good diagnostic performance (sensitivity 88.2%, 80.3-93.1%; specificity 65.2%, 55-74.2%). Best practice recommendations were proposed to reduce bias in future DTA studies. Particular attention should be dedicated to widen the use of alternative techniques to conventional dermoscopy.
PubMed: 33968951
DOI: 10.3389/fmed.2021.637069 -
Journal of the European Academy of... Jul 2021Dermoscopy and trichoscopy are non-invasive methods used as auxiliary tools in diagnostics of different dermatoses. To date, no systematic review concerning the utility... (Review)
Review
Dermoscopy and trichoscopy are non-invasive methods used as auxiliary tools in diagnostics of different dermatoses. To date, no systematic review concerning the utility of dermoscopy and trichoscopy in the diagnostics of primary cutaneous lymphomas has been published. The aim of this study was to summarize the current state of knowledge on this topic based on systematic search of PubMed database and related references published before 8th of August 2020. Besides dermoscopic features, type of dermoscope, polarization mode, magnification, number of cases and histopathological correlation were analysed. A total of 34 records were included into the final analysis, evaluating 141 patients diagnosed with primary cutaneous T-cell lymphomas and 70 patients with primary cutaneous B-cell lymphomas. Most of the analysed records evaluated dermoscopic features (n = 206); trichoscopy was analysed in only 5 cases. Structures most commonly observed in classical mycosis fungoides (n = 108) were fine short linear vessels/linear vessels, spermatozoa-like vessels and orange-yellow patchy areas. In folliculotropic mycosis fungoides (n = 12), most frequently observed were comedonal lesions/comedo openings/central keratotic plugs and white halo around hair follicles/perifollicular accentuation. Primary cutaneous marginal zone B-cell lymphoma (n = 42) and primary cutaneous follicle centre lymphoma (n = 20) most commonly presented with salmon-coloured background and fine short/linear irregular/serpentine vessels. For other PCL, with less than 10 cases reported in the analysed records, details have been provided in the article. Most observations analysed in this systematic review rely on findings from case reports/case series (with the level of evidence V) and lack a control group. A few studies provided information concerning technical aspects of dermoscopic/trichoscopic examination. The role of dermoscopy/trichoscopy in diagnostics of cutaneous lymphomas requires further studies, especially in entities where dermoscopic features have been described in only single or a few cases. However, it seems that this practical, accessory tool in future may provide additional clues during clinical assessment.
Topics: Dermoscopy; Humans; Lymphoma, B-Cell; Lymphoma, T-Cell, Cutaneous; Male; Mycosis Fungoides; Skin Neoplasms
PubMed: 33710688
DOI: 10.1111/jdv.17219 -
International Journal of Dermatology Mar 2022Balloon cell melanoma (BCM) is a rare presentation of malignant melanoma characterized by large, foamy melanocytes lacking pigmentation. This is a comprehensive review... (Review)
Review
Balloon cell melanoma (BCM) is a rare presentation of malignant melanoma characterized by large, foamy melanocytes lacking pigmentation. This is a comprehensive review of the clinical, dermoscopic, and histological features among BCM cases reported in the literature. A systematic review of all case reports and series published since 1970 was conducted via MEDLINE, Embase, and Web of Science, using "balloon cell melanoma" and synonymous search terms. Our systematic search identified 76 cases (49% male, 51% female) of BCM in the literature. The mean age at presentation was 57.81 years. Prior skin cancer, particularly melanoma (47%), accounted for 58% of pertinent medical history. Prominent clinical exam findings included raised (46%), ulcerated (73%) lesions larger than 1 cm (68%) in the lower extremities (35%). Median Breslow thickness of primary BCM cases was 2.5 mm. Hairpin vessels (75%) and structureless architecture (75%) were predominant on dermoscopy. Notable histopathology included large (47%), vacuolated (58%) cells with foamy cytoplasm (62%) and conspicuous nucleoli (27%). Positive S-100 immunohistochemistry (73%) was most frequently employed to diagnose BCM. We observed 47% primary and 53% metastatic BCM cases. Of metastatic BCMs, balloon cells in the primary lesion were unknown in 48%, devoid in 33%, and present in 20% of cases. All metastases displayed predominant balloon cell morphology. BCM may represent an advanced phase in the progression of malignant melanoma. Improved awareness of BCM characteristics among clinicians may reduce the risk of misdiagnoses.
Topics: Dermoscopy; Female; Humans; Immunohistochemistry; Male; Melanocytes; Melanoma; Skin Neoplasms
PubMed: 33645660
DOI: 10.1111/ijd.15448 -
International Journal of Environmental... Feb 2021Early detection of melanoma is critical to reduce the mortality and morbidity rates of this tumor. Total body photography (TBP) may aid in the early detection of... (Review)
Review
Early detection of melanoma is critical to reduce the mortality and morbidity rates of this tumor. Total body photography (TBP) may aid in the early detection of melanoma. To summarize the current evidence on TBP for the early detection of melanoma, we performed a systematic literature search in Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for eligible records up to 6th August 2020. Outcomes of interest included melanoma incidence, incisional and excisional biopsy rates, as well as the Breslow's index of detected tumors. Results from individual studies were described qualitatively. The risks of bias and applicability of the included studies was assessed using the QUADAS-2 checklist. In total, 14 studies published between 1997 and 2020 with an overall sample size of = 12082 (range 100-4692) were included in the qualitative analysis. Individuals undergoing TBP showed a trend towards a lower Breslow's thickness and a higher proportion of in situ melanomas compared to those without TBP. The number needed to excise one melanoma varied from 3:1 to 14.3:1 and was better for lesions that arose de novo than for tracked ones. The included studies were judged to be of unclear methodological concern with specific deficiencies in the domains "flow and timing" and "reference standard". The use of TBP can improve the early detection of melanoma in high-risk populations. Future studies are warranted to reduce the heterogeneity of phenotypic risk factor definition and the technical implementation of TBP. Artificial intelligence-assisted analysis of images derived from 3-D TBP systems and digital dermoscopy may further improve the early detection of melanoma.
Topics: Artificial Intelligence; Dermoscopy; Humans; Melanoma; Photography; Sensitivity and Specificity; Skin Neoplasms
PubMed: 33578996
DOI: 10.3390/ijerph18041726 -
International Journal of Dermatology Jul 2021Discoid lupus erythematosus (DLE) may lead to disfiguring scarring and permanent hair loss. Dermoscopy may serve as a noninvasive tool useful in the preliminary... (Review)
Review
BACKGROUND
Discoid lupus erythematosus (DLE) may lead to disfiguring scarring and permanent hair loss. Dermoscopy may serve as a noninvasive tool useful in the preliminary diagnosis of hair loss and inflammatory skin diseases. The aim of the paper was to summarize and analyze the dermoscopic features of DLE lesions in various anatomical locations.
METHODS
A systematic review of PubMed, Scopus and Web of Science was performed using the search terms: 'lupus' OR 'discoid lupus' OR 'cutaneous lupus' combined with 'dermoscopy' OR 'dermatoscopy' OR 'videodermoscopy' OR 'videodermatoscopy' OR 'trichoscopy' OR 'mucoscopy' OR 'onychoscopy'.
RESULTS
About 29 out of 318 initially identified papers were included in the analysis. In scalp DLE (n = 166), the most common findings were: white structureless areas (62%), arborizing vessels (57.8%), white scales (54.2%), follicular keratotic plugs (47%), absent follicular openings (45.8%), perifollicular scaling (43.9%), pink-white background (40.4%), speckled brown pigmentation (38%), and fibrotic white dots (33.7%). In non-scalp DLE (n = 129), the most frequent features were: follicular keratotic plugs (66.7%), white perifollicular halo (65.9%), white scale (39.5%), speckled brown pigmentation (38.8%), white structureless areas (37.2%), and arborizing vessels (34.9%). There are scarce data in the literature on dermoscopic findings in labial (n = 8), mucosal (n = 3) and ungual DLE (n = 1).
CONCLUSIONS
DLE is characterized by a wide variety of dermoscopic findings with variable frequencies depending on the location of the lesions. Nevertheless, further studies are needed in order to reliably assess frequencies, correlation with disease stage and significance of individual dermoscopic features.
Topics: Alopecia; Dermatitis; Dermoscopy; Humans; Lupus Erythematosus, Discoid; Scalp
PubMed: 33319363
DOI: 10.1111/ijd.15365 -
International Journal of Dermatology Aug 2021Terra firma-forme dermatosis (TFFD) is an acquired pigmentation disorder that promptly regresses after applying isopropyl alcohol 70%. The clinical presentation ranges... (Review)
Review
Terra firma-forme dermatosis (TFFD) is an acquired pigmentation disorder that promptly regresses after applying isopropyl alcohol 70%. The clinical presentation ranges from patches of brownish discoloration to velvety hyperkeratotic plaques. Critical analyses of current data are lacking, so etiologies, pathogenesis, and disease associations are still debated in the literature. A literature search was done in the PubMed and Google Scholar databases to identify the published papers reporting clinical cases of TFFD. Of 102 papers screened, 64 met the including criteria. Overall, the records of 256 patients presenting a mean age of 18.34 years and a female:male ratio of 1:37 were reviewed. The present article aims to provide a key point-summary regarding the clinical outcome, associated comorbidities, pathogenesis, histopathology, dermoscopy, and therapeutic modalities of TFFD.
Topics: Adolescent; Databases, Factual; Female; Humans; Hyperpigmentation; Male
PubMed: 33280096
DOI: 10.1111/ijd.15301 -
Dermatologic Surgery : Official... Dec 2020Melasma is a common acquired disorder of hyperpigmentation, classically manifesting as symmetric brown patches on the face. Although the exact pathogenesis is not fully...
BACKGROUND
Melasma is a common acquired disorder of hyperpigmentation, classically manifesting as symmetric brown patches on the face. Although the exact pathogenesis is not fully understood, vascular abnormalities have been implicated in melasma.
OBJECTIVE
To evaluate the laboratory and clinical evidence regarding the safety and efficacy of antivascular agents for the treatment of melasma.
METHODS
A systematic review of PubMed, EMBASE, and Cochrane was conducted on May 13, 2020, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Original research articles investigating the role of vascularity and/or evaluating the use of antivascular therapeutics in melasma were included. Clinical recommendations were based on the American College of Physicians guidelines.
RESULTS
A total of 34 original research articles as follows were identified: 4 laboratory studies, 15 diagnostic studies, and 15 therapeutic studies.
CONCLUSION
There is promising evidence supporting the use of tranexamic acid and laser/light therapies to treat the vascular component of melasma, and more rigorous clinical trials are needed to validate their efficacy. Clinicians may consider treatment with one or more antivascular therapeutics in patients with melasma. Further research is warranted to characterize the role of cutaneous vascularization in melasma and may provide insights for novel therapies.
Topics: Administration, Cutaneous; Administration, Oral; Angiogenesis Inhibitors; Dermoscopy; Humans; Lasers, Solid-State; Low-Level Light Therapy; Melanins; Melanocytes; Melanosis; Neovascularization, Pathologic; Randomized Controlled Trials as Topic; Skin; Tranexamic Acid; Treatment Outcome
PubMed: 33252894
DOI: 10.1097/DSS.0000000000002770 -
Dermatology Practical & Conceptual Oct 2020Dermoscopy is a tool that aids clinicians in the diagnosis of actinic keratosis; however, few diagnostic accuracy studies have determined its sensitivity and specificity... (Review)
Review
INTRODUCTION
Dermoscopy is a tool that aids clinicians in the diagnosis of actinic keratosis; however, few diagnostic accuracy studies have determined its sensitivity and specificity for this diagnosis.
OBJECTIVE
Determine the diagnostic accuracy of dermoscopy on actinic keratosis.
METHODS
A systematic review was conducted on EMBASE, PubMed, Scopus and the Cochrane Central Registry of Controlled Trials from inception to August 2019.
RESULTS
We screened 485 titles and abstracts. Two studies comprising 219 actinic keratoses were eligible for qualitative analysis. The number and heterogeneity of included studies limited a quantitative analysis.
CONCLUSIONS
Studies that focus specifically on the diagnostic accuracy of dermoscopy for actinic keratosis are lacking.
PubMed: 33150042
DOI: 10.5826/dpc.1004a121 -
Journal of Cosmetic Dermatology Mar 2021Despite the constant development of aesthetic medicine, there is still a lack of objective methods to assess the effectiveness of antiaging treatments and their impact...
BACKGROUND
Despite the constant development of aesthetic medicine, there is still a lack of objective methods to assess the effectiveness of antiaging treatments and their impact on the skin. Histopathological examination of the skin section provides most of the key information about the condition of the skin, but it is an invasive procedure that requires a skin biopsy, which may be associated with the formation of a scar that is considered to be an aesthetic defect. Non-invasive imaging methods of the skin like dermoscopy, skin ultrasonography and reflectance confocal microscopy may be a useful solution.
AIMS AND METHODS
In this systematic review, we present the possible application of noninvasive skin imaging methods in esthetic medicine. The literature search was conducted via medical database (PubMed, Google Scholar).
RESULTS
The research suggests the use of dermoscopy during laser therapy, for the targeted treatment of vascular lesions and appropriate adjustment of laser parameters. Skin ultrasonography, especially high-frequency ultrasonography, has been widely used in aesthetic medicine-during and after volumetric treatments and in the assessment of the effects of anti-cellulite therapies, treatments that correct discolorations and improve skin quality. Publications also highlight the importance of reflexive confocal microscopy in the evaluation of the results of anti-aging treatments using the fractional laser, moisturizing preparations or micro puncturing combined with hyaluronic acid injections.
CONCLUSION
Non-invasive skin imaging methods are useful tools for pre- and postoperative assessment in aesthetic medicine and their wide application may help to objectively assess the impact of anti-aging procedures on the skin.
Topics: Dermoscopy; Esthetics; Humans; Microscopy, Confocal; Skin; Skin Neoplasms
PubMed: 32910527
DOI: 10.1111/jocd.13685