Dermoscopy in general dermatology: A practical overview

Over the last few years, dermoscopy has been shown to be a useful tool in assisting the noninvasive diagnosis of various general dermatological disorders. In this article, we sought to provide an up-to-date practical overview on the use of dermoscopy in general dermatology by analysing the dermoscopic differential diagnosis of relatively common dermatological disorders grouped according to their clinical presentation, i.e. dermatoses presenting with erythematous-desquamative patches/plaques (plaque psoriasis, eczematous dermatitis, pityriasis rosea, mycosis fungoides and subacute cutaneous lupus erythematosus), papulosquamous/papulokeratotic dermatoses (lichen planus, pityriasis rosea, papulosquamous sarcoidosis, guttate psoriasis, pityriasis lichenoides chronica, classical pityriasis rubra pilaris, porokeratosis, lymphomatoid papulosis, papulosquamous chronic GVHD, parakeratosis variegata, Grover disease, Darier disease and BRAF-inhibitor-induced acantholytic dyskeratosis), facial inflammatory skin diseases (rosacea, seborrheic dermatitis, discoid lupus erythematosus, sarcoidosis, cutaneous leishmaniasis, lupus vulgaris, granuloma faciale and demodicidosis), acquired keratodermas (chronic hand eczema, palmar psoriasis, keratoderma due to mycosis fungoides, keratoderma resulting from pityriasis rubra pilaris, tinea manuum, palmar lichen planus and aquagenic palmar keratoderma), sclero-atrophic dermatoses (necrobiosis lipoidica, morphea and cutaneous lichen sclerosus), hypopigmented macular diseases (extragenital guttate lichen sclerosus, achromic pityriasis versicolor, guttate vitiligo, idiopathic guttate hypomelanosis, progressive macular hypomelanosis and postinflammatory hypopigmentations), hyperpigmented maculopapular diseases (pityriasis versicolor, lichen planus pigmentosus, Gougerot-Carteaud syndrome, Dowling-Degos disease, erythema ab igne, macular amyloidosis, lichen amyloidosus, friction melanosis, terra firma-forme dermatosis, urticaria pigmentosa and telangiectasia macularis eruptiva perstans), itchy papulonodular dermatoses (hypertrophic lichen planus, prurigo nodularis, nodular scabies and acquired perforating dermatosis), erythrodermas (due to psoriasis, atopic dermatitis, mycosis fungoides, pityriasis rubra pilaris and scabies), noninfectious balanitis (Zoon's plasma cell balanitis, psoriatic balanitis, seborrheic dermatitis and non-specific balanitis) and erythroplasia of Queyrat, inflammatory cicatricial alopecias (scalp discoid lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia and folliculitis decalvans), nonscarring alopecias (alopecia areata, trichotillomania, androgenetic alopecia and telogen effluvium) and scaling disorders of the scalp (tinea capitis, scalp psoriasis, seborrheic dermatitis and pityriasis amiantacea)

Recalcitrant livedoid vasculopathy associated with hyperhomocysteinaemia responding to folic acid and vitamins B6/B12 supplementation

is missing (Short communication)

An evaluation of the early implementation of school-based bullying prevention programs in Massachusetts

Thesis (Dr.P.H.)--Boston UniversityBackground: A quarter of U.S. children are bullied annually. State legislatures have responded to high profile media exposure of bullying and increased public concern by passing legislation aimed at preventing bullying among school children. Methods: The RE-AlM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was used to evaluate public school district responses to a Massachusetts 2010 anti-bullying law (MGL Ch. 71, Section 370). Massachusetts parents, school committee members, law enforcement leaders, and superintendents were surveyed about their perceptions of the law and its implementation. Comparative analyses were conducted using chi-square tests for categorical data. School district stakeholders in four diverse Massachusetts communities also were interviewed in depth to identify factors affecting adoption, implementation, and maintenance of school bullying prevention. Findings from these case studies were analyzed using standard qualitative analysis techniques and software. Results: The law had broad reach across Massachusetts public schools, with high levels of awareness of the law's existence (93.4%) and support for the mandate (81.3%) from an array of school constituencies. Across all stakeholders, there was a low degree of belief that bullying rates had decreased after the law's implementation. Superintendents were more likely than school committee members or parents to believe school bullying interventions were effective. There was no evidence to suggest that school districts modified or realigned their anti-bullying strategies in response to the legislation. School districts have complied with the letter of the law, but adoption of the law has been challenged by competing priorities, absence of community consensus about the importance of the problem, concern about the evidence base for anti-bullying curricula, and the appropriateness of delegating responsibility for bullying prevention to schools. Conclusion: The anti-bullying mandate catalyzed school districts to standardize their response to bullying, but there is no evidence to suggest an impact on bullying rates. The narrow focus of a bullying law could redirect resources away from equally important priorities and programs related to socio-mental health and root causes of bullying. Findings suggest that re-direction of narrow regulatory efforts mandated by the law into collaborative development of broader health promotion programming with local flexibility may address bullying more effectively

Dermoscopy as a useful supportive tool for the diagnosis of pityriasis amiantacea-like tinea capitis

Clinical distinction between pityriasis amiantacea-like tinea capitis and pityriasis amiantacea due to noninfectious inflammatory diseases is a troublesome task, with a significant likelihood of diagnostic errors/delays and prescription of inappropriate therapies. We report a case of pityriasis amiantacea-like tinea capitis with its dermoscopic findings in order to highlight the usefulness of dermoscopy in improving the recognition of such a condition

Dermoscopy in tinea manuum

Tinea manuum is a dermatophytosis which is often mistaken for other keratodermas, especially palmar psoriasis and chronic hand eczema. We report the use of dermoscopy as a diagnostic aid in a case of tinea manuum. The dermoscopic clue turned out to be the presence of whitish scaling located mainly in the furrows. This aspect has never been seen in other keratodermas and therefore can be considered as a useful finding to assist in the recognition of tinea manuum

Hypopigmented macules of the limbs in two sisters: Report on familial bier spots

Bier spots are asymptomatic, small, irregular, hypopigmented macules characterized by a normal histological appearance, which are usually found on the arms and legs of young adults. We describe the simultaneous presence of Bier spots in two siblings. This finding is unusual since, to the best of our knowledge, concurrent familial cases have never been reported in the literature

Lichen striatus associated with psoriasis vulgaris treated with oral acitretin.

Lichen striatus (LS) is an uncommon dermatosis of unknown etiology that presents as a continuous or interrupted linear band of pink, tan, red or skin-colored papules in a blaschkoid distribution. The lesions are generally solitary and unilateral, but unusual extensive cases with multiple and bilateral lesions have been also described. Albeit LS is typically an asymptomatic and self-limited dermatosis, it may cause a significant psychological distress in some patients, thus requiring an appropriate therapy. Topical steroid is the most commonly used treatment but it is not always effective. We report a case of LS unresponsive to topical steroid therapy associated with psoriasis vulgaris successfully treated with oral acitretin

Plaque-Type Psoriasis Treated with Calcipotriene Plus Betamethasone Dipropionate Aerosol Foam: A Prospective Study on Clinical and Dermoscopic Predictor Factors in Response Achievement and Retention

Introduction: Little information on possible local factors that can influence the achievement and retention of response of plaque-type psoriasis to calcipotriene plus betamethasone dipropionate aerosol foam is available. The aim of this study was to assess possible correlations between baseline clinical/dermoscopic features of psoriatic plaques and therapeutic response, and between residual dermoscopic findings in clinically improved/healed lesions and post-treatment relapse. Methods: For each target lesion, we calculated the local psoriasis severity index and assessed dermoscopic findings at baseline and at the end of a 4-week treatment, correlating the therapeutic outcome with the initial clinical and dermoscopic features. The lesions were also followed for a 4-week post-treatment period, and possible associations between relapse and (1) baseline clinical/dermoscopic features and (2) dermoscopic findings detected at the end of the treatment were assessed. Results: A total of 105 lesions from 35 patients were included in the analysis. After 4\ua0weeks of therapy, 13 lesions showed no/limited improvement, while partial and optimal response were observed in 51 and 41 plaques, respectively. Poor outcomes were correlated with both legs localization\ua0and degree of lesion infiltration at baseline. Similarly, presence of globular vessels at baseline dermoscopy was more commonly associated with no/limited response and lesions on the legs, particularly those showing resistance to treatment. A correlation was also found between dotted vessels on the baseline dermoscopic examination and good outcomes (partial/optimal response). After a 4-week post-treatment follow-up, 58.7% of the lesions achieving improvement at the end of the therapy showed relapse, with a correlation between recurrence and vessel persistence\ua0on dermoscopy at the end of the therapy. Conclusion: Clinical response of plaque-type psoriasis to calcipotriol/betamethasone dipropionate spray foam may be adversely affected by the degree of infiltration of lesions at baseline and by legs\ua0localization, and the presence of globular vessels at the baseline dermoscopic assessment is related to poor outcomes. A significant post-treatment relapse rate was observed, and persistence of vascular changes on dermoscopy seems to play a role in promoting disease recurrence