Granulomatous skin disease

From dermoscopedia

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 Authored by: Sabine Ludwig     ·  Aimilios Lallas

 Keywords:   granulomatous
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Author(s) Sabine Ludwig · Aimilios Lallas
Owner Aimilios Lallas→ send e-mail
Status released
Status update July 11, 2017
Status by Ralph P. Braun
Subchapter(s): 

Sarcoidosis and lupus vulgaris

Cutaneous leishmaniosis

Granuloma annulare
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GranulomatousThis glossary term has not yet been described. skin diseases

In dermoscopyDermoscopy is a non invasive diagnostic method., the presence of orange-yellowish globules or areas and linear vesselsLinear mildly curved vessels considered irregular when different sizes shapes and curves with a haphazard or random distribution are presented and considered regular when short and fine (thin) linear vessels prevail various diagnoses are highly suggestive of dermal granulomas and therefore easily allows the diagnosisThis glossary term has not yet been described. of granulomatousThis glossary term has not yet been described. skin diseases. However, their differential diagnosis remains challenging due to identical dermoscopic presentation produced by several causes. Notably, the plaque form of cutaneous sarcoidosisThis glossary term has not yet been described. may resemble necrobiosis lipoidica.[1][2] The longer and more branching telangiectasias of necrobiosis lipoidica, caused by atrophic changes not present in cutaneous sarcoidosis, were reported to be an important feature for discrimination from other granulomatous diseases.[3][4]

SarcoidosisThis glossary term has not yet been described. and lupus vulgarisThis glossary term has not yet been described.

In sarcoidosis [1] and lupus vulgaris[5], orange-yellowish translucent globular-like or structureless areas in combination with linear vessels have been described, which are suggested to correspond to the underlying granulomas.

Cutaneous leishmaniasis

In cutaneous leishmaniasis, dermoscopy reveals generalized erythema, yellow tears (follicular plugs), hyperkeratosis and central erosion/ulceration. The characteristic translucent orange-yellowish colorColor (American English) or colour (Commonwealth English) is the characteristic of human visual perception described through color categories, with names such as red, yellow, purple, or blue. of sarcoidosis may additionally be present.[6]

Granuloma annulareThis glossary term has not yet been described.

Granuloma anulare may reveal a high variability of dermoscopic findings. VesselsThis glossary term has not yet been described. may be dotted, short linear or linear arborizing, while background color displays various combinations of red, white and yellow. In certain cases, pigmented structures may be detected. The observation that granuloma anulare rarely exhibits features of other granulomatous skin diseases, such as necrobiosis lipoidica or sarcoidosis, might help clinicians rule out the latter conditions.[4]

Necrobiosis lipoidica

Necrobiosis lipoidica exhibits a characteristic and repetitive pattern, typified by a prominent network of linear arborizing vesselsanalytic term is branched vessels; Bright red sharply in focus large or thick diameter vessels dividing into smaller vessels; BCC and a yellow background color. The prominent vascular network of necrobiosis lipoidica represent the most valuable feature for differential diagnosis from other granulomatous diseases.[7][3] This typical vascular morphologyThis glossary term has not yet been described. should be differentiated from the classical ‘arborizing' vesselsThis glossary term has not yet been described. of nodularThis glossary term has not yet been described.-cystic basal cell carcinomais the most common skin cancer, and one of the most common cancers in the United States.[1] While BCC has a very low metastatic risk, this tumor can cause significant disfigurement by invading surrounding tissues. Classical arborizing vessels usually reveal ramifications into finest capillaries, while vessels in necrobiosis lipoidica exhibit only few diameter variegations and reveal multiple anastomosing ramifications.[4] Ulcerations and yellow crusts represent the most common additional features.[7]
  1. 1.0 1.1 Pellicano et al.: Dermoscopy of cutaneous sarcoidosis. Dermatology (Basel) 2010;221:51-4. PMID: 20375489. DOI.
  2. Bakos et al.: Dermatoscopy of early-onset necrobiosis lipoidica. J. Am. Acad. Dermatol. 2012;66:e143-4. PMID: 22421129. DOI.
  3. 3.0 3.1 Balestri et al.: Dermoscopic subpatterns of granulomatous skin diseases. J. Am. Acad. Dermatol. 2013;69:e217-8. PMID: 24124838. DOI.
  4. 4.0 4.1 4.2 Pellicano et al.: Dermoscopy of necrobiosis lipoidica and granuloma annulare. Dermatology (Basel) 2013;226:319-23. PMID: 23797090. DOI.
  5. Brasiello et al.: Lupus vulgaris: a new look at an old symptom--the lupoma observed with dermoscopy. Dermatology (Basel) 2009;218:172-4. PMID: 19060460. DOI.
  6. Llambrich et al.: Dermoscopy of cutaneous leishmaniasis. Br. J. Dermatol. 2009;160:756-61. PMID: 19120331. DOI.
  7. 7.0 7.1 Bakos et al.: Dermatoscopy of early-onset necrobiosis lipoidica. J. Am. Acad. Dermatol. 2012;66:e143-4. PMID: 22421129. DOI.