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Dermoscopy as an ancillary tool for the diagnosis of pityriasis versicolor
Dermoscopy as an ancillary tool for the diagnosis of pityriasis versicolor Hui Zhou, MD, PhD, Xu Hua Tang, MD, PhD, Jian De Han, MD, and Mu-Kai Chen, MD Guangzhou, China Key words: dermoscopy; pityriasis versicolor.
CLINICAL PRESENTATION A 53-year-old man presented with a 21-years history of multiple hyperpigmented macules and patches without obvious flakes on the trunk and limbs (Fig 1, A and B). The lesions were asymptomatic and enlarged slowly over time. The initial diagnosis rendered for this hyperpigmented lesion was lichen planus pigmentosus.
Fig 1. A, Clinical appearance of pityriasis versicolor (PV). Multiple hyperpigmented macules and coalescing patches involved the midback and upper extremities. B, Hyperpigmented macules scattered on the abdomen.
DERMOSCOPIC APPEARANCE Dermoscopy found a netlike distribution of pigmented skin lesions consisting of pigmented stripes with fine scales (Fig 2, A and B).
Fig 2. Pityriasis versicolor (PV). A, Dermoscopic examination of the pigmented lesions found a pigmented network composed of pigmented stripes. B, The fine scales were adhered to the hyperpigmented skin. From the Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University. Funding sources: None. Conflicts of interest: None declared. Reprints not available from the authors. Correspondence to: Prof. Mu-kai Chen, MD, Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen
University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China. E-mail: [email protected]. J Am Acad Dermatol 2015;73:e205-6. 0190-9622/$36.00 ª 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.08.058
e205
e206 Zhou et al
J AM ACAD DERMATOL
DECEMBER 2015
HISTOLOGIC DIAGNOSIS Histologic evaluation (Fig 3, A and B) found multiple roundish spores and short nonbranching hyphae in the stratum corneum. The following microscopic examination found numerous short hyphae and spores with a ‘‘spaghetti-and-meatball’’ appearance on a potassium hydroxide preparation of skin scrapings, confirming the diagnosis of pityriasis versicolor (PV).
Fig 3. Pityriasis versicolor. A, Histologic examination of the pigmented skin found multiple roundish spores with short hyphae of Malassezia in the horny layer and increased numbers of melanophages in the superficial dermis. B, Multiple roundish spores and short nonbranching hyphae in the stratum corneum. (A, Hematoxylin-eosin stain; original magnification: 3400; B, Periodic Acid-Schiff stain; original magnification: 3400.)
KEY MESSAGE PV can be diagnosed by its characteristic skin lesions (finely scaling, thin patches) and the spaghetti-and-meatball appearance of fungal forms.1 However, the fine scale on the affected skin of PV is not easily seen.2 Sometimes it becomes more apparent only when the skin is scraped. As suggested by our case, the fine scale on the involved skin can be readily observed by dermoscopy without the need of scratch, and the presence of fine scaling overlying the pigmented lesions prompts clinicians to distinguish this form of skin hyperpigmentation from other causes of cutaneous hyperpigmentation by the microscopic examination of skin flakes, which can then prevent unnecessary invasive procedures, such as biopsy. Dermoscopy may be an auxiliary tool for the diagnosis of PV.
REFERENCES 1. Pedrosa AF, Lisboa C, Goncalves RA. Malassezia infections: a medical conundrum. J Am Acad Dermatol. 2014;71:170-176. 2. Renati S, Cukras A, Bigby M. Pityriasis versicolor. BMJ. 2015;350:h1394.
CLINICAL PRESENTATION A 53-year-old man presented with a 21-years history of multiple hyperpigmented macules and patches without obvious flakes on the trunk and limbs (Fig 1, A and B). The lesions were asymptomatic and enlarged slowly over time. The initial diagnosis rendered for this hyperpigmented lesion was lichen planus pigmentosus.
Fig 1. A, Clinical appearance of pityriasis versicolor (PV). Multiple hyperpigmented macules and coalescing patches involved the midback and upper extremities. B, Hyperpigmented macules scattered on the abdomen.
DERMOSCOPIC APPEARANCE Dermoscopy found a netlike distribution of pigmented skin lesions consisting of pigmented stripes with fine scales (Fig 2, A and B).
Fig 2. Pityriasis versicolor (PV). A, Dermoscopic examination of the pigmented lesions found a pigmented network composed of pigmented stripes. B, The fine scales were adhered to the hyperpigmented skin. From the Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University. Funding sources: None. Conflicts of interest: None declared. Reprints not available from the authors. Correspondence to: Prof. Mu-kai Chen, MD, Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen
University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China. E-mail: [email protected]. J Am Acad Dermatol 2015;73:e205-6. 0190-9622/$36.00 ª 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.08.058
e205
e206 Zhou et al
J AM ACAD DERMATOL
DECEMBER 2015
HISTOLOGIC DIAGNOSIS Histologic evaluation (Fig 3, A and B) found multiple roundish spores and short nonbranching hyphae in the stratum corneum. The following microscopic examination found numerous short hyphae and spores with a ‘‘spaghetti-and-meatball’’ appearance on a potassium hydroxide preparation of skin scrapings, confirming the diagnosis of pityriasis versicolor (PV).
Fig 3. Pityriasis versicolor. A, Histologic examination of the pigmented skin found multiple roundish spores with short hyphae of Malassezia in the horny layer and increased numbers of melanophages in the superficial dermis. B, Multiple roundish spores and short nonbranching hyphae in the stratum corneum. (A, Hematoxylin-eosin stain; original magnification: 3400; B, Periodic Acid-Schiff stain; original magnification: 3400.)
KEY MESSAGE PV can be diagnosed by its characteristic skin lesions (finely scaling, thin patches) and the spaghetti-and-meatball appearance of fungal forms.1 However, the fine scale on the affected skin of PV is not easily seen.2 Sometimes it becomes more apparent only when the skin is scraped. As suggested by our case, the fine scale on the involved skin can be readily observed by dermoscopy without the need of scratch, and the presence of fine scaling overlying the pigmented lesions prompts clinicians to distinguish this form of skin hyperpigmentation from other causes of cutaneous hyperpigmentation by the microscopic examination of skin flakes, which can then prevent unnecessary invasive procedures, such as biopsy. Dermoscopy may be an auxiliary tool for the diagnosis of PV.
REFERENCES 1. Pedrosa AF, Lisboa C, Goncalves RA. Malassezia infections: a medical conundrum. J Am Acad Dermatol. 2014;71:170-176. 2. Renati S, Cukras A, Bigby M. Pityriasis versicolor. BMJ. 2015;350:h1394.