Dermoscopy in General Dermatology: Practical Tips for the Clinician

A. Lallas; J. Giacomel; G. Argenziano; B. García-García; D. González-Fernández; I. Zalaudek; F. Vázquez-López

Disclosures

The British Journal of Dermatology. 2014;170(3):514-526. 

In This Article

Abstract and Introduction

Abstract

In addition to its well-documented value in improving the diagnosis of skin tumours, dermoscopy is continually gaining appreciation in the field of general dermatology. Dermoscopy has been shown to facilitate the clinical recognition of several inflammatory and infectious diseases, as well as their discrimination from skin tumours. Moreover, recent data indicate that it might also be profitable in assessing the outcome and adverse effects of various treatments. Application of dermoscopy should follow the standard procedure of acquiring information from patient history and clinically evaluating the number, location and morphology of the lesion(s). Four parameters should be assessed when applying dermoscopy in the realm of inflammatory and infectious diseases: (i) morphological vascular patterns; (ii) arrangement of vascular structures; (iii) colours; and (iv) follicular abnormalities, while the presence of other specific features (clues) should also be evaluated. It must be underlined that dermoscopic findings should always be interpreted within the overall clinical context of the patient, integrated with information from the history and the macroscopic examination. With new evidence continuously being gathered, the dermatoscope gradually acquires a role similar to the stethoscope of general practitioners, becoming an irreplaceable clinical tool for dermatologists. In this article, we provide a succinct summary of existing data on dermoscopy in general dermatology. Practical tips are suggested, which can assist clinicians in profitably utilizing and applying the available knowledge in their everyday practice.

Introduction

Dermoscopy is continually gaining appreciation in the field of general dermatology, while recent data indicate that it might also be profitable in assessing the outcome and adverse effects of various treatments.[1–4] By revealing morphological structures invisible to the unaided eye, dermoscopy improves cutaneous clinical examination. The expansion of dermoscopy has been facilitated by the development of handheld dermatoscopes using polarized light, which are highly portable, do not require skin contact or immersion fluid, and allow fast screening of numerous lesions.[2]

Application of dermoscopy should always follow the standard procedure of acquiring information from patient history and clinically evaluating the number, location and morphology of the lesion(s). Four parameters should be assessed when applying dermoscopy in the realm of inflammatory and infectious diseases: (i) morphological vascular patterns; (ii) arrangement of vascular structures; (iii) colours; and (iv) follicular abnormalities, while the presence of other specific features (clues) should also be evaluated. To date, the dermoscopic patterns of several inflammatory and infectious skin diseases have been described. Some dermoscopic criteria appear to be highly specific for a particular disease, while other can be seen in more than one entity and are subsequently considered 'nonspecific'. However, a 'nonspecific' feature may be rendered particularly valuable when coupled with certain other clinical dermoscopic criteria, forming a set of features that frequently leads to either an accurate single diagnosis or a narrowed list of possible differential diagnoses.

In this article, we provide a succinct summary of existing data on dermoscopy in general dermatology. Practical tips are suggested, which can assist clinicians in profitably utilizing and applying the available knowledge in their everyday practice.

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