Dermoscopy is a new diagnostic tool in diagnosis of common hypopigmented macular disease: A descriptive study

Abstract

One of the most frequent complaints in dermatology clinics is the eruption of hypopigmented patchy skin lesions. The aim of the study was to investigate the utility of dermoscopy in common hypopigmented macular diseases. Patients with the followings diseases were examined by dermoscopy: vitiligo, pityriasis alba, nevus depigmentosus, achromic pityriasis versicolor, idiopathic guttate hypomelanosis, and extragenital guttate lichen sclerosus. This study showed that these hypopigmented macular diseases might display specific dermoscopic features. In vitiligo, the mean dermoscopic features were the presence of a diffuse white glow with perifollicular pigment, perilesional hyperpigmentation, leukotrichia and the pigmentary network. In idiopathic guttate hypomelanosis, the characteristic features were the presence of multiple, shiny, scaly macules with welland ill-defined edges borders that coalesced into polycyclic macules. For nevus depigmentosus, the mean features were hypopigmented patches with irregular border with a faint reticular network. For pityriasis alba, the fairly ill-demarcated hypopigmented macules with fine scales were the mean feature. In lichen sclerosus, there were white structureless areas, perilesional erythematous halo, follicular plugging and white chrysalis like structures. Dermoscopy of achromic pityriasis versicolor showed a fairly demarcated white area with fine scales localized in the skin creases.

Keywords: Dermoscopy; Diagnosis; Hypopigmented macules; Vitiligo.

Conflict of interest statement

Conflict of interest: the author declares no potential conflict of interest.

Figures

Figure 1.

(A) Dermoscopic view for vitiligo show depigmented patch, perilesional hyperpigmentation (blue arrows) and depigmented hair (leukotrichia) (red arrow). It is prominent in the same view that the lower margin of the depigmented patch with ill-defined margins that merge indistinctly into the surrounding (Nebulous pattern) (blue stars). (B) Dermoscopic view for vitiligo show Polka dot appearance with several depigmented macules within a hyperpigmented background. Few macules show perifollicular repigmentation and leukotrichia as well.

Figure 2.

(A) Dermoscopy of a lesion of idiopathic guttate hypomelanosis shows multiple, roundish, homogenous, white-porcelain macules, and two were well defined (amoeboid pattern) (red arrows) and with irregular cloudy whitish pattern (nebuloid) (blue arrow). Several white shades present within the field represents the scales. In addition, these whitish areas were surrounded by a patchy hyperpigmented network (cloudy- sky pattern) (blue stars). (B) The hypopigmented patches of nevus depigmentosus with irregular border (serrated) and with a faint reticular network within the patch.

Figure 3.

(A) Dermoscopic feature for a child with pityriasis alba. The hypopigmented macules were fairly ill-demarcated white area with fine scales that are commonly distributed within and outside the macules. The hair inside the patches was of normal color. There is no sharp margin to differentiate the hypopigmented patch from the surrounding skin. (B) Dermoscopic view for achromic pityriasis versicolor showed a fairly demarcated white area with fine scales that are commonly localized in the skin creases.

Figure 4.

Histopathology of a lesion of extragenital lichen sclerosus showed hyperkeratosis, epidermal atrophy, squamatization of the basal cell layer and homogenization and hyalinization of the upper dermis.

Figure 5.

The dermoscopic features of new lichen sclerosus et atrophicus (A) and an old LSE lesions (B). Dermoscopy showing white structureless areas (blue stars) and comedolike openings (yellow arrows) with telangiectasia of different lengths and calibers (red arrows).