Anna Elisa Verzì

Advances in non‐invasive techniques as aids to the diagnosis and monitoring of therapeutic response in plaque psoriasis: a review

Plaque psoriasis is a common, chronic, inflammatory disease with a multifactorial etiopathogenesis. Although its diagnosis is often based on clinical features, in ambiguous cases a biopsy with histopathologic confirmation may be necessary. Advanced high‐definition imaging techniques may be useful in the study of skin properties in vivo and may facilitate therapeutic monitoring. Available imaging tools vary in their resolution, depth of penetration and visual representation (horizontal, vertical, three‐dimensional), and in the type of skin structures visualized. The purpose of this review is to analyze a variety of non‐invasive techniques that may assist in establishing definitive diagnoses, as well as in the therapeutic monitoring of psoriasis. These include dermoscopy, videocapillaroscopy (VC), high‐frequency ultrasound (HFUS), reflectance confocal microscopy (RCM), laser Doppler imaging (LDI), optical coherence tomography (OCT), optical microangiography (OMAG) and multiphoton tomography (MPT). Their characteristics, indications, advantages, and limits are reviewed and discussed. Dermoscopy may be useful for a first, rapid outpatient evaluation. Videocapillaroscopy and HFUS represent the imaging techniques with the longest history of use in psoriasis. However, whereas VC is useful in both diagnosis and therapeutic monitoring, the utility of HFUS appears to be limited to the monitoring of response to therapy only. Both devices are cost‐effective and easy to use in the office setting. Both RCM and OCT allow high‐resolution microscopic imaging of psoriatic plaque in a manner comparable with that of virtual histopathology and represent more promising techniques. The utility of LDI, OMAG, and MPT in psoriasis skin imaging requires further study and validation.

Scabies: Advances in Noninvasive Diagnosis

Scabies is a common, highly contagious skin parasitosis caused by Sarcoptes scabiei var. hominis. Early identification and prompt treatment of infested subjects is essential, as missed diagnosis may result in outbreaks, considerable morbidity, and significantly increased economic burden. The standard diagnostic technique consists of mites’ identification by microscopic examination of scales obtained by skin scraping. This is a time-consuming and risk-associated procedure that is also not suitable to a busy practice. In recent years, some advanced and noninvasive techniques such as videodermatoscopy, dermatoscopy, reflectance confocal microscopy, and optical coherence tomography have demonstrated improved efficacy in the diagnosis of scabies. Their advantages include rapid, noninvasive mass screening and post-therapeutic follow-up, with no physical risk. A greater knowledge of these techniques among general practitioners and other specialists involved in the intake care of overcrowded populations vulnerable to scabies infestations is now viewed as urgent and important in the management of outbreaks, as well as in consideration of the recent growing inflow of migrants in Europe from North Africa.

Alternative uses of dermoscopy in daily clinical practice: An update

&NA; Dermoscopy is a noninvasive diagnostic tool that is currently being used for neoplastic skin lesions, several inflammatory and infectious diseases, and skin appendage disorders. As the clinical applications of dermoscopy beyond pigmented lesions are constantly increasing, the aim of this article is to provide an update on this topic. This comprehensive review substantiates how several diseases may show peculiar dermoscopy features so as to enhance the diagnosis and avoid (in selected cases) unnecessary histologic confirmation. In other cases, dermoscopy features may be shared with other conditions, with the advantage of narrowing down the differential diagnosis by ruling out those dermatoses with similar clinical aspect but different dermoscopic presentation.

Clinical and Ultrasonographic Correlation of Acne Scars

BACKGROUND Consensus concerning nomenclature and classification of acne scars is lacking. Classification based solely on clinical examination represents an unmet need that could be improved with the use of objective, reproducible assessments. OBJECTIVE To assess clinical and ultrasound morphologic features in 41 patients with scars resulting from moderate to severe acne and to determine whether correlation exists. MATERIALS AND METHODS Eighty‐one lesions clinically identified as boxcar, ice pick, rolling, hypertrophic, or keloidal were evaluated using high‐frequency ultrasound (22 MHz). RESULTS Ultrasound results generally correlated with clinical appearance. Eight scars clinically classified as ice pick showed a typical boxcar morphology upon ultrasound examination. Ultrasound showed that ice pick and boxcar scars were the deepest, with 95.8% between 0.2 and 0.5 mm. CONCLUSIONS High‐frequency ultrasound is a noninvasive technique that is useful in the evaluation and correct classification of acne scars. It represents an important adjunct to clinical examination, because it provides reliable objective and reproducible information useful to the selection of the best treatment option specifically customized to each individual patients needs.

Low-Cost Equipment for Diagnosis and Management of Endemic Scabies Outbreaks in Underserved Populations

TO THE EDITOR—Scabies is a skin parasitosis caused by Sarcoptes scabiei var hominis and represents a global health problem. Neglected and missed diagnoses for scabies may result in endemic outbreaks, significantly increased economic burden, and considerable morbidity [1]. Scabies diagnosis is traditionally based on microscopic examination of samples obtained by skin scraping. This laborintensive method provides good specificity, but repeated scrapings may be necessary. Videodermatoscopy is a noninvasive tool useful for early diagnosis of melanoma that has also been shown to be safe and reliable in the diagnosis of scabies [2–4]. Using videodermatoscopy, falsenegative results are quite rare and falsepositive results are nonexistent, as the images obtained are definitive. The roundish translucent body of the mite is clearly visible with visualization of additional anatomical structures of the mite, including legs and rostrum; in most cases, it is possible to visualize real-time movement of the mite inside the burrow. Training for recognition of typical signs (burrows at low magnification; mites/ eggs/feces at high magnification) is simple. Videodermatoscopy is primarily designed for pigmented lesions, with capability for optimal magnification, high-resolution, and software storage, hence involving significant investment (up to US

Reflectance confocal microscopy in the diagnosis of vesicobullous disorders: case series with pathologic and cytologic correlation and literature review

20 000). Recently, low-cost videomicroscopes (VMs) (approximately US

A three-cohort comparison with videodermatoscopic evidence of the distinct homogeneous bushy capillary microvascular pattern in psoriasis vs atopic dermatitis and contact dermatitis

30) are available for nonmedical use in entomology/botany/ microelectronics. We, therefore, compared a medically marketed videodermatoscope (VD) with 2 nonmedical VMs by assessing their reliability in the diagnosis of scabies in a controlled noninferiority clinical trial with independent assessment from dermatologists. Twenty patients with presumed scabies infestation underwent examination by high-resolution VD (Hirox KH-1300, approximately US

Starburst hair follicles: A dermoscopic clue for aplasia cutis congenita

20 000) as well as 2 low-resolution VMs (Oitez-eScope and Micron Technology USB-Microscope, both approximately US

Evaluation of the Vascular Pattern in Psoriatic Plaques in Children Using Videodermatoscopy: An Open Comparative Study

30). Images obtained by the 3 systems (×30–×150 magnification) were independently evaluated by 3 dermatologists blinded to the system used. In all cases, examinations were well tolerated and performed in 10 minutes or less per device. All 3 dermatologists provided definitive diagnoses of scabies based on VD and VM images of burrows, mites, and/or eggs for 15 of the 20 patients, and the 5 remaining patients were negative; this finding was further confirmed by microscopic evaluation of skin scrapings. As the independently determined diagnostic results were identical for all 3 dermatologists, the root mean square deviation of each nonmedically marketed VM compared to the medically marketed VD was equal to zero, establishing the noninferiority of low-resolution VMs compared to high-resolution VD in the

Double-ended Pseudocomedones in Hidradenitis Suppurativa: Clinical, Dermoscopic, and Histopatho­logical Correlation

Vesicobullous disorders are characterized by intraepidermal or subepidermal blistering resulting from different pathogenetic mechanisms. The diagnosis is generally based on clinical examination and semi‐invasive/invasive procedures such as cytology and histopathology. In vivo reflectance confocal microscopy (RCM) is a non‐invasive technique for real‐time, en face imaging of the epidermis and upper dermis with high resolution close to conventional histopathology.