Dermatoscopy in vitiligo and pathergy

Dermoscopy in Vitiligo
Reversed Pigmentary Network in evolving lesions of vitiligo. (Image credit Dr sarvesh thatte)
Dermoscopy in Vitiligo
Reversed Pigmentary Network in evolving lesions of vitiligo. (Image credit Dr
sarvesh thatte)

A recent study 1 from India has identified dermoscopic signs of evolving lesions of vitiligo. Authors observed reduced pigmentary network, absent pigmentary network, reversed pigmentary network, perifollicular hyperpigmentation and perilesional hyperpigmentation in the evolving vitigo lesions; a white glow was present in 27 (90%) of 30 patients. It is interesting to note that reversed pigmentary network, a well-known finding in dermatoscopy of melanoma and melanocytic nevus was also noted in many cases of evolving vitiligo. The authors conclude that dermoscopy scores over routine histopathology in the diagnosis of evolving lesions of vitiligo and can obviate the need for a skin biopsy in doubtful cases.

Skin Pathergy Test (SPT) – hypersensitivity of the skin to minimal trauma – is used as a diagnostic test in Behçet’s Disease with doubtful specificity. It is usually performed over the forearm with a blunt, sterilized needle. This article 2 recommends dermatoscopy for identifying sub-clinical pathergy reaction. The clinical relevance would have been much bigger if dermoscopy could replace biopsy in identifying pathergy. The authors have not clearly established the utility of dermoscopy in SPT. Authors have also mentioned about the significance of Thrombomodulin (TM) in pathergy. Thrombomodulin (TM) is a membrane-bound receptor of thrombin on vascular endothelial cells, which activates protein C and inactivates thrombin. High blood levels of TM were strongly correlated with positive skin pathergy test (SPT), suggesting that this test could be an alternative to the SPT.

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Bell Eapen

Techie Dermatologist, Information Systems Ph.D. candidate, Supporter of Open-Source Software, Machine Learning and AI geek,loves cricket, Canadian wine and beer, skeptical about the worth of Cosmetic Dermatology. [Resume]
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References:

  1. Thatte Sarvesh S, Khopkar Uday S. The utility of dermoscopy in the diagnosis of evolving lesions of vitiligo. Indian journal of dermatology, venereology and leprology 2014;80(6):505-508.
  2. Scherrer Maria A, Castro Lúcia P, Rocha Vanessa B, Pacheco Leonardo. The dermatoscopy in the skin pathergy testing: case series in patients with suspected behçet’s disease. Revista brasileira de reumatologia (english edition) 2014;54(6):494-498.
About Bell Eapen 244 Articles
Techie Dermatologist, Information Systems Ph.D. candidate, Supporter of Open-Source Software, Machine Learning and AI geek, loves cricket, Canadian wine and beer, skeptical about the worth of Cosmetic Dermatology. [Resume]

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