Dermatoscopy of Cutaneous Granulomatous Disorders

Abstract

Cutaneous granulomatous disorders represent diseases with underlying granulomas on histology and are broadly divided into infectious and noninfectious disorders. Although histology is sine qua non in diagnosis of granulomatous disorders, lately dermoscopy has come up as a useful tool assisting in diagnosis of granulomatous disorder. Dermoscopy of granulomatous disorder is characterized by localized or diffuse, structureless yellowish-orange areas, along with vessels. Dermoscopic features of granulomatous disorders can be overlapping among various disorders, but detailed accurate assessment of various findings and their pattern may be useful in differentiating among them. In addition to this, peculiar dermatoscopic findings seen can also prove useful in distinguishing between various disorders. Hereby, we discuss dermatoscopic findings of various granulomatous disorders.

Dermoscopy in the diagnosis and assessment of treatment response in granulomatous cheilitis

“…Dermoscopy of various granulomatous diseases is characterised by a common feature of diffuse or localised yellow-orange areas (corresponding to the diffuse or focal granulomatous infiltration, respectively), commonly with telangiectatic vessels. 2 Similar features were observed in our case, which, in conjunction with the clinical features, prompted a diagnosis of granulomatous cheilitis that was confirmed histologically. Disappearance of the yellow-orange areas is a dermoscopic indicator of disease resolution and/or a good treatment response, which was observed on serial dermoscopic follow-up in our case.…”

Auricular granuloma annulare

“…4 Other dermoscopic features include pigmented structures, whitish scaling, rosettes, and crystalline leaf venations. 4,5 Apart from the common dermoscopic features of granuloma annulare, we observed a special daisy pattern in our patient, which has also been described in chondrodermatitis nodularis helicis. 6 Granuloma annulare localised to the external ear is very rare.…”

“…The common dermoscopic features of granuloma annulare include multiform whitish areas, yellowish-orange structureless areas, and unfocused vessels (dotted, linear and branching) with an evident pinkish-reddish background. 4,5 Whitish areas probably result from collagen degeneration and mucin deposition in dermis, while the granuomatous infiltrate is depicted by yellowish-orange structureless areas. 4 Other dermoscopic features include pigmented structures, whitish scaling, rosettes, and crystalline leaf venations.…”

“…17 The dermoscopic findings comprise a pink or pink and white mixed homogeneous background, reticulate pigmentation, and fewer vessels. 5 Chondrodermatitis nodularis helicis typically presents as a tender round nodule with raised edges with a central ulcer or crust, involving the helix or antihelix. Histopathology reveals epidermal ulceration surrounding acanthosis, orthokeratosis, dermal inflammation and hyalinised eosinophilic material overlying the cartilage.…”

Dermoscopy of Oral Mucosal Lesions

“…Mucoscopic findings of chronic gralunomatous inflammation of lips are similar to other granulomatous cutaneous diseases causing swelling of lips. [ 30 ] However, mucoscopy can be beneficial in differentiating nongranulomatous disorders like amyloidosis, hereditary angioedema, or contact cheilitis.…”