Dermatology Reports 2019; volume 11:7916 Dermoscopy is a new diagnostic One of the commonest complaints in der- tool in diagnosis of common matology clinics is the eruption of macular Correspondence: Khitam Al-Refu, Faculty of or patchy hypopigmented skin lesions. This Medicine, Mutah University, Jordan. hypopigmented macular disease: complaint may be very disturbing to the Tel.: 00962797401149. A descriptive study patient, especially for those with dark skin. E-mail: [email protected] - Some of important hypopigmented macular [email protected] diseases1 are vitiligo, pityriasis alba, extra- Khitam Al-Refu Key words: Dermoscopy; Diagnosis; genital lichen sclerosus, achromic pityriasis Faculty of Medicine, Mutah University, Hypopigmented macules; Vitiligo. versicolor, idiopathic guttate hypome- Jordan lanosis and nevus depigmentosus. Conflict of interest: the author declares no Generally, these disorders share the same potential conflict of interest. patient’s complaint which is characterized Abstract by the presence of hypo or depigmented Funding: none. patches or macules. In this study, the aim One of the most frequent complaints in was to provide an overview on the use of Received for publication: 26 October 2018. dermatology clinics is the eruption of dermoscopy in dermatology by analyzing Revision received: 28 November 2018. hypopigmented patchy skin lesions. The Accepted for publication: 29 November 2018. the dermoscopic features of some of impor- aim of the study was to investigate the util- tant hypopigmented macular diseases. New ity of dermoscopy in common hypopig- This work is licensed under a Creative studies have documented dermoscopic fea- mented macular diseases. Patients with the Commons Attribution-NonCommercial 4.0 tures in vitiligo.10-19 Very few reports docu- International License (CC BY-NC 4.0). followings diseases were examined by der- mented these changes in idiopathic guttate moscopy: vitiligo, pityriasis alba, nevus hypomelanosis20,21 nevus depigmentosus,22-24 ©Copyright K. Al-Refu, 2018 depigmentosus, achromic pityriasis versi- achromic pityriasis versicolor25 and extra- Licensee PAGEPress, Italy color, idiopathic guttate hypomelanosis, and Dermatology Reports 2019; 11:7916 genital lichen sclerosus.26-28 This study extragenital guttate lichen sclerosus. doi:10.4081/dr.2018.7916 investigated 108 patients presented at der- This study showed that these hypopig- only matology clinics during the last three years mented macular diseases might display spe- complaining of hypopigmented and depig- cific dermoscopic features. In vitiligo, the for other hypopigmented skin diseases as mented cutaneous lesions. This current mean dermoscopic features were the pres- the diagnosis was based on clinical back- ence of a diffuse white glow with perifollic- study contained a larger number ofuse cases, ground combined with Wood’s light exami- ular pigment, perilesional hyperpigmenta- aiming to describe the common and uncom- nation and potassium hydroxide (KOH) tion, leukotrichia and the pigmentary net- mon dermoscopic features for the hypopig- scrapping. All of the cases were underwent work. In idiopathic guttate hypomelanosis, mented macular disease; comparing the Wood’s light examination. This was a very findings with the previous reports and doc- the characteristic features were the presence crucial method to confirm the diagnosis of umenting the frequency of them. of multiple, shiny, scaly macules with well- some cases such as vitiligo and pityriasis and ill-defined edges borders that coalesced versicolor. All of the scaly macules and into polycyclic macules. For nevus depig- patches were examined with potassium mentosus, the mean features were hypopig- Materials and Methods hydroxide scrapping. This is a very impor- mented patches with irregular border with a A total of 108 patients were seen at the tant test to confirm the diagnosis of all sus- faint reticular network. For pityriasis alba, dermatology clinics (Mutah University pected cases of pityriasis versicolor. The the fairly ill-demarcated hypopigmented Medical Center) during January 2015 to gently scrapped skin scales were placed macules with fine scales were the mean fea- commercialOctober 2017 complaining of patchy or directly onto a microscope slide and are ture. In lichen sclerosus, there were white macular hypopigmented lesions. Detailed covered with 10% potassium hydroxide, structureless areas, perilesional erythema- and informed consent was taken from the and were left to stand until clear and gently tous halo, follicular plugging and white patients. The sample collection was not heated to speed up the action of KOH. A chrysalis like structures. Dermoscopy of consecutive, as the intention was to investi- dermoscopic examination of all cases was achromic pityriasis versicolorNon showed a gate the patients who were diagnosed with performed using a hand-held dermoscope fairly demarcated white area with fine specific hypopigmented skin diseases. The (Dermlite DL3, Gen, USA) application scales localized in the skin creases. following skin diseases were included in the (10× magnification) with both polarized research: vitiligo, pityriasis alba, nevus and non-polarized lights. iPhone camera depigmentosus, achromic pityriasis versi- was attached to capture images. The dates color, idiopathic guttate hypomelanosis, and and times of capturing photos were auto- Introduction extragenital guttate lichen sclerosus. All of matically stored. The dermoscopic exami- Over the last few years, dermoscopy the cases which were on treatment were nation was done for all cases looking for has been shown to be a helpful tool in the excluded from the study. This was of partic- specific diagnostic finding for each case. diagnosis of many general dermatological ular concern for the cases of vitiligo; the The dermoscopic examination was done disorders.1-7 In addition to its well-docu- patients were on no treatment for three blindly without referring to the clinical or mented value in the diagnosis of skin months prior investigations. A detailed his- histological information. The following tumors and pigmentary melanocytic tory was taken, and dermatological exami- parameters were taken into consideration lesions, dermoscopy is very helpful in nation was done. A histopathological exam- when applying dermoscopy in these dis- assisting the diagnosis of various general ination was done for all cases of idiopathic eases: i) presence of altered pigmentation dermatological disorders, including guttate hypomelanosis and lichen sclerosus within the patch or macule; ii) The edge of scalp/hair diseases,8 nail/ nail-fold abnor- et atrophicus to confirm the diagnosis of the the macules or patch; whether it is fairly malities,9 and inflammatory dermatoses.1 disease. The histology was not performed demarcated or ill-defined; iii) Presence of [Dermatology Reports 2019; 11:7916] [page 1] Article the scales within the lesion or surrounding lesion (28% of lesions). Figure 1 demon- Nevus depigmentosus was one of the skin; iv) Presence of perifollicular pigmen- strates some of these dermoscopic features common differential diagnosis of vitiligo. tation; v) Presence of perilesional reticulat- in vitiligo patients. All of the presented cases in this research ed hyperpigmentation or telangiectasia; vi) Patients with idiopathic guttate were children. Eight cases presented with The color of the hair within the hypopig- hypomelanosis were 11 cases (7 males, four an asymptomatic light patches that had been mented lesions; vii) The morphology/ females). The Average age of the patients first noted in the neonatal period. The arrangement of vascular structures. was 55.3 years with a range of 35 years to patches had been stable in shape, texture, Regarding the pattern or the shape of mac- 80 years. On physical examination, there but increasing in size with age. The mean ules in dermoscopy, there were different were multiple circular hypopigmented mac- age of presentation was 3 years with a range patterns described included:10 trichrome ules of various sizes ranging from 1 to 3 (1.5-12 years). Physical examination for pattern, nebulous pattern, polka dot pattern mm in diameter. The skin was scaly and each patient revealed a single, well-defined, (several depigmented macules), comet tail- showed some features of sun-damage. hypopigmented patch, with a serrated bor- ing of the lesion, amoeboid pattern, and Average disease duration was 6 years. The der. The surrounding skin was normal. petaloid pattern. histopathological findings for skin biopsies Wood’s light examination of the patch from these lesions demonstrated basket- showed an off-white accentuation without wave hyperkeratosis, epidermal atrophy, fluorescence. On dermoscopy (Figure 2B), and flattened rete ridges, and reduction of the hypopigmented patch with an irregular Results melanin pigment and numbers of and serrated boarder was the prominent fea- melanocytes. Dermoscopic features (Figure ture. Some of patches showed faint reticular In this study, 108 patients with the fol- 2A) for these cases were nearly similar in network within them. The borders also lowings diseases were enrolled in the study: all cases and was characterized by the pres- showed pseudopods pattern protruding into vitiligo (48 cases), pityriasis alba (16 ence of multiple, shiny, porcelain-white the normal skin. Hairs within the patches cases), nevus depigmentosus (8 cases), macules with well- and ill-defined edges was of normal colors, and there was no achromic pityriasis versicolor