Dermoscopic Features of Follicular Dermatoses: A Cross-Sectional Study

Rinni R Patel; Hita H Mehta; Manal D Dave

doi:10.5826/dpc.1601a5775

Dermoscopic Features of Follicular Dermatoses: A Cross-Sectional Study

Authors

Rinni R Patel Department of Dermatology, Venereology and Leprosy, Government Medical College, Bhavnagar, India
Hita H Mehta Department of Dermatology, Venereology and Leprosy, Government Medical College, Bhavnagar, India
Manal D Dave Department of Dermatology, Venereology and Leprosy, Government Medical College, Bhavnagar, India

Keywords:

follicular dermatoses, Dermoscopy

Abstract

Introduction: Follicular dermatoses are conditions characterized by localization around hair follicles, often presenting as small papular lesions. These dermatoses can be challenging to diagnose with the naked eye, making dermoscopy an important adjunctive diagnostic tool. However, the literature on the dermoscopic features of follicular dermatoses remains limited.

Objectives: To evaluate dermoscopic findings in follicular dermatoses.

Methods: This cross-sectional study was conducted from November 2022 to January 2024 at the dermatology department of a tertiary hospital. Patients were categorized into inflammatory and keratinization follicular dermatosis. A fully developed lesion was dermoscopically examined using a DermLite DL-5 dermoscope. The data were statistically analyzed.

Results: We studied 147 patients. Most follicular dermatoses on dermoscopy showed classical findings such as keratotic plugs, perifollicular white halo, or brown halo. However, they also exhibited characteristic features unique to each dermatoses. Keratosis pilaris exhibited coiled hair (77.41%). Reactive perforating collagenosis presented a central yellowish plug (100%), whitish rim (100%), and peripheral erythematous halo (87.5%). Follicular LP showed reduced follicular ostia (45.45%) and blue-gray globules (40.90%), with newer findings like radial white stria and rosette. Follicular psoriasis displayed regular red dots (100%), while follicular eczema showed red globules (50%) and irregular red dots (16.7%). Acne keloidalis nuchae exhibited radial white streaks (62.5%), perifollicular white globules (50%), V-shaped hair (50%), and radial linear vessels (18.75%). Darier disease showed central hyperpigmented and white keratotic plugs, comedo-like openings, and interfollicular exaggerated pseudo-pigment areas.

Conclusion: Our study highlights that each follicular dermatosis presents specific dermoscopic patterns, supporting dermoscopy as a useful, noninvasive tool for differentiation that can complement histopathology.

References

Kumar P, Ravindra, Malkud, Shashikant. Clinico-histopathological correlation of follicular skin lesions. IP Indian J. Clin. Exp. Dermatol, 2019, 5.4. DOI:10.18231/j.ijced.2019.046.

Sacchidanand S, Savitha AS, Shilpa K, Shashi Kumar BM, editors. IADVL Textbook of Dermatology. 5th ed. Mumbai: Bhalani Publishing House; 2022.

Bolognia JL, Schaffer JV, Cerroni L, editors. Dermatology. 4th ed. Philadelphia: Elsevier; 2018.

Gangadhar, Meghana, Adya, Keshavmurthy A, Inamdar, Arun C. A study of clinical, dermoscopic and histopathological correlation in follicular keratotic diseases: Preliminary observations in 30 cases. Indian Dermatol. Online J., 2021, 12.5: 731. DOI: 10.4103/idoj.IDOJ_96_21 PMID: 34667761.

Behera B, Gochhait D, Remya R, Resmi MR, Kumari R, Thappa DM. Follicular psoriasis-dermoscopic features at a glance. Indian J. Dermatol. Venereol. Leprol. 2017 Nov 1;83:702. DOI: 10.4103/ijdvl.IJDVL_12_17. PMID: 28984622.

Kumar S, Vinay K, Radotra BD. Dermoscopy of erythrodermic pityriasis rubra pilaris. Indian Dermatol. Online J. 2019 Jul 1;10(4):500-1. DOI: 10.4103/idoj.IDOJ_156_18 PMID: 31334088.

Kaliyadan F, Kuruvilla J, Al Ojail HY, Quadri SA. Clinical and dermoscopic study of pseudofolliculitis of the beard area. Int. J. Trichology. 2016 Jan 1;8(1):40-2. DOI: 10.4103/0974-7753.179385 PMID: 27127378.

Silva-Hirschberg C, Cabrera R, Rollán MP, Castro A. Darier disease: the use of dermoscopy in monitoring acitretin treatment. An. Bras. Dermatol.. 2022 Sep 30;97(5):644-7. DOI: 10.1016/j.abd.2021.05.021 PMID: 35853773.

Sardana K. Follicular disorders of the face. Clinics in Dermatology. 2014 Nov 1;32(6):839-72. DOI: 10.1016/j.clindermatol.2014.02.024 PMID: 25441478.

Ogunbiyi A. Pseudofolliculitis barbae; current treatment options. Clinical, cosmetic and investigational dermatology. 2019 Apr 16:241-7. DOI: 10.2147/CCID.S149250 PMID: 31354326.

Kittisak P, Tanaka M. Dermoscopic findings in a case of reactive perforating collagenosis. Dermatology Practical &Conceptual. 2015 Apr;5(2):75. DOI: 10.5826/dpc.0804a11.

Ozbagcivan O, Lebe B, Fetil E. Dermoscopic pattern of Kyrle's disease. An. Bras. Dermatol.. 2020 Mar 1;95(2):244-6. DOI: 10.1016/j.abd.2019.07.007 PMID: 32146011.

Al‐Saif FM, Baqays AA, AlSaif HF, Alhumidi AA. Erythromelanosis follicularis faciei et colli with reticulated hyperpigmentation of the extremities. Clin. Case Rep. 2017 Oct;5(10):1576. DOI: 10.1002/ccr3.1095 PMID: 29026548.

Behera B, Thappa DM, Chandrashekar L. Floret or pseudo rosette appearance under nonpolarized contact dermoscopy. J Am Acad Dermatol. 2016 Sep 1;75(3):e95-6. DOI: 10.1016/j.jaad.2016.02.1144 PMID: 27543243.

Verheyden MJ, Howard V, Gupta M. Phrynoderma: an under‐recognized condition reflecting nutritional deficiency. Med J Aust. 2024 Jul 15. DOI: 10.5694/mja2.52362.

Thomas M, Khopkar US. Keratosis pilaris revisited: is it more than just a follicular keratosis? Int. J. Trichology. 2012 Oct 1;4(4):255-8. DOI: 10.4103/0974-7753.111215 PMID: 23766609.

Sonthalia S, Bhatia J, Thomas M. Dermoscopy of keratosis pilaris. Indian Dermatol. Online J. 2019 Sep 1;10(5):613-4. DOI: 10.4103/idoj.IDOJ_279_18 PMID: 31544095.

Ismail S, Omar SS. Clinical and dermoscopic evaluation of fractional carbon dioxide laser in management of keratosis pilaris in Egyptian type skin. J Cosmet Dermatol. 2020 May;19(5):1110-20. DOI: 10.1111/jocd.13140 PMID: 31523919.

Rather S, Shah AA, Shah FY. Dermoscopy as a noninvasive diagnostic modality in erythromelanosis follicularis faciei et colli: a case series. Dermatol. Pract. Concept. 2021 Mar;11(2). DOI: 10.5826/dpc.1102a20.

Maouni S, El Anzi O, Sqalli A, Znati K, Meziane M, Hassam B. Erythromelanosis follicularis faciei et colli: dermoscopy and dermatopathology correlates. JAAD Case Rep. 2019 Jun;5(6):535. DOI: 10.1016/j.jdcr.2019.04.011 PMID: 31205998.

Ormerod E, Atwan A, Intzedy L, Stone N. Dermoscopy features of acquired reactive perforating collagenosis: a case series. Dermatol. Pract. Concept. 2018 Oct;8(4):303. DOI: 10.5826/dpc.0804a11 PMID: 30479861.

Horn G, Siebel MD, Facci DS. Clinical and dermoscopic correlation of reactive perforating collagenosis. Surg Cosmet Dermatol. 2016;8:61-3. DOI:10.5935/scd1984-8773.201681746.

Matsunaga AM, Tortelly VD, Machado CJ, Pedrosa LR, Melo DF. High frequency of obesity in acne keloidalis nuchae patients: a hypothesis from a Brazilian study. Skin Appendage Disord. 2020 Nov 13;6(6):374-8. DOI: 10.1159/000509203 PMID: 33313055.

Chouk C, Litaiem N, Jones M, Zeglaoui F. Acne keloidalis nuchae: clinical and dermoscopic features. BMJ Case Rep. 2017 Sep 22;2017:bcr-2017. DOI: 10.1136/bcr-2017-222222 PMID: 28942416.

Estrada BD, Tamler C, Sodré CT, Barcaui CB, Pereira FB. Dermoscopy patterns of cicatricial alopecia resulting from discoid lupus erythematosus and lichen planopilaris. An. Bras. Dermatol. 2010;85:179-83. DOI: 10.1590/s0365-05962010000200008 PMID: 20520933.

Nirmal B, George R, Kodiatte TA. Invisible lichen planopilaris unmasked by dermatoscopy. Int. J. Trichology. 2017 Apr 1;9(2):76-8. DOI: 10.4103/ijt.ijt_81_16 PMID: 28839393.

Durdu M, Errichetti E, Eskiocak AH, Ilkit M. High accuracy of recognition of common forms of folliculitis by dermoscopy: An observational study. J Am Acad Dermatol. 2019 Aug 1;81(2):463-71. DOI: 10.1016/j.jaad.2019.03.054 PMID: 30914342.

Lallas A, Apalla Z, Karteridou A, Lefaki I. Photoletter to the editor: dermoscopy for discriminating between pityriasis rubra pilaris and psoriasis. Journal of Dermatological Case Reports. 2013 Mar 3;7(1):20. DOI: 10.3315/jdcr.2013.1131 PMID: 23580911.

Jha AK, Lallas A, Sonthalia S, Jhakar D, Udayan UK, Chaudhary RK. Differentiation of pityriasis rubra pilaris from plaque psoriasis by dermoscopy. Dermatol. Pract. Concept. 2018 Oct;8(4):299. DOI: 10.5826/dpc.0804a10 PMID: 30479860.

Adya KA, Inamadar AC, Palit A. Dermoscopy of localized darier's disease in fitzpatrick type IV skin. Indian Dermatol. Online J.. 2020 Mar 1;11(2):298-300. DOI: 10.4103/idoj.IDOJ_412_18 PMID: 32478011.

Al Rudaisat MA, Cheng H. Dermoscopy features of cutaneous warts. International Journal of General Medicine. 2021 Dec 16:9903-12. DOI: 10.2147/IJGM.S335276 PMID: 34938109.

Lacarrubba F, Verzì AE, Errichetti E, Stinco G, Micali G. Darier disease: Dermoscopy, confocal microscopy, and histologic correlations. J Am Acad Dermatol. 2015 Sep 1;73(3):e97-9. DOI: 10.1016/j.jaad.2015.04.066 PMID: 26282823.

Kansal NK, Vasisht S, Bhatia R. Dermoscopic features of lichen nitidus. BMJ Case Reports CP. 2024 Apr 1;17(4):e259998.