Dermoscopy of Inflammatory Dermatoses (Inflammoscopy) in Skin of Color—A Systematic Review by the International Dermoscopy Society “Imaging in Skin of Color” Task Force

Martyna  Sławińska; Jakub  Żółkiewicz; Biswanath  Behera; Delaney D  Ding; Aimilios Lallas; Payal  Chauhan; Soumil  Khare; Nkechi Anne  Enechukwu; Bengu Nisa  Akay; Balachandra S  Ankad; Yasmeen J  Bhat; Abhijeet Kumar  Jha; Feroze  Kaliyadan; Awatef  Kelati; Shekhar  Neema; Nisha V  Parmar; Jennifer Stein; Richard P  Usatine; Keshavamurthy  Vinay; Michał  Sobjanek; Enzo Errichetti

doi:10.5826/dpc.1304S1a297S

Dermoscopy of Inflammatory Dermatoses (Inflammoscopy) in Skin of Color—A Systematic Review by the International Dermoscopy Society “Imaging in Skin of Color” Task Force

Authors

Martyna Sławińska Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Poland
Jakub Żółkiewicz Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Poland
Biswanath Behera Department of Dermatology and Venereology, AIIMS, Bhubaneswar, India
Delaney D Ding University of Florida College of Medicine, Gainesville, FL, USA
Aimilios Lallas First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
Payal Chauhan Department of Dermatology, All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, India
Soumil Khare Department of Dermatology, Venereology and Leprosy, AIIMS, Raipur, India
Nkechi Anne Enechukwu Nnamdi Azikiwe University/Nnamdi Azikiwe Teaching Hospital Nnewi, Anambra State, Nigeria
Bengu Nisa Akay Department of Dermatology, School of Medicine, Ankara University, Ankara, Turkey
Balachandra S Ankad Department of Dermatology, Venereology and Leprosy, SN Medical College, Bagalkot, Karnataka, India
Yasmeen J Bhat Department of Dermatology, Venereology and Leprology, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India
Abhijeet Kumar Jha Department of Dermatology & STD, Patna Medical College & Hospital, Patna, India
Feroze Kaliyadan Department of Dermatology, Sree Narayana Institute of Medical Sciences, Ernakulum, India
Awatef Kelati Dermatology Department, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
Shekhar Neema Department of Dermatology, Venereology and Leprology, Armed Force Medical College, Pune, Maharashtra, India
Nisha V Parmar Department of Dermatology, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
Jennifer Stein The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
Richard P Usatine Department of Dermatology and Cutaneous Surgery, Department of Family and Community Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
Keshavamurthy Vinay Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Michał Sobjanek Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Poland
Enzo Errichetti University of Udine, Italy

Keywords:

dermoscopy, dermatoscopy, epiluminescence, inflammoscopy, pigmentaroscopy, skin of color, dark skin, black skin, ethnic skin, dark phototype, african skin, systematic review

Abstract

Dermoscopic patterns of inflammatory dermatoses (inflammoscopy) have been extensively studied in the recent years, though data on patients with darker phototypes (IV-VI) are sparse. The aims of this systematic review were to summarize the current state of knowledge on inflammoscopy applied to skin of color and provide a standardized nomenclature of reported findings. Besides dermoscopic features, type of setting and magnification, number of cases, and histopathological correlation were analyzed. Eighty-five papers addressing 76 different dermatoses (25 papulosquamous dermatoses, 19 hyperpigmented dermatoses, seven hypopigmented dermatoses, four granulomatous dermatoses, two sclerotic dermatoses, five facial inflammatory dermatoses, and 14 miscellaneous conditions) for a total of 2073 instances were retrieved. Only one study showed a level of evidence of III (cross-sectional study), whereas 10 and 74 displayed a level of evidence of IV (case-control studies) and V (case-series and case-reports), respectively. Moreover, our analysis also highlighted that most of papers focalized on a limited number of dermatoses, with several conditions having only single dermoscopic descriptions. Additionally, few studies compared findings among phototypes belonging to the “skin of color” spectrum. Further studies designed according to a systematic approach and considering the above-mentioned issues are therefore needed.

References

Bhat, Y.J. and A.K. Jha, Dermatoscopy of Inflammatory Diseases in Skin of Color. Indian Dermatol Online J, 2021. 12(1): p. 45-57.

Ankad, B. and V. Koti, Dermoscopic approach to inflammatory lesions in skin of color. Clinical Dermatology Review, 2020. 4(2): p. 74-78.

Howick, J., et al., Oxford centre for evidence-based medicine 2011 levels of evidence. Centre for Evidence-Based Medicine. Retrieved July from https://www. cebm. net/wp-content/uploads/2014/06/CEBM-Levels-of-Evidence-2.1. pdf, 2011.

Errichetti, E., et al., International Dermoscopy Society criteria for non-neoplastic dermatoses (general dermatology): validation for skin of color through a Delphi expert consensus. Int J Dermatol, 2022. 61(4): p. 461-471.

Behera, B., et al., Dermoscopic features of acquired perforating dermatosis: a retrospective analysis of 19 cases. Clin Exp Dermatol, 2021. 46(1): p. 184-187.

Llamas-Molina, J.M., et al., Acrokeratosis verruciformis of Hopf: dermoscopy approach in dark skin patients. J Eur Acad Dermatol Venereol, 2022. 36(11): p. e944-e945.

Adya, K.A., A.C. Inamadar, and A. Palit, Dermoscopy of Localized Darier's Disease in Fitzpatrick Type IV Skin. Indian Dermatol Online J, 2020. 11(2): p. 298-300.

Errichetti, E., et al., Dermoscopy in general dermatology (non-neoplastic dermatoses) of skin of colour: a comparative retrospective study by the International Dermoscopy Society. Eur J Dermatol, 2020. 30(6): p. 688-698.

Nayak, S., et al., Dermoscopy of general dermatological conditions in Indian population: A descriptive study. Clinical Dermatology Review, 2017. 1(2): p. 41-51.

Sonthalia, S., J. Bhatia, and M. Thomas, Dermoscopy of Keratosis Pilaris. Indian Dermatol Online J, 2019. 10(5): p. 613-614.

Behera, B., et al., Dermoscopic features of primary cutaneous amyloidosis in skin of colour: A retrospective analysis of 48 patients from South India. Australas J Dermatol, 2021. 62(3): p. 370-374.

Dincy Peter, C.V., et al., Dermoscopy in Cutaneous Amyloidosis. - A Prospective Study from India. Indian J Dermatol, 2022. 67(1): p. 94.

Jakhar, D., et al., Dermatoscopic features of lichen nitidus. Pediatr Dermatol, 2018. 35(6): p. 866-867.

Malakar, S., S. Save, and P. Mehta, Brown Shadow in Lichen Nitidus: A Dermoscopic Marker! Indian Dermatol Online J, 2018. 9(6): p. 479-480.

Jose, S. and G. Kurien, Diagnostic dermoscopic features and the correlation between dermoscopic and histopathologic features in lichen planus. International Journal of Research in Dermatology, 2020. 6(5).

Garg, P. and T. Kaur, Study of the Dermoscopic Findings and Their Correlation with Histopathological Findings in Various Lichenoid Dermatoses. Journal of Clinical & Experimental Dermatology Research, 2015. 06(06).

Ankad, B.S. and S.L. Beergouder, Pityriasis lichenoides et varioliformis acuta in skin of color: new observations by dermoscopy. Dermatol Pract Concept, 2017. 7(1): p. 27-34.

Hanumaiah, B. and J.M. Joseph, Role of Dermoscopy in the Diagnosis of Hypertrophic Lichen Planus and Prurigo Nodularis. Indian J Dermatol, 2019. 64(5): p. 341-345.

Ankad, B.S. and S.L. Beergouder, Hypertrophic lichen planus versus prurigo nodularis: a dermoscopic perspective. Dermatol Pract Concept, 2016. 6(2): p. 9-15.

Chandravathi, P.L., PraneetAwake, and M. Kota, A cross-sectional analysis of dermoscopic patterns distinguishing between psoriasis and lichen planus: a study of 80 patients. Journal of Evolution of Medical and Dental Sciences, 2015. 4: p. 17017+.

Makhecha, M., T. Singh, and Y. Khatib, Dermoscopy Differentiates Guttate Psoriasis from a Mimicker-Pityriasis Rosea. Dermatol Pract Concept, 2021. 11(1): p. e2021138.

Nwako-Mohamadi, M.K., et al., Dermoscopic Features of Psoriasis, Lichen Planus, and Pityriasis Rosea in Patients With Skin Type IV and Darker Attending the Regional Dermatology Training Centre in Northern Tanzania. Dermatol Pract Concept, 2019. 9(1): p. 44-51.

Behera, B., et al., Follicular psoriasis - dermoscopic features at a glance. Indian J Dermatol Venereol Leprol, 2017. 83(6): p. 702-704.

Kaliyadan, F., K. Feroze, and J. Kuruvilla, Dermoscopy of Dermatitis Neglecta in the Periocular Area in Skin of Color. Indian Dermatol Online J, 2020. 11(4): p. 678-679.

Charlin, R., et al., Hydroquinone-induced exogenous ochronosis: a report of four cases and usefulness of dermoscopy. Int J Dermatol, 2008. 47(1): p. 19-23.

Mishra, S.N., et al., Diagnostic utility of dermatoscopy in hydroquinone-induced exogenous ochronosis. Int J Dermatol, 2013. 52(4): p. 413-7.

Ghuse, V.M. and S. Someshwar, Patch Testing as a Corroborative and Diagnostic Tool in Patients Suspected of Contact Allergen Induced Facial Melanosis. Indian J Dermatol, 2021. 66(4): p. 337-342.

Sharma, V.K., et al., Dermoscopy and patch testing in patients with lichen planus pigmentosus on face: A cross-sectional observational study in fifty Indian patients. Indian J Dermatol Venereol Leprol, 2017. 83(6): p. 656-662.

Pirmez, R., et al., Clinical and dermoscopic features of lichen planus pigmentosus in 37 patients with frontal fibrosing alopecia. Br J Dermatol, 2016. 175(6): p. 1387-1390.

Yalamanchili, R., V. Shastry, and J. Betkerur, Clinico-epidemiological Study and Quality of Life Assessment in Melasma. Indian J Dermatol, 2015. 60(5): p. 519.

Khunger, N., et al., A clinical, dermoscopic, histopathological and immunohistochemical study of melasma and facial pigmentary demarcation lines in the skin of color. Dermatol Ther, 2020. 33(6): p. e14515.

Ibrahim, Z.A., et al., Evaluation of the efficacy and safety of combinations of hydroquinone, glycolic acid, and hyaluronic acid in the treatment of melasma. J Cosmet Dermatol, 2015. 14(2): p. 113-23.

Sonthalia, S., A.K. Jha, and S. Langar, Dermoscopy of Melasma. Indian Dermatol Online J, 2017. 8(6): p. 525-526.

Ankad, B.S. and S.L. Beergouder, Dermoscopic evaluation of idiopathic guttate hypomelanosis: A preliminary observation. Indian Dermatol Online J, 2015. 6(3): p. 164-7.

Wali, V., M. Deepali, and A. Hogade, A panoramic study of dermascopic patterns in vitiligo. MedPulse - International Medical Journal, 2016. 3(4): p. 436-439.

Purnima, G., N.A. Tejaswitha Gudivada, and T.V. Narasimharao, Dermoscopy - a tool to assess stability in vitiligo. Int J Contemp Med Res, 2017. 4(10): p. 2066-2068.

Jha, A.K., S. Sonthalia, and A. Lallas, Dermoscopy as an evolving tool to assess vitiligo activity. J Am Acad Dermatol, 2018. 78(5): p. 1017-1019.

Chandrashekar, L., Dermatoscopy of blue vitiligo. Clin Exp Dermatol, 2009. 34(5): p. e125-6.

Sonthalia, S., R. Sarkar, and R. Arora, Novel dermoscopic findings of perifollicular depigmentation and evolving leukotrichia in areas of clinically unaltered pigmentation: An early predictive sign of impending vitiligo! Pigment International, 2014. 1(1): p. 28-30.

Thatte, S.S., A.M. Dongre, and U.S. Khopkar, "Reversed pigmentary network pattern" in evolving lesions of vitiligo. Indian Dermatol Online J, 2015. 6(3): p. 222-3.

Ramadan, S., D. Hossam, and M.A. Saleh, Dermoscopy could be useful in differentiating sarcoidosis from necrobiotic granulomas even after treatment with systemic steroids. Dermatol Pract Concept, 2016. 6(3): p. 17-22.

Chauhan, P., D. Meena, and N. Hazarika, Dermoscopy of Sarcoidosis: A Useful Clue to Diagnosis. Indian Dermatol Online J, 2018. 9(1): p. 80-81.

Hadj, I. and F.Z. Mernissi, Dermoscopic features of sarcoidosis. Pan Afr Med J, 2014. 18: p. 111.

Nirmal, B., R. George, and R.B. Telugu, Polymorphous Cutaneous Sarcoidosis Associated with Peripheral Vascular Disease and its Dermatoscopic Findings. Indian Dermatol Online J, 2018. 9(4): p. 256-258.

Ankad, B.S., et al., Implications of Dermoscopy and Histopathological Correlation in Discoid Lupus Erythematosus in Skin of Color. Indian J Dermatol, 2022. 67(1): p. 5-11.

Arshdeep, et al., Seborrheic melanosis and dermoscopy: Lumping better than splitting. Indian J Dermatol Venereol Leprol, 2018. 84(5): p. 585-587.

Chabchoub, I., N. Litaiem, and F. Zeglaoui, Pediatric rosacea in a patient with a dark phototype: Clinical and dermoscopic features. Clin Case Rep, 2020. 8(12): p. 3257-3259.

Nair, P. and K. Pariath, A Case of Kyrle's Disease with Dermatoscopic Findings. Indian Dermatol Online J, 2018. 9(5): p. 364-366.

Ramirez-Fort, M.K., et al., Acquired perforating dermatosis: a clinical and dermatoscopic correlation. Dermatol Online J, 2013. 19(7): p. 18958.

Garcia-Garcia, B., et al., Dermoscopy of lichen planus: Vascular and Wickham striae variations in the skin of colour. Australas J Dermatol, 2019. 60(4): p. 301-304.

Chung, I.Y., C.C. Wong, and M.A. Rodrigues, The importance of dermoscopy in subclinical lichen planus in skin of color. Int J Womens Dermatol, 2021. 7(2): p. 205-206.

Conforti, C., et al., Dermatoscopic features of Koebner phenomenon in lichen planus on light and dark skin. Acta Dermatovenerol Alp Pannonica Adriat, 2019. 28(2): p. 93-94.

Litaiem, N., et al., Dermoscopic signs of lichen planus. BMJ Case Rep, 2016. 2016.

Scarfi, F., et al., Lichen Planus Mimicking Atypical Melanocytic Lesion in a Man With Dark Skin. Dermatol Pract Concept, 2020. 10(3): p. e2020060.

Jha, A.K. and Raihan, Dermoscopy of lichen planus hypertrophicus: a retrospective analysis. Journal of Pakistan Association of Dermatology, 2017. 27: p. 64-66.

Ankad, B.S., S.L. Beergouder, and L. Sujana, Dermoscopy of Hypertrophic Lichen Planus. Austin J Dermatolog, 2014. 1(3): p. 1013.

Madke, B., et al., Palmar lichen planus mimicking tinea nigra. Indian J Dermatol, 2013. 58(5): p. 407.

Thomas, M., T. Yadav, and U. Khopkar, The role of dermoscopy using a triple light source in the diagnosis of pityriasis rosea: an observational pilot study. Int J Dermatol, 2017. 56(7): p. e147-e148.

Reyna-Rodriguez, I.L., J.A. Garcia-Lozano, and J. Ocampo-Candiani, Pigmented disseminated superficial actinic porokeratosis in dark-skinned patients: Clinical, dermoscopic, and histopathologic features. J Cosmet Dermatol, 2021. 20(9): p. 3054-3056.

Bhat, Y., N. Nabi, and R. Wani, Dermoscopy of disseminated superficial actinic porokeratosis in skin of color. Indian Journal of Dermatopathology and Diagnostic Dermatology, 2020. 7(2): p. 100-101.

Jha, A.K., S. Sonthalia, and A. Lallas, Dermoscopy of Porokeratosis of Mibelli. Indian Dermatol Online J, 2017. 8(4): p. 304-305.

Shah, V.H., et al., Clinico-investigative Study of Facial Acanthosis Nigricans. Indian Dermatol Online J, 2022. 13(2): p. 221-228.

Vinay, K., et al., Dermatoscopic evaluation and histopathological correlation of acquired dermal macular hyperpigmentation. Int J Dermatol, 2017. 56(12): p. 1395-1399.

Gil, I., et al., Dermoscopic and reflectance confocal microscopic features of exogenous ochronosis. Arch Dermatol, 2010. 146(9): p. 1021-5.

Neema, S. and A. Jha, Lichen planus pigmentosus. Pigment International, 2017. 4(1): p. 48-49.

Sonthalia, S., et al., Maturational Hyperpigmentation: Cutaneous Marker of Metabolic Syndrome. Dermatol Pract Concept, 2020. 10(2): p. e2020046.

Verma, S.B., et al., Seborrheic melanosis: An entity worthy of mention in dermatological literature. Indian J Dermatol Venereol Leprol, 2017. 83(3): p. 285-289.

Bhat, Y.J., S. Akhtar, and I. Hassan, Dermoscopy of Morphea. Indian Dermatol Online J, 2019. 10(1): p. 92-93.

Kumar, P., et al., Becker's Nevus Coexisting with Morphea: A Rare Case Report. Skin Appendage Disord, 2021. 7(1): p. 46-49.

Ankad, B.S., S.D. Shah, and K.A. Adya, White rosettes in discoid lupus erythematosus: a new dermoscopic observation. Dermatol Pract Concept, 2017. 7(4): p. 9-11.

Malakar, S., ‘Red starburst’ pattern: a new dermoscopic indicator in discoid lupus erythematosus. Our Dermatology Online, 2019. 10(1): p. 103-105.

Behera, B., et al., Dermoscopic features of acute cutaneous lupus erythematosus: A retrospective analysis from a tertiary care centre of East India. Australas J Dermatol, 2021. 62(3): p. 364-369.

Behera, B., et al., Dermoscopy in the diagnosis of generalized acute cutaneous lupus erythematosus. Int J Dermatol, 2021. 60(8): p. e306-e308.

Behera, B., et al., Subacute Cutaneous Lupus Erythematosus: Diagnosis and Follow Up by Dermoscopy. Indian Dermatol Online J, 2021. 12(5): p. 755-757.

Behera, B., et al., Dermoscopic Appearance of an Annular Subacute Cutaneous Lupus Erythematosus. Dermatol Pract Concept, 2021. 11(2): p. e2021013.

Adya, K.A., A.C. Inamadar, and A. Palit, Dermoscopy of Cutaneous Mastocytoma. Indian Dermatol Online J, 2018. 9(3): p. 218-219.

Kumar, S., D. Jakhar, and R. Misri, Dermoscopy of Telangiectasia Macularis Eruptiva Perstans. Indian Dermatol Online J, 2020. 11(1): p. 131-132.

Nirmal, B., et al., Dermatoscopy of Urticaria Pigmentosa with and without Darier's Sign in Skin of Colour. Indian Dermatol Online J, 2019. 10(5): p. 577-579.

Chauhan, P., N. Bhardway, and N. Shirazi, Dermoscopy of Urticaria Pigmentosa. Indian Dermatol Online J, 2020. 11(3): p. 475-476.

Neema, S., et al., Dermoscopy of Dermatomyositis in Dark Skin. Dermatol Pract Concept, 2022. 12(1): p. e2022013.

Valdebran, M., et al., Fixed drug eruption of the eyelids. A dermoscopic evaluation. Our Dermatology Online, 2013. 4(3): p. 344-346.

Singal, A., I. Kaur, and D. Jakhar, Fox-Fordyce Disease: Dermoscopic Perspective. Skin Appendage Disord, 2020. 6(4): p. 247-249.

Chauhan, P., D. Meena, and N. Hazarika, Dermoscopy of Hailey Hailey Disease. Indian Dermatol Online J, 2018. 9(2): p. 139-140.

Gupta, P., et al., Dermatoscopy and clinicopathological correlation of juvenile xanthogranuloma in skin of colour: a series of six patients. J Eur Acad Dermatol Venereol, 2022. 36(11): p. e884-e886.

Behera, B., et al., Dermoscopic features of three cases of Langerhans cell histiocytosis. Indian J Dermatol Venereol Leprol, 2018. 84(6): p. 730-735.

Behera, B., et al., Dermoscopy of Langerhans cell histiocytosis. J Am Acad Dermatol, 2017. 76(2S1): p. S79-S81.

Bhat, Y., et al., Langerhans cell histiocytosis: Can dermoscopy help in diagnosis? Indian Journal of Paediatric Dermatology, 2020. 21(3).

Jindal, R., et al., Idiopathic perniosis presenting as acral purpuric lesions: Clustering of cases before COVID-19 pandemic and their comparison with chilblain like lesions reported in the literature. Dermatol Ther, 2021. 34(3): p. e14951.

Soni, R., A.J. Lokhande, and P. D'Souza, Atypical Presentation of Sweat Dermatitis with Review of Literature. Indian Dermatol Online J, 2019. 10(6): p. 698-703.