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The skin is the most common organ of involvement during the course of lupus erythematosus (LE). The literature data concerning the dermatoscopic patterns of the different clinical variants of cutaneous LE (CLE), namely chronic (CCLE), subacute (SCLE), and acute (ACLE), are scarce. To determine the dermatoscopic spectrum of CLE and to correlate the dermatoscopic features with the histological findings. This was a retrospective, observational, multicenter, cohort study. We evaluated the dermatoscopic features in a cohort of patients diagnosed with CLE. Furthermore, we investigated their frequency per clinical subtype and correlated them with the anatomic alterations. We included 79 patients. The most prevalent dermatoscopic features of CCLE included follicular plugs (86.4%, P < .01), patchy distribution (75%, P = .1) of mostly linear curved vessels (56.8%, P = .8), white scales (68.2%, P < .01), and structureless white color (68.2%, P < .01). The most common criteria of SCLE were patchy distribution (90%, P = .1) of mostly linear curved vessels (53.3%, P = .8) and fine white scales (60%, P < .01), while ACLE was characterized by erythema (100%, P < .05) and patchy distribution (100%, P = .1) of mostly dotted vessels (60%, P = .4). Follicular plugs/rosettes in dermatoscopy strongly correlated with follicular plugs in histology (rho = 0.919). Hyperkeratosis significantly correlated with white (rho = 0.644) and yellow/brown scales (rho = 0.225), telangiectasia with linear curved vessels (rho = 0.321) and white color with dermal fibrosis (rho = 0.623). Depending on CLE subtype, distinct dermatoscopic patterns are recognized. In CLE there is a high correlation between certain dermatoscopic criteria and the underneath anatomic alteration.

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Background Takotsubo syndrome (TS) is not usually diagnosed until a patient with suspected acute coronary syndrome (ACS) is found to have no hemodynamically significant lesions on coronary angiography (CA). Purpose We explored whether a cardiac biomarker profile can contribute to early diagnosis of TS, which could be useful when CA is either not available or does not provide a definitive diagnosis. Methods Ratios of N-terminal-pro brain natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) [admission and peak levels of the two consecutive days following admission, expressed in pg/mL] were compared in 41 patients with TS and 50 ACS patients. Results Both admission NT-proBNP/cTnT ratio and peak NT-proBNP/peak cTnT ratio were higher in patients with TS compared to those with ACS (38.8±57.1 vs 15.2±33.1, p=0.038 and 29.1±26.2 vs 2.2±3.9, p&lt;0.001, respectively). Only the association of peak NT-proBNP/peak cTnT ratio remained statistically significant after adjustment for age and gender when multiple linear regression analysis was used (R square=0.746, p&lt;0.001). ROC curve analysis of peak NT-proBNP/peak cTnT ratio discriminated patients with TS as opposed to those with ACS (AUC=0.921 with 95% CI: 0.851–0.990, p&lt;0.001). A cut-off value of peak NT-proBNP/peak cTnT ratio &gt;5.5 had a sensitivity of 85%, a specificity of 90% and an accuracy of 88.1% in detecting TS as opposed to ACS. Conclusions Peak NT-proBNP/peak cTnT ratio &gt;5.5 obtained within the first 3 days of admission has a good diagnostic accuracy to identify patients with TS among those presenting with ACS. This could be useful for the early discrimination between the two entities when CA is not easily available, particularly in patients without ST-segment elevation and low or intermediate-risk. Funding Acknowledgement Type of funding sources: None.