Dermoscopy, Trichoscopy and Onychoscopy in Diseases of the Pigmented Skin: An Atlas and Short Text Uday S Khopkar, Ankit H Bharti
INDEX
Page numbers followed by, f refer to figure, fc refer to flowchart, and t refer to table
A
Acantholytic dyskeratotic acanthoma, subungual 293
Acanthosis nigricans 95, 100, 102f, 104f
dermatoscopy of 25f
mild 101f
moderate 102f
severe 103f
sulci pattern of 104f
Acanthotic epidermis 463f
Accentuated dark-brown pigment network 117
Achromatic lens 5
Achromic areas 173
Acne vulgaris 107f, 455
Acral amelanotic melanoma, dermoscopic features of 444
Acral skin 53
Acrosyringia 231
Acrotrichia 231
Actinic keratosis 71, 80, 434
clinical variants of 435
dermoscopy of 435
diagnosis of 434, 435
hypertrophic 435, 436f
nonpigmented 435
pigmented 435, 437f
proliferative 435
various grades of 436t
Actinic lentigo 117
Active papular lesion 399f
Active scleroderma pattern 328f
Adnexal openings, characteristic sparing of 127
Adnexal tumors 69
Alcoholic disinfectant 25
Alopecia
areata 82, 314, 315f, 334, 344, 345f, 346f, 369, 370f, 373f, 374f
active border of 371f
dermoscopic findings of 370
stable patch of 372f
chemotherapy-induced 351, 351f
congenital triangular 349
frontal fibrosing 337, 357
patchy
nonscarring 369
scarring 379
temporal triangular 349
Alopecic patch 344
Ameboid 170, 173, 179
pattern 177, 200, 201f
Amyloidosis, systemic 276
Anagen
matrix, affection of 373
telogen ratio 387, 392
Androgenetic alopecia 335, 341, 342, 363, 364
dermatoscopy of 82
Angiofibroma 411, 423
Angiogenesis 324
Angiokeratoma 411, 423, 425f
Angioma serpiginosum 154
Anisotrichosis 342
Annular granular pattern 435
Antigen 300
Antiseptic solution 2
Apocrine hidrocystoma 411, 428
Arboriform vascular pattern 349
Arciform structures 143f
short 142
Argyriasis 96
Arrector muscle bundles 157
Arsenic pigmentation 96
Ashy dermatosis 246, 247t, 249f, 250f, 251f, 253
dermoscopy of 253f255f
Ataxia telangiectasia 158
Atopic dermatitis 104f, 266, 485
Atrichia 449
focal 343
Atrophy 141, 401f
epidermal 251f
focal epidermal 248
Atypical pigment network 20
Atypical red vessels 262, 266, 268f, 354
Aurora borealis pattern 284f
Avascular areas 324, 325
B
Bamboo hair 361
Bannayan-Riley-Ruvalcaba syndrome 158
Basal cell
carcinoma 18, 69, 78, 89, 90f, 293, 307, 428, 434, 441, 441f443f, 459, 468f
dermatoscopy of 91f
dermoscopic features of 440t
dermoscopy of 440
early 467f
multiple 466
nodular 69
pigmented 17f
syndrome 466, 469
degeneration 248
Basal keratinocytes, vacuolar alterations of 231
Basal layer vacuolar change 460
Beaded hair 359
Becker's nevus 96, 156, 157f, 159f161f, 165
center of 163
classical lesion of 160
dermoscopic findings of 159
diagnosis of 157
periphery of 160
Benign acral nevi, lattice pattern of 444f
Benign skin tumors 410
dermoscopy of 410
Bizarre pigmentation pattern 109
Black colloid milia 141
Black dots 335, 336f, 363, 364fc, 484
Bleomycin 295
Blood
inclusion of 419
vessels 57, 340, 355, 434
macrophages around 154
Bloom syndrome 158
Blue nevi 415
Blue-gray
blotches 114, 467, 467f
dots 100, 463
globules 109, 440, 467f
ovoid nests 440, 441f
pigmentation 468
Blue-white
lacunae 423
structures 446
veils 20, 231
Bone and joint 294
Borderline lepromatous Hansen's disease 404
hypopigmented patch of 405f
ichthyotic patch of 404f
Borderline lepromatous leprosy, ichthyotic lesion of 404
Bowen's disease 80, 293, 301, 305, 306, 434, 437, 438f, 459
dermoscopy of 437
Brain-like cerebriform appearance 79f
Breast 294
Broken hair 344, 347f, 349, 363, 364fc, 370, 371f, 484, 484f
majority of 82
short 347
Brown black pigment 308
Brown crusts 238
Brown dots 268, 337
Brown globules 110, 238
Brown skin, diseases of 10
Brownish granules, form of 232
Brownish orange dots 264
Brownish peripheral rim 423
Bushy capillaries 289, 325
C
Cadaverized hairs 335, 369
Café au lait macules 156158, 158f, 161, 161t163f
dermoscopy of 160
Canfield VEOS DS3 30, 41, 42, 43f
Canfield VEOS HD1 27
Capillaroscopic microvascular morphology 322
Capillaroscopy 24
pattern 325
Capillary architecture 325
disorganization of 289
Capillary dilation 289
Capillary distribution 55
Capillary loop
clusters 324
inextricable knot of 321
Capillary loss 289, 325, 329
Carcinoma, onychodermal 294
Caviar-like papules 136, 139
Cellulitis, dissecting 335, 358
Central centrifugal alopecia 353, 358
Central linear depigmented macule 172
Central red globules 152
Central white crust 185
Central yellow-brown areas 231
Cerebriform pattern 20
Cherry angioma 73, 79f, 411, 416, 418f
Chloronychia 277, 278f
Chromonychia 281
Chromophores 12
Chronic granulomatous infection 404
Chrysalis 440, 442
Cicatricial alopecia 353
causes of 379
inflammatory 89
Cicatricial patches 383
Clark's level of invasion 309
Clear cell acanthoma 80
characteristic of 62
Clustered glomerular vessels 438f
Coiled hairs 344, 348
Colloid bodies 248
Combines standard epiluminescence microscopy 392
Comb-like white structures project 210
Comedo-like openings 181, 420
Comedones 469
Comet-tail
appearance 177
like projection 170f
Comma hair 334, 347f, 375, 483
Comma vessels 16, 63, 66, 67f, 268, 354
Common benign tumors, classification of 411t
Compound nevus 67f, 415
Compulsive disorder 377
Concomitant atopy, manifestation of 453
Confetti macules 169f
Confetti-like depigmented dots 144
Confocal reflectance microscopy 93
Connective tissue
disease 321, 322, 325
papillae 51
Contact dermatoscopy, nonpolarized 54
Contact dermoscope 7
principle of 3f
Contact leukoderma 33, 166
Coral vessels 71
Corkscrew 16, 347
hairs 334, 347, 347f
vessels 64, 70
Cornoid lamella 459, 459f
Corns 481
pearls 231
Cosmetic dermatitis, pigmented 109
Coudability hairs 344
Coudability sign 344
Coxsackievirus 478
Crawling snake 361
Crista intermedia 444
Crista limitans 443
Crista profunda
intermedia 53
limitans 53
Crown
pattern 481
vessels 63, 68, 423
Cryosurgery 295
Cupuliform depressions 313
Curvilinear depressions 105
Curvilinear structures 144
Cutanea tarda, porphyria 96
Cutaneous horn 302
Cutaneous inflammatory diseases 84
Cutaneous lupus vulgaris, plaque of 397
Cuticle 55, 272f
Cyst
malignant onycholemmal 294
milia-like 27, 397, 412, 420, 475
onychodermal 294
Cystic lesions 469
Cytoplasmic organelles 125
D
Darier's disease 276, 277f, 301
Dark blue lagoons 423
Dark brown macules 157
Dark lacunae and scar-like appearance 416
Deafness 449
Delta wing 488f
Demodex 338
Dendrites 125
Depigmentation, islands of 176
Depression, margins of 471
Dermabrasion 145
Dermal collagen 31
Dermal granuloma 397
suggestive of 407
Dermal melanocytes, melanin of 173
Dermal melanocytic nevus 411
Dermal melasma 131f, 136
Dermal nevi 18
Dermal papillae 106
Dermal pigmentation 35
Dermal plexus, subpapillary 60
Dermal vascular plexuses, anatomy of 59
Dermatitis
seborrheic 266, 268f, 353, 354t, 485
stasis 154, 266
Dermatofibroma 18, 19, 73, 80, 411, 416
hallmark of 416
Dermatoglyphic furrows 443
Dermatoglyphic lines 471
Dermatoglyphic ridges 444
Dermatomyositis 86f, 289, 324, 325
Dermatopathology 11
Dermatophyte infection 374
Dermatoscope 1, 30
choice of 23, 37t
compact 29
history of 23
nonpolarized 24, 26
polarized 26
traditional 40
types of 24
Dermatoscopy 11, 23, 31, 32, 80, 84, 89
application of 76, 77, 197
expediency of 77
green light in 34
guided biopsies 78
nonpolarized 27
oral mucosal 34
patterns 84
role of 148
yellow light in 34
Dermatosis
common inflammatory 84
inflammatory 4
lesions, purpuric 148f
progressive pigmentary 147f
Dermis 111
diffuse fibrosis in 113
reticular 96
Dermlite 3Gen DL1 41
Dermlite carbon 27
Dermlite DL1 43, 44f
basic 30
Dermlite DL200 HR 27
Dermlite Hüd 30
Dermoepidermal junction 443
damaged 111
Dermoepidermal structures 10
Dermoscope
component of 6
parts of 5
role of 166
Dermoscopic analysis 156
Dermoscopic appearance varies 435
Dermoscopic criteria 89
Dermoscopic findings, basis of 434
Dermoscopic vascular patterns 63t
shortlist of 62
Dermoscopy 10, 11, 60, 73, 107, 111, 123, 141, 150153, 175, 192, 253, 259, 295, 377
based classification 126
basic of 1
clinical need of 148
findings 375
infections 473
infestations 473
principles of 1, 2
purpose of 204, 369, 374, 377, 380, 382
specificity of 435
techniques of 1
use of 197, 410, 431
value of 145
Desmin 300
Desquamative patches plaques 89
Diamond necklace 463, 464f
Diffuse brown pigmentation 49
Diffuse erythema, presence of 105
Diffuse structureless brownish areas 219
Digital dermatoscopes 333
Digital fibrokeratoma 293, 294, 302
toenail, acquired 302f
Digital mucous cyst 293, 304, 304f
Direct skin contact fluid 77
Discoid lupus 89
erythematosus 82, 82f, 96, 112, 334, 356, 363, 376, 381, 383f, 384f
dermoscopic features of 382
Disseminated superficial porokeratosis 457, 458f
Distal end onychoscopy 285f
Distal interphalangeal joint 304
Dot pattern 51
Dotted vessels 62, 63, 183, 191
Double follicular units 56
Doucas and Kapetanakis, eczematoid-like purpura of 146, 148f
Dowling-Degos disease 469, 470f, 472f
late macule of 471f
Dyskeratosis congenita 96
Dyskeratotic cells 460
Dystrophic hair 357
E
Eccrine
pores 100
sweat glands 53f
Ectodermal dysplasia 449
Eczema 259
chronic 238
dermoscopic features of 268t
dermoscopy in 264
follicular 453, 453f
nummular 265
Eepidermal thickness, reduced 105
Electrodessication 307
Empty hair follicle 344f
presence of 343
Entomodermatoscopy 23
Entomodermoscopy 80
Epidermal cyst 411, 426, 427f
Epidermal growth factor receptor 298
Epidermal hyperplasia, mild 250f
Epidermal melanin, loss of 176
Epidermal nevus, androgen-dependent 156
Epidermal rete ridges, types of 53
Epidermis 106, 111
upper layer of 129, 449
Epiluminescence microscope 1, 47
Episcope 1
Erbium-doped yttrium aluminium garnet laser 295
Erosion 400
Eruptive vellus hair cyst 455
Erythema 104f, 141, 141f, 172f, 236f, 377, 397, 434
blotchy 107
dyschromicum perstans 96, 98, 246
mild 187f
peripheral 423, 425f
Erythrodermas 89
Erythronychia 276, 276f
longitudinal 277f
Exclamation mark hairs 344, 349, 370, 371f, 372, 373, 378
Exogenous ochronosis 96, 98, 135, 135f, 136, 139, 142
diagnosis of 145
incidence of 135
initial stage of 141f
over malar area 140f
over zygomatic process 140f
Exostosis, subungual 293, 294, 303
F
Face 49, 253, 255, 258
Facial
acanthosis nigricans, early 104f
hyperpigmentation 95, 96
dermoscopy of 119
disorders of 95
inflammatory skin diseases 89
melanosis, common 132t
pigmentary disorders 136
skin, dermatoscopy of 50f
Faint erythema 127
Fanconi anemia 158
Fern leaf pattern 209
Fibrokeratoma 301, 411, 428
Fibrous tissue tumors 294
Filaggrin 449
Filiform wart 68f
Fine short linear vessels 183
Fingerprint-like
pattern 51
structures 416
Fish scale-like pattern 51
Fissures, longitudinal 281
Fixed drug eruption 96, 111, 111f
Flame hairs 349
Focal hyperpigmented dots 100
Follicles 349
Follicular globules 105, 129f
forming sulci pattern 105
Follicular hyperplasia 358
Follicular openings 219, 449, 451f
loss of 400
obliteration of 135
Follicular orifice 363, 363fc
Follicular ostia 56, 357, 359, 373, 374f, 435
empty 378
loss of 112
Follicular ostium, single 56
Follicular papules, prominent raised 454
Follicular plugs 110, 380, 397, 400, 407
Follicular red dots 356
Follicular scale-crust 377
Follicular structures 142
Follicular unit hair transplantation 82
Folliculitis 455
bacterial 341
decalvans 341, 353, 358
dissecting 358
tufted 353, 358, 484
Fotofinder dermoscopeó 31
Fotofinder handyscope 30, 41, 44, 45f
Freckles 96
Frontotemporal hairline 357
Fungal
elements 375
infection 483
deep 402
G
Galaxy sign 178f, 198, 199f
Genetic hair shaft abnormalities 359
Genitourinary tract 294
Genodermatoses 466
Genus Leishmania 190
Giant capillaries 324, 325
Giant melanosomes, occasional presence of 157
Giant vessels 55
Globular yellowish brown pigmentation 237
Globules 151, 163, 209
Glomerular vessels 64, 70, 71f, 191, 262, 268, 340f, 353f, 354, 437
presence of 154
Glomus cells 299
Glomus tumor 276, 293, 294, 299, 300, 300f, 301
vascularity of 31
Glutaraldehyde 295
Glycerin 2
Granular layer
absence 459
reduced 459
Granuloma
annulare 405
annular plaque of 406f
noncaseating 406
pyogenic 411, 417, 419f
pyogenicum 293, 294, 297, 297f
Granulomatous dermatoses, patterns of 396
Granulomatous disorders 396, 405, 407
Granulomatous skin disease
dermoscopic hallmark of 397
dermoscopy of 396
Gray dots 150, 337
Gray-black granules 100
Grayish white veil-like structureless WS 224
Guttate hypomelanoses 173
Guttate lichen sclerosus 166
Guttate psoriasis 262, 263f
Guttate vitiligo 179, 197, 199f
lesions of 198
H
Hailey-Hailey disease 276
Hair
and scalp 56
dermatoscopy 56
diseases 23, 80
chromophores of 12
clipping of 387
density 343, 386
diameter measurement 389
follicle 49, 161, 373, 486f
openings 334
growth 391f
rate, measurement of 394
length of 390, 391f
loss
assessment of 386
disorders 373
female pattern 341
irregular patches of 379
monilethrix-like 344
parameters of 386
pulling tic 377
regrowth 346
shafts 56, 333, 378
diseases 82
short stubs of 375
zigzag-shaped 347
Hairpin
loops 60
vessel 16, 63, 67, 68f, 191
Halo nevus 411, 413, 415f
Hand
eczema, chronic 264, 265
foot, and mouth disease 473, 478
illuminated microscopes 8
Hanging curtain sign 233
Hanging glider sign 488
Hansen's disease 189, 404, 473, 475
hypopigmented patch of 189, 190f
Hebra circle 486
Heine delta 20 plus 27
HEINE iC1 30, 41, 44, 45f
Hemangioma 18
Hematomas, subungual 275f
Hemorrhage 55, 326f, 328f
perifollicular 378
splinter 277f, 278, 279f, 281, 300, 313, 314, 317
Hemosiderin laden macrophages 153
Hidden hair 262, 266, 354
High-resolution ultrasonography 310
Histoplasmosis 402
indurated plaque of 403f
umbilicated papule of 403f
Homogeneous globular
components 114
pattern 114
Homogeneous purpuric patches, irregular-shaped 153
Homogeneous round achromic areas 164
Honeycomb-like reticular pigment network 57
Honeycomb pigment
networks 112
pattern 268
Honeycomb pigmentation 339f, 343
Hori nevus 133
Human enterovirus 478
Human papillomavirus 295
Hutchinson's sign 308
Hybrid dermatoscopes 27
Hydroquinone 145
prolonged application of 139
use of 134
Hypergranulosis 248
wedge-shaped 231
Hypergranulotic infundibula 232
Hyperkeratosis 248
subungual 285f, 313
Hyperkeratotic follicular plugging 383
Hyperkeratotic ridge, diamond necklace appearance of 464f
Hypermelanotic rete ridges 412
Hyperpigmentary skin 126
Hyperpigmentation 96, 141, 161, 197, 247, 338
blotchy areas of 159
diseases of 198
disorders of 95
evaluation of 105
honeycombed 380
macular 163
parafollicular 160, 160f, 161, 163
perifollicular 102, 106, 107f, 171, 172f, 250f, 378, 412
perilesional 171
periorbital 95, 105
peripheral reticulate 402f
postinflammatory 95, 105, 107f, 148, 218f
Hyperpigmented
border 460
globules 100
lesion 157f
macules, areas of 136
maculopapular diseases 89
margin 112, 170
papules 224
plaque 476f
rete ridges 117
tracks 463
triangular solid structure 488
Hyperplasia
epidermal 481
focal 252f
epidermal 248
rete ridge pattern of 248
sebaceous 68, 69f, 411, 423, 424f
Hypertrichosis 134f, 156, 157f, 412
Hyphal pattern 51
Hypomelanosis 176
pharmacologic 176
Hyponychium 54, 55, 280, 281f
Hypopigmentary disorders 175
Hypopigmentation 197
central 469
diseases of 198
disorders of 166, 175, 176
perifollicular 160, 160f, 453
postinflammatory 92f, 176, 177, 187f, 188f, 191, 191f
Hypopigmented
area 192
halo 247
holes 126
lesions, differential diagnosis of 175
macular dermatosis 89
macules 185
mycosis fungoides 176, 183
patch 189, 402f, 477f
accentuation of 31
dermoscopic evaluation of 183
scaly macules 485f
vellus hairs 344
Hypovitaminosis A 455
I
Ice pick scars 106
Ichthyosis 449, 453
follicularis 449
vulgaris 449
Idiopathic guttate hypomelanosis 166, 175, 179, 197, 198, 202f
dermoscopy of 181f
petaloid pattern of 180f
Imiquimod, topical 307
Impetigo 474, 474f
Inbuilt illuminating system 5
Inbuilt photography systems 6
Infections 283
bacterial 176, 474
Infectious disease
common 80
transmission of 80
Inflammatory disease 23, 277, 369
dermoscopic examination of 84
Inflammatory disorders 47
Inflammatory purpura, types of 153
Inflated balloon appearance 400
Infundibulum, follicular 111, 225f, 449
Ingrown hair 454
Ink furrow test 445f
Interfollicular
area 383
dermis 380
epidermis 338
Interfollicular region 110, 383
Intrapapillary capillary loops 52
Irregular brown globules 100
Irregular polycyclic margin 173
Isopropyl alcohol 25
Itchy 485
papulonodular lesions 89
Ivory white
areas 359
background 428
color 427
J
Jelly like synovial fluid 305
Jelly sign 127, 129f
Jet contrail sign 488f
K
Keratin
filled craters 221
plugs 112
over follicular ostia 49
Keratinization, disorders of 449
Keratinocyte 125, 410
Keratinous plug 448, 451f
Keratitis 449
Keratoacanthoma 67, 293
Keratosis
pilaris 448, 452f
clinical differentials of 454
dermoscopic features of 449
dermoscopy of 448, 450f
differential diagnosis of 453, 455t
pathogenesis of 449
reduction of 449
subungual 281
Keratotic
follicular papules 453
papules, dermoscopy of 224
ridge 458f
Koebner's phenomenon 200, 211, 242, 242f
classical 214f
dermoscopy of 243f
Koenen's tumor 293, 294, 302, 303, 303f
Kumkum pigment, granules of 111
L
Large blue-gray ovoid nests 443
Large brown globules 102, 105
Laser irradiation 145
Late scleroderma pattern 329f
Leaf venation pattern 209
Leishmaniasis 176, 190
cutaneous 80, 190
Lentigines 96
Lentiginosis 164
Lentigo
maligna 19
simple 78
simplex 117
dermoscopy of 118f
Leopard syndrome 158
Leprosy 176, 177
hypopigmented patch of 189, 189f
Lesion
annular 220f
center of 159
dermoscopic image of 217f, 218f, 234f, 235f, 239f
dermoscopy of 236f
distribution of 486
evolution of 150
periphery of 160, 161f
Leukocytoclastic vasculitis 149
Leukonychia 171, 276, 276f, 278, 313, 317
longitudinal 277f
Lice nits 362f
Lichen
planopilaris 82, 224, 335, 353, 354, 355f, 370, 379
characteristic feature of 381f
dermatoscopy of 28f, 35f
dermoscopic features of 380
dermoscopic image of 381f, 382f
scalp 226f
trichoscopy of 83f
planus 86, 154, 204, 212f, 301
annular 219
classic lesion of 214f
dermoscopic evaluation of 209
dermoscopy in 204
diagnosis of 204
early lesion of 210f
follicular 224, 455
hypertrophic 221, 221f223f
lesions, dermoscopy of 205
lesions nearing resolution 216f, 217f
mucosal 224
pigmented lesions of 219
pigmentosus 96, 98, 99f, 131, 133, 246, 247t, 249f252f, 255, 257f
dermoscopy of 256f
lesions of 249f
subsided lesion of 218f
types of 205
sclerosus et atrophicus 181, 182f
scrofulosorum 397, 399f, 400f
simplex chronicus 238, 240f
Lichenoid
actinic keratosis 435
dermatosis 146, 244
drug eruption 232, 237f
papules 247
Light dermoscopy, polarized 106, 460
Light-brown blot 119
Light-colored calms 161
Light-emitting diode 5
bright illumination of 11
Linear crista cutis 100
Lip mucosa, dermatoscopy of 52f
Liquid paraffin 25
Loop pattern 51
Lung 294
Lunula 272f, 301, 313
Lupus erythematosus 232, 236f
early lesion of 235f
Lupus vulgaris 89, 397, 398f, 473, 474
lesion 399f
reddish plaque of 398f
Lymphangioma circumscriptum 411, 419
Lymphocytes 250f
less infiltration of 153
perivascular infiltrate of 151, 154
M
Macular hypomelanosis, progressive 166
Macule
border of 247
depigmented 136, 171
hyperpigmentated 158f
Majocchi's disease 146
Majocchi's purpura 147f
Malar 123
Malignant cutaneous tumors, dermoscopy of 434
Malignant melanoma 293, 294, 307
dermoscopy of 443
histological subtypes of 443
Maple leaf-like areas 440, 442, 442f
Marginal reticular pigmentation 171
Mastocytoma 119
Mastocytosis
cutaneous 119
maculopapular 119
Matrix cyst 293
Mature lesion 213f, 226
Mature melanocytic nevi, diagnosis of 66
Mature melanosomes 125
Mature violaceous
papules 211
plaques 211
McCune-Albright syndrome 158
Medulla, intermittent 360
Melanocyte 117, 125, 410
epidermal 95, 175
follicular 95, 175
loss of 167
Melanocytic criteria 423
Melanocytic lesion 18, 59
Melanocytic nevus 24, 78, 293, 294, 411
acquired 17f, 412, 414f, 443, 445f
congenital 157, 163, 164f, 411, 412, 413f
dermoscopy of 177
junctional 411
Melanodermatitis toxica 109
Melanoma 18, 69, 276
dermoscopy of 177
metastasis 70
ungual 308t
Melanonychia 273
benign 275f
longitudinal 307
Melanophages 106
clusters of 100
presence of 125, 144
Melasma 96, 126, 127f, 132, 145
characteristic feature of 127
classification of 126t
clinical classification of 123, 124f
dermoscopic
characteristics of 128t
features of 126
dermoscopy in 122
displays, dermoscopy of 142
epidermal 97f, 130f, 136
global feature of 128f
histopathological classification of 125t
lesions of 145
mixed 98f
patches 140f, 142
prognosis of 136
Methylated spirit 7
Mibelli classic porokeratosis 458f
Microhemorrhages 289
local 324
Micro-Hutchinson sign 274
Micro-Koebner's phenomenon 167
Micropustules 377
Microscopic pigmentation, retention of 444
Microsporum 346
canis 483
Microvascular involvement, different patterns of 287t
Microvascular loops 324
Microvessels, cutaneous 333
Mid spinous layer 460
Milia 411, 423, 426f
Mini triangle sign 488
Moh's micrographic surgery 307
Molescope 41, 44, 46f
Molluscum bodies 481f
Molluscum contagiosum 68, 81f, 473, 480
Monilethrix 334, 359, 359f
hair shaft defect, trichoscopy of 83f
Morphea 96
Morse code hair 484
Moth eaten borders 420
Mucosa 50
dermatoscopy of 50
Multilobular white-yellow amorphous structures 80
Multiple blue-gray globules 440, 443
Multiple endocrine neoplasia 158
Multiple follicular plugs 384f
Multiple lentigines syndrome 158
Multiple small erosions 442
Mycobacterium leprae 404
Mycobacterium tuberculosis 475
Mycosis fungoides 183
Myosin 299
Myxoid cyst 294
N
Nail 47, 54
apparatus, melanoma of 443
bed 55, 278, 281, 294
hyperkeratosis 309
involvement 313
vessels 280
chromophores of 12
disorders 271
dystrophy of 308
fold
abnormalities 23
capillaroscopy 7, 85f, 287, 321
lateral 272
videocapillaroscopy pattern, normal 323f
lichen planus 281, 282f
matrix 278, 293, 300
involvement 313
melanin unit 294
pigmentation 273
pitting 281
plate 55, 272f, 273, 278, 300, 309
depression, linear band of 303f
dermatoscopy of 55f
greenish discoloration of 278f
psoriasis 260, 261, 261f, 277, 281f, 283, 313
dermoscopic features of 317t
dermoscopy of 313
trichrome vitiligo 166
tumors 276
unit
benign tumors of 293t, 295
different parts of 272f
malignant tumors of 293t, 305
melanoma, onychoscopic diagnosis of 274
pigmentation 274fc
trichrome vitiligo of 173
tumors, classification of 292
Naked eye
diagnosis 78
examination 244
Nebula-like appearance 190
Nebular pattern 198
Nebulous pattern 171, 199f
Necrobiosis lipoidica 406, 407
dermoscopic examination of 407
lesions of 407
Neodymium-doped yttrium aluminum garnet 134, 295
Neoplastic nail unit disorders 292
Netherton syndrome 361
Neurofibroma 302, 411, 416, 417f
Neurofibromatosis 158, 158f
Nevoid basal cell carcinoma 468f, 469f
syndrome 466
Nevus depigmentosus 166, 192, 193f
dermoscopy of 192f
Nevus depigmentosus
hypopigmented macules of 192
irregular border of 193
Nevus of Ota 114
dermoscopy of 113f, 114
Nevus spilus 114, 115f, 164, 411, 414
dermoscopy of 114, 164
Nevus types 415
Noncicatricial alopecia 341
Noninfectious balanitis 89
Noninflammatory purpura 153
Noninflammatory tinea capitis 377
Noninvasive alternative method 158
Nonmelanocytic round structure 455
Nonscarring alopecia 89
Normal pigmentary network lines 160
Normal scalp, trichoscopy of 341
Normal skin 48
and appendages, dermatoscopy of 47
dermatoscopy of 48f
dermoscopy of 127f
Numerous brown pigment globules 142
Numerous cutaneous diseases 76
O
Occipital scalp 57
Ochronosis 131, 132, 139
diagnosis of 144
Oil-drop patches 313
Onychocytic matricoma 293
Onychodermal band 272f, 314
Onycholemmal cyst, proliferating 294
Onycholemmal horn 294
Onycholysis 261, 261f, 278, 280f, 281, 285f, 307, 313, 317
dermoscopy of 318t
traumatic 318
Onycholytic bands 284f
Onychomatricoma 276, 293, 300
Onychomycosis 283, 283f285f, 301, 306, 313, 318, 319f
distal lateral 318, 318t
proximal subungual 284f, 318
total dystrophic 318
Onychopapilloma 276, 293, 301
Onychoscopy 23, 278, 310
indications of 273fc
overview of 271
Optilia digital capillaroscopy system 31
Orange-yellowish patchy areas 183, 185
Orthohyperkeratosis 243
Orthokeratosis 232
Osteochondroma 294
P
Pale cytoplasm 299
Palmar
pits 469f
dermoscopic image of 472f
psoriasis 264, 264f
skin, dermatoscopy of 53f
Palmoplantar
lesions 224
skin 53
Palms 47
Papillary dermal structures 10
Papillary dermis 96, 100
Papillomatosis 157
Papular lesions 449
Papule
dermoscopy of 242f
early 209
erythematous 236f
numerous skin-colored 402
Papulonodules 141
Papulosquamous disorders 204
Parallel pattern 51
Parasitic infection 176
Paronychia, chronic 306
Patch
dermoscopy of 142f
histopathology of 144f
Patchy alopecia 369
trichoscopy of 369
Pediculosis capitis 362, 485
Periappendageal pigment loss 187f
Perifollicular cellular infiltrate 252f
Perifollicular depigmentation 167, 169f
Perifollicular discoloration 343
Perifollicular epidermis 333, 338
Perifollicular erosion, dermoscopy of 398f
Perifollicular erythema 378, 382f
varying degrees of 448
Perifollicular halo
diffuse telangiectasia 110
typical 112
Perifollicular lymphocytic infiltrate 248
Perifollicular openings, sparing of 129
Perifollicular pigmentation 173, 199f, 202f, 262, 263f, 268, 354, 380
Perifollicular region, sparing of 111
Perifollicular scale 221, 352
Perifollicular white scale 266, 268f
Perifolliculitis capitis 358
Periorbital melanosis 105
evaluation of 105
Peripheral brown rim 428
Peripheral globules 412
Peripheral microscales 239f
Peripheral pigment network 416
Peripheral reticular network 412
Peripheral vessels, prominent 215
Peripilar cast 380
Peripilar gray-white halo 358
Peripilar sign 339f, 343
Periungual tissue 294
Periungual warts 286, 286f, 296f
fingerlike projections of 296f
multiple coalescing 286f
Perpendicular axes 446
Petaloid 179
pattern 177, 200f
Petechiae over hard palate 479f
Phototrichogram 386, 387, 392, 395
automated 392
classical 394
contrast-enhanced 391
Pig tail 344
Pigment
around hair follicle, retention of 178f
brown granules of 180f
brownish 221
clusters, granules of 100
diffuse network of 164
incontinence 248
loss, perifollicular accentuation of 188f
network
distribution of 200
gradual loss of 185
like structures 420
loss of 167f, 382
perifollicular sparing of 106
presence of 200
reduction of 167f
reticular pattern of 50, 100
reversed 167, 177
pattern, accentuated 119
Pigmentary demarcation lines 96, 116f, 117, 131, 133
Pigmentary dermatoses 8
Pigmentary disorders, primary 84
Pigmentary network 161
absent 177
interrupted 164
Pigmentary purpuric dermatosis 84
Pigmentation 49
black dotted 338f
blotchy 159, 376
homogeneous 164
bluish gray 135
depth of 96
disorders of 197
distribution of 249f
enhancement of 125
intense 471
pattern of 105, 119
perifollicular retention of 166, 167, 168f
postinflammatory 164, 244
pseudoreticular pattern of 153f
reservoirs of 171
structures 397, 407
tends 209
visualized 205
well-defined 173
Pigmented contact dermatitis 109, 109f, 110, 110f
pathology of 110
Pigmented lesions 13
hallmark of 49
Pigmented macules 469
dermoscopy of 470f
Pigmented purpuric dermatoses 146, 150f, 151f
types of 155
Pigmented rings 469
Pigtail hairs 334, 346
Pili annulati 334, 360, 361
Pili torti 334, 360
Pilosebaceous units, presence of 49
Pits 278
over nail plate 317
Pityriasis alba 166
Pityriasis lichenoides 185, 192
chronica 176, 187f
active lesion of 186f
Pityriasis rosea 88f, 233, 238f, 239f
Pityriasis rubra pilaris 455
Pityriasis versicolor 185, 187f, 188f, 474, 485
hypochromic lesions of 485
white light image 185
Plane warts 242
Plantar lesions 227f
Plaque psoriasis 260, 260f
Plexus, subpapillary 59, 60
Pohle-Pinkus constrictions 344
Poikiloderma of Civatte 123
Polka dot 167, 168f
Polygonal globules 20
Polymyositis 289
Pompholyx 265, 266f
Porokeratosis 457, 460, 464f
hallmark of 458f
histopathology of 459f
of Mibelli 457
superficial 31
Post-kala-azar dermal leishmaniasis 191, 400, 401f
plaque of 401f
Potassium hydroxide 319, 483
Prephotodynamic therapy 91f
Proximal erythematous band 280f
Proximal nail fold 54, 280, 295, 296f
capillaries 283
dermatoscopy of 54f
Prurigo nodularis 241, 241f
Pruritus 247
Pseudofolliculitis 454f
Pseudomonas aeruginosa 277
Pseudopelade 370
of Brocq 353, 357
Pseudopods 20
Pseudoreticular pattern 106
Psoriasis 233f, 259, 279f, 285f, 314, 314f317f, 353, 354t
chronic plaque of 232, 234f
dermatoscopy of 27f, 87f
dermoscopic features of 268t
dermoscopy in 260
follicular 455
scales 353f
vulgaris 84
Purpura
annularis telangiectodes 146, 147f
steroid-induced 153
Purpuric clothing dermatitis 148
Purpuric dermatosis, progressive pigmented 146
Pustules, follicular 358
Q
Q-switched neodymium-doped yttrium aluminum garnet laser 134
R
Ramirez ashy dermatosis 98
Raynaud's phenomenon 287, 321, 322
Recurrent nevi 13
Red blood cells, extravasation of 151
Red dots 149, 151, 230, 262, 337, 337f, 354
presence of 154
Red globules 230, 231, 262, 354
Red spots 313
Reddish brown crust 241
Reddish homogeneous areas, presence of 417
Reddish tinge reduces 152
Reflectance confocal microscopy 77
Regrowing hair 344, 346
Residual perifollicular pigmentation, presence of 171
Reticular pattern 164, 412
Reticular pigmentation, lesional 171
Reticular streaks 397, 407
Reticuloglobular network, irregular accentuation of 109
Reticuloglobular pattern 95, 97f, 98f, 107, 114, 117
Reverse skin pigmentary network 404
Riehl's melanosis 109, 131, 133
Ring-like pattern 51
Rolling scars 106
Rosacea 89
Round corneal structures 221
Round-to-oval red lacunas 154
Russell-Silver syndrome 158
S
Sagrada Familia sign 301
Salicylic acid 295
Salmon 313
colored ovoid structures 400
patch 278, 279f
Sarcoid granulomas 406
Sarcoidosis 89, 406, 407
Sarcoptes scabiei var hominis 486
Scabies 486
scybala of 488
Scale
color 268
distribution 268
peripheral collarette of 233
Scaling 377, 467, 468
scalp disorders 89
Scalp 47
dermatoscopy of 56f, 57f
dissecting cellulitis of 358
psoriasis 66f, 262, 263f, 352, 353
Scaly hair loss, patchy area of 483f
Scanty white crusts 266
Scarring alopecia, multiple patches of 381
Scars, pitted 469
Schamberg's disease 146, 147f, 148, 149f, 153f
Scleroderma 288f, 289f
pattern 325
early 326f
Sclerosis
systemic 287, 321, 324, 325
tuberous 158
Scurvy 455
Sebaceous glands, absence of 449
Seborrhea 352f
Seborrheic alopecia 352
Seborrheic distribution 485
Seborrheic keratosis 13, 14f, 18, 67, 73, 411, 420, 422f
dermatoscopy of 79f
Semicircular hair 451f, 452f
Senile purpura 153
Siderophages 153
Sieve-like pattern 260
Signet ring vessels 262, 268, 340, 354
Silvery-white scaling 259
Single-lens reflex 27
Skin
biopsy 77
cancers, keratinizing 434
chromophores of 12
colored papule 242f, 482f
diseases, infectious 396
disorders, inflammatory 87f
furrows 485
interfollicular 57
lesions
nonpigmented 396
pigmented 396
lightening agents 135
perifollicular 57
sun-damaged 435
surface microscope 1, 332
tumors, evaluation of 396
Smartphone
dermatoscopes 29, 40, 44
dermoscopy 41
Snail-track appearance 162f
Solar lentigo 78, 117
Sparkle pattern 114
Sparse hair 378
Spitz nevus 411, 416
Spoke wheel
appearance 17f
area 20, 440, 442, 443
Spongiosis, follicular 110
Sprinkled hair 349
Squamous cell carcinoma 19, 67, 69, 80, 293, 295, 306, 434, 439f
dermoscopy of 438
types of 437
Starburst pattern 20, 397
Starry sky pattern 209, 355
Stasis pigmentation 148
Steatocystoma 411, 428, 429f
Steroid
abuse, treatment assessment of 131
application 117
topical 136
Stratum malpighii 12
Strawberry pattern 20
Subtle leukotrichia, unmasking of 176
Subtle sulci pattern 100
Subungual warts, fingerlike projections of 296f
Sulcus cutis 100
Superficial papillary dermal vessels, hemorrhage of 146
Superficial perivascular infiltrate 250f
Superficial small blood vessels, macrophages around 151
Supernumerary digits 302
Sweat gland openings 49
Syringoma 411, 430, 430f
Systemic lupus erythematosus 329
T
Tapering hairs 351, 372
Tapioca sago 170
T-cell lymphoma, common primary cutaneous 183
Telangiectasia 172f, 182, 302, 337, 402, 407, 468, 476f
arborizing 191, 397, 443
deeper 183f
fine focused 397
globular 404
linear 110, 402
macularis eruptiva perstans 119
presence of 171
reticular 119
short 112
superficial 440, 441f
Telogen
effluvium 343, 344f
hairs 391f
Terminal hair 56f
pilosebaceous unit of 449
Thick honey color crust-scale 475f
Thyroid diseases 122
Tinea capitis 341, 346, 347f, 374, 375, 375f, 474, 483, 485
dermoscopic image of 376f
Tiny lichenoid papules 397
Traction alopecia 349, 350f
hair cast 350f
Tranexamic acid 134
Triangular pigmentary band 274
Trichoanalysis 30
Trichoepithelioma 411, 428
Trichophyton 346
soudanense 483
tonsurans 483
violaceum 483
Trichoptilosis 344, 347, 378
Trichorrhexis
invaginata 334, 361
nodosa 334, 344, 361
Trichoscan 386, 392, 395
Trichoscopy 23, 82f, 332, 333, 359
equipment 333
overview of 332
patterns 333
structures 333
terminologies 333
Trichothiodystrophy 360
Trichotillomania 82, 334, 347, 348f, 377, 378
dermoscopic
findings in 378
image of 379f
Trichrome
pattern 177
sign 168f
Tuberculosis
cutis lichenoides 397
cutaneous 397
Tuberculous foci 475
Tubular casts 354
Tubular perifollicular scales 354, 355f, 356f
Tulip hair 349
Tumors
benign
melanocytic 411t
nonmelanocytic 411, 411t
metastatic 293
nail specific 294f
subungual filamentous 293
U
Ulcer 400
Ulceration 89, 309, 440, 441f, 442, 443, 467
Ultraviolet 31
light 31, 175
dermoscopy 463, 464f
radiation 122
use of 377
Upper epidermis appears 96
Urticarial vasculitis 154
V
Vascular endothelial growth factor 122
Vascular lacunae 79f
Vellus follicle 450f
Vellus hair 56, 56f, 346, 370
follicles 402
nonpigmented 159
short 344, 372
Verruca 293, 481
plana 14f, 242f, 243f
vulgaris 302
Vessels
arborizing 69, 70f, 89, 356, 440
coral pattern of 72f
crown of 80
cutaneous 13
linear 14, 16t, 224, 427, 428
irregular 64, 71, 191, 460
onychodermal 317
pattern of 268
polymorphous 73
thrombosed 295
tortuous 224
types of 268
variable dermoscopic pattern of 183
Videodermoscope 5, 8f
principle of 3f
Videodermoscopy
principles of 1
techniques of 1
Violaceous brown pigmentation 356f
Viral infections 473, 478
Visceral leishmaniasis 191, 400
Vitiligo 176, 177t, 178f, 179, 179f, 203
active lesion of 169f
dermatoscopy of 32f, 33f
dermoscopic signs of 189
dermoscopy in 166
diagnosis of 166
evolving lesions of 179
histopathology of 198
hypopigmented
macules of 176
patch of 190
lesions of 202
like perifollicular pigmentation, dermoscopic features of 200
localized 197
macule 176
perifollicular pigmentation hallmark of 202f
progressive 170f
repigmenting 171
stable 171, 171f
repigmenting 172f
Volcanic crater 460
V-pattern 51
V-sign 349
W
Wart 294
viral 295, 301
White chrysalis-like areas 182
White discoloration 343
White dots 335, 336f, 349
White light dermoscopy 460
White rail line 417
White starburst pattern 242
White track 460
Whitish irregular blotches 106
Whitish papules 224
Whitish-blue areas, structureless 428
Wickham striae 204, 205, 211f, 212f, 221, 230, 235f
annular 211
demonstration of 244
linear 205
patterns of 206f208f
rapid recognition of 204
reticular 211
ring-shaped 219
round 205
whitish globular 224
Wood's lamp 123, 125, 126t, 198
Woolly hair syndrome 361
Y
Yellow clods 49
Yellow dots 268, 334, 335f, 349, 371f
Yellow orange blot 119
Yellow scales 183
Yellowish brown hyperkeratotic plug 86
Yellowish scales 266
Yellowish tubular scaling 358
Z
Zygoma 123
Zygomatic region 141f
×
Chapter Notes

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Dermoscopy Trichoscopy and Onychoscopy: In Diseases of the Pigmented Skin: AN ATLAS AND SHORT TEXT
Dermoscopy Trichoscopy and Onychoscopy: In Diseases of the Pigmented Skin: AN ATLAS AND SHORT TEXT
Second Edition
Editor Uday S Khopkar MD FIDP Consultant Dermatologist and Dermatopathologist Emeritus Professor of Dermatology Department of Dermatology and Venereology Seth Gordhandas Sunderdas Medical College (GSMC) and the King Edward Memorial (KEM) Hospital Mumbai, Maharashtra, India Assistant Editor Ankit H Bharti MD FIDD Consultant Dermatologist and Dermatopathologist Department of Skin and Dermatopathology Referral Center General Hospital Vyara, Gujarat, India
Jaypee Brothers Medical Publishers (P) Ltd.
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Dermoscopy, Trichoscopy and Onychoscopy in Diseases of the Pigmented Skin: An Atlas and Short Text
First Edition: 2012
Second Edition: 2020
9789389034011
Printed at
Contributors Preface to the Second Edition
I am pleased to write a preface for this revised 2nd edition of Dermoscopy, Trichoscopy and Onychoscopy in Diseases of the Pigmented Skin: An Atlas and Short Text. Several new chapters have been added and some are completely rewritten by experts in this field like Drs Archana Singal, Laxmisha Chandrashekhar, Manas Chatterjee, Omprakash HM, Nirmal B, Feroze Kaliyadan, and Subrata Malakar among others. I am sure, this has added value to this text and made it more comprehensive.
Dermoscopy, as a technique, has rapidly evolved over the last decade and this made it necessary to replace many of the pictures in the previous edition of this book. The authors have taken efforts to introduce new dermoscopic images to cover recently described signs and conditions. This should make it instructive to go through this update. I am thankful to the contributors and my editorial assistant for delivering the goods in time and keeping the pressure on me to bring this project to completion.
I wholeheartedly thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Ms Chetna Malhotra Vohra (Associate Director—Content Strategy) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for stimulating me to bringing out this update. I am also thankful to the Jaypee desktop publication team, especially Ms Savleen Kaur, for doing job neatly in such a short time.
I appeal to my colleagues and postgraduates to send me their feedback regarding this book so that we can improve it to suit their needs. I end with expressing hope that this book stimulates interest in dermoscopy of the spectrum of pigmentary and inflammatory skin, hair, and nail diseases especially for the new entrants.
Uday S Khopkar
Preface to the First Edition
I am happy to write a preface to this short compilation of articles released on the occasion of the First National CME on Dermoscopy organized by the Department of Dermatology at Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India. Majority of the articles are being presented as papers at the CME and we could have easily published them as an abstract book. However, I decided to do more since the most important information in any dermoscopy presentation are the images flashed, and without images, it is difficult to appreciate the findings being communicated at the presentation.
Moreover, I expect that armed with this book, my colleagues would find it easier to practice dermoscopy on their patients when they return to their clinics to cater to their patients. This should help propagating the noninvasive technique of dermoscopy in a small way. I also thank my colleagues and guest speakers at the conference for readily penning the text according to the requirement of this atlas and text on dermoscopy.
I express my deep gratitude towards our popular Dean and Director, Dr Sanjay Oak, without whose encouragement, this CME or this publication would not have been possible. I wholeheartedly thank Shri Jitendar P Vij (Group Chairman) of M/s Jaypee Brothers Medical Publishers (P) Ltd., for agreeing to do this publication at a very short notice. I am also thankful to the Jaypee desktop publication team for doing this job neatly in such a short time. Like any publication done at short notice, there may be some shortcomings in this. If they are scientific, I am sure my colleagues will point them out and we hope to correct them in subsequent editions. If they are of technical nature, I assure you that they are due to oversight and not intentional.
I end with expressing hope that this small book stimulates interest in dermoscopy of the spectrum of pigmentary and inflammatory skin diseases observed in the brown skin and in trichoscopy.
Uday S Khopkar
Prologue to the First Edition
The field of dermoscopy is relatively unexplored and provides exciting opportunities for original observations. Although the technique of dermoscopy was invented more than 100 years back, till recently, the instrument was used mainly on the white skin for diagnosis of skin melanoma and monitoring of melanocytic nevi.
I have been using various versions of dermoscope over the last 25 years and with help of my students and colleagues I made several observations, particularly in the field of inflammatory and pigmentary skin diseases in brown-skinned patients. While some of the observations have a diagnostic value and fill up lacunae in diagnosis (where even a biopsy is not offering reliable differentiation), and others help in clinical decision making or assessing prognosis.
Dermoscope should not be viewed as just another magnifying glass, but is a completely new way to look at the skin. It shows not only surface features but also subsurface features. The benefits of this noninvasive technique multiply as we start using it on a routine basis. Dermoscopy has its own terminologies that allow precise scientific communication. It is imperative for dermatologists to get used to the terminologies and the images that it corresponds with. This will allow them to use dermoscope on a daily basis, so as to eventually transfer its benefits to their patients. It is with this intent of creating a bank of images of applications of dermoscopy in diseases affecting the brown skin, that we have compiled this book. I am sure that many more diseases lend themselves to study with dermoscope and this compilation will stimulate my colleagues to undertake more such observations in the coming years.
Uday S Khopkar
Editor, 1st edition, January 2012