Use of Ultraviolet-Induced Fluorescence Dermoscopy Provides Complementary Benefit

Ron GoldbergMarch 7, 2024

Ultraviolet-induced fluorescence (UVF) dermoscopy improved recognition of non-neoplastic dermatoses and its use should complement polarized light-based dermoscopy in general dermatology diagnostics, according to study results published in the Journal of the European Academy of Dermatology & Venerology.

Researchers of this multicenter retrospective study sought to assess the diagnostic accuracy of UVF vs polarized-light-based dermoscopy in patients with clinically similar non-neoplastic conditions. Outcomes of interest included polarized and UVF dermoscopic findings, as well as comparative analysis and accuracy data. The Fisher's exact and Fisher-Freeman-Halton tests were used to comparatively analyze clinically similar dermatoses for both UVF and polarized light-based dermoscopic findings.

The study involved 5 dermatology centers and comprised a total of 208 patients (mean age, 46.9 years; men, 53.37%) with common non-neoplastic dermatoses (infectious or inflammatory). Eligibility criteria included a diagnosis based on the diagnostic gold standard (microbiologic evaluation, histologic examination, or typical clinical pattern/course) and the availability of dermoscopic images of the target lesion magnified by a factor of 10 under both polarized and UV light. The images were randomly evaluated by 2 independent investigators who were blinded to the associated clinical data and definitive diagnoses.

Patients were grouped according to 5 clinical morphological patterns: foot intertrigo (n=31), intertrigo of major creases (n=57), papulosquamous dermatoses (n=46), hypopigmented macular dermatoses of the trunk (n=45), and acne (n=16) vs Malasseziafolliculitis (n=13). A control group was included to validate dermoscopic clues.

Further investigations aiming at comparing the use of the 2 techniques alone and in combination are required to validate our retrospective findings.

Significant UVF was observed in several conditions:

• Foot intertrigo: green fluorescence for Pseudomonas (P <.001), red fluorescence for Corynebacterium (P <.001), and no fluorescence for dermatophytic infection (P<.001);
• Intertrigo of major creases: red fluorescence for psoriasis and erythrasma, blue fluorescent concretions along the hair shaft for erythrasma (P <.001), and no fluorescence for candidiasis and tinea infection (P <.001);
• Papulosquamous dermatoses: red fluorescence (in 57.1% of patients) for psoriasis (P <.001);
• Hypopigmented macular dermatoses of the trunk: lack of fluorescence for idiopathic guttate hypomelanosis and vitiligo, light green fluorescence (P =.002), follicular blackout areas (P <.001), and progressive macular hypomelanosis (P<.001) with central follicular red fluorescence for achromic pityriasis versicolor; and
• Acne vs Malassezia folliculitis: follicular blackout areas for acne (P <.001) and blue follicular fluorescence for Malasseziafolliculitis (P <.001).

UVF dermoscopy was related to the most accurate feature in 9 of the 17 analyzed dermatoses: Pseudomonas (green fluorescence), Corynebacterium (red fluorescence), dermatophytic foot intertrigo (no fluorescence), erythrasma (red polygonal fluorescence), candidiasis (no fluorescence), acne (follicular blackout areas), Malassezia folliculitis (blue follicular fluorescence), progressive macular hypomelanosis (central follicular red fluorescence), and achromic pityriasis versicolor (follicular blackout areas). Polarized light-based dermoscopy, on the other hand, was related to the most accurate feature in 8 of the 17 analyzed dermatoses.

Study limitations include the lack of subanalyses considering microbial subtype, duration of lesions, and patient sex and age.

"Further investigations aiming at comparing the use of the 2 techniques alone and in combination are required to validate our retrospective findings," the researchers concluded.

Errichetti E, Pietkiewicz P, Bhat YJ, Salwowska N, Szlązak P, Stinco G. Diagnostic accuracy of ultraviolet-induced fluorescence dermoscopy in non-neoplastic dermatoses (general dermatology): a multicentric retrospective comparative study. J Eur Acad Dermatol Venereol. Published online January 30, 2024. doi:10.1111/jdv.19795

Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

Please excuse the shortness of this message, as it has been sent from
a mobile device.