Granulomatous skin disease

From dermoscopedia

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 Editor: Aimilios Lallas

 Author(s): Sabine Ludwig     ·  Aimilios Lallas
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Author(s) Sabine Ludwig · Aimilios Lallas
Responsible author Aimilios Lallas→ send e-mail
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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 dermoscopyThe examination of [skin lesions] with a 'dermatoscope'. This traditionally consists of a magnifier (typically x10), a non-polarised light source, a transparent plate and a liquid medium between the instrument and the skin, and allows inspection of skin lesions unobstructed by skin surface reflections. Modern dermatoscopes dispense with the use of liquid medium and instead use polarised light to cancel out skin surface reflections., 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 diagnosisis the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines with variations in the use of logic, analytics, and experience to determine "cause and effect". In systems engineering and computer science, it is typically used to determine the causes of symptoms, mitigations, and solutions of granulomatousThis glossary term has not yet been described. skin diseases. However, their differential diagnosis remains challenging due to identical dermoscopic presentationThis glossary term has not yet been described. 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 combinationThis glossary term has not yet been described. 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 color 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 structuresThis glossary term has not yet been described. may be detected. The observation that granuloma anulare rarely exhibits features of other granulomatous skin diseases, such as necrobiosis lipoidica or sarcoidosis, might helpRefers to giving assistance or support to others for mutual benefit clinicians rule out the latter conditions.[4]

Necrobiosis lipoidica

Necrobiosis lipoidica exhibits a characteristic and repetitive pattern, typified by a prominent networkThis glossary term has not yet been described. 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 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.. 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.