- Email: [email protected]
Dermoscopic subpatterns of granulomatous skin diseases
DERMOSCOPY
CASES OF THE MONTH
Dermoscopic subpatterns of granulomatous skin diseases Riccardo Balestri, MD,a Michelangelo La Placa, MD, PhD,a Federico Bardazzi, MD,a and Giulia Rech, MDb Bologna and Trento, Italy
CLINICAL PRESENTATION Case 1 (Fig 1, A) and case 2 (Fig 1, B) presented with multiple, persistent, yellow-brown to livid violaceous lesions with prominent telangiectatic vessels, involving the limbs. These lesions first appeared several weeks earlier.
Fig 1. Clinical appearance of granulomatous skin disorders. A, Necrobiosis lipoidica. B, Cutaneous sarcoidosis.
DERMOSCOPIC APPEARANCE Both cases had translucent yellow to orange areas associated with linear vessels, suggesting the diagnosis of a granulomatous skin disorder.1,2 However, case 1 (Fig 2, A) had longer and more branching telangiectasias than case 2 (Fig 2, B), which conversely showed short telangiectasias and white lines and dots between the translucent orange globules.
Fig 2. Dermoscopic appearance of granulomatous skin disorders. A, Necrobiosis lipoidica. B, Cutaneous sarcoidosis. From the Divisions of Dermatology at the Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Universita di Bologna,a and the Ospedale Santa Chiara, Trento,b Italy. Funding sources: None. Conflicts of interest: None declared. Reprints not available from the authors. Correspondence to: Riccardo Balestri, MD, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Universita
di Bologna, Clinica Dermatologica, Via Massarenti 1, 40138 Bologna, Italy. E-mail: [email protected]. J Am Acad Dermatol 2013;69:e217-8. 0190-9622/$36.00 ª 2013 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2013.03.030
e217
e218 Balestri et al
J AM ACAD DERMATOL
NOVEMBER 2013
HISTOLOGIC DIAGNOSIS The histologic examination of case 1 (Fig 3, A) was consistent with necrobiosis lipoidica, while case 2 (Fig 3, B) was consistent with cutaneous sarcoidosis.
Fig 3. Histologic appearance of granulomatous skin disorders. A, Necrobiosis lipoidica. B, Cutaneous sarcoidosis.
KEY MESSAGE The differential diagnosis of granulomatous skin disorders is often difficult; in particular, the plaque form of cutaneous sarcoidosis may closely resemble necrobiosis lipoidica. Both diseases share similar dermoscopic features. To this regard, the dermoscopic characteristics of cutaneous sarcoidosis and necrobiosis lipoidica were recently described as translucent yellow to orange areas associated with linear vessels,1,2 and the authors concluded that such similar patterns may not be sufficient to differentiate between these two granulomatous skin disorders.2 Although the dermoscopic features are strictly similar, we believe that a more accurate observation by dermoscopy could provide a possible insight into such features and help differentiation. In fact, we wish to highlight the longer and more branching telangiectasias of necrobiosis lipoidica, probably caused by atrophic changes not present in cutaneous sarcoidosis.
REFERENCES 1. Pellicano R, Tiodorovic-Zivkovic D, Gourhant JY, Catricala C, Ferrara G, Caldarola G, et al. Dermoscopy of cutaneous sarcoidosis. Dermatology 2010;221:51-4. 2. Bakos RM, Cartell A, Bakos L. Dermatoscopy of early-onset necrobiosis lipoidica. J Am Acad Dermatol 2012;66:e143-4.
CASES OF THE MONTH
Dermoscopic subpatterns of granulomatous skin diseases Riccardo Balestri, MD,a Michelangelo La Placa, MD, PhD,a Federico Bardazzi, MD,a and Giulia Rech, MDb Bologna and Trento, Italy
CLINICAL PRESENTATION Case 1 (Fig 1, A) and case 2 (Fig 1, B) presented with multiple, persistent, yellow-brown to livid violaceous lesions with prominent telangiectatic vessels, involving the limbs. These lesions first appeared several weeks earlier.
Fig 1. Clinical appearance of granulomatous skin disorders. A, Necrobiosis lipoidica. B, Cutaneous sarcoidosis.
DERMOSCOPIC APPEARANCE Both cases had translucent yellow to orange areas associated with linear vessels, suggesting the diagnosis of a granulomatous skin disorder.1,2 However, case 1 (Fig 2, A) had longer and more branching telangiectasias than case 2 (Fig 2, B), which conversely showed short telangiectasias and white lines and dots between the translucent orange globules.
Fig 2. Dermoscopic appearance of granulomatous skin disorders. A, Necrobiosis lipoidica. B, Cutaneous sarcoidosis. From the Divisions of Dermatology at the Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Universita di Bologna,a and the Ospedale Santa Chiara, Trento,b Italy. Funding sources: None. Conflicts of interest: None declared. Reprints not available from the authors. Correspondence to: Riccardo Balestri, MD, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Universita
di Bologna, Clinica Dermatologica, Via Massarenti 1, 40138 Bologna, Italy. E-mail: [email protected]. J Am Acad Dermatol 2013;69:e217-8. 0190-9622/$36.00 ª 2013 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2013.03.030
e217
e218 Balestri et al
J AM ACAD DERMATOL
NOVEMBER 2013
HISTOLOGIC DIAGNOSIS The histologic examination of case 1 (Fig 3, A) was consistent with necrobiosis lipoidica, while case 2 (Fig 3, B) was consistent with cutaneous sarcoidosis.
Fig 3. Histologic appearance of granulomatous skin disorders. A, Necrobiosis lipoidica. B, Cutaneous sarcoidosis.
KEY MESSAGE The differential diagnosis of granulomatous skin disorders is often difficult; in particular, the plaque form of cutaneous sarcoidosis may closely resemble necrobiosis lipoidica. Both diseases share similar dermoscopic features. To this regard, the dermoscopic characteristics of cutaneous sarcoidosis and necrobiosis lipoidica were recently described as translucent yellow to orange areas associated with linear vessels,1,2 and the authors concluded that such similar patterns may not be sufficient to differentiate between these two granulomatous skin disorders.2 Although the dermoscopic features are strictly similar, we believe that a more accurate observation by dermoscopy could provide a possible insight into such features and help differentiation. In fact, we wish to highlight the longer and more branching telangiectasias of necrobiosis lipoidica, probably caused by atrophic changes not present in cutaneous sarcoidosis.
REFERENCES 1. Pellicano R, Tiodorovic-Zivkovic D, Gourhant JY, Catricala C, Ferrara G, Caldarola G, et al. Dermoscopy of cutaneous sarcoidosis. Dermatology 2010;221:51-4. 2. Bakos RM, Cartell A, Bakos L. Dermatoscopy of early-onset necrobiosis lipoidica. J Am Acad Dermatol 2012;66:e143-4.