Dermoscopy of Infectious Dermatoses (Infectiouscopy) in Skin of Color—A Systematic Review by the International Dermoscopy Society “Imaging in Skin of Color” Task Force

Abstract

Dermoscopy has been showed to facilitate the non-invasive recognition of several infectious disorders (infectiouscopy) thanks to the detection of peculiar clues. Although most of the knowledge on this topic comes from studies involving light-skinned patients, there is growing evidence about its use also in dark phototypes. This systematic literature review summarizes published data on dermoscopy of parasitic, bacterial, viral and fungal dermatoses (dermoscopic findings, used setting, pathological correlation, and level of evidence of studies) and provides a homogeneous terminology of reported dermoscopic features according to a standardized methodology. A total of 66 papers addressing 41 different dermatoses (14 bacterial, 5 viral, 11 fungal infections, and 11 parasitoses/bites and stings) and involving a total of 1096 instances were included in the analysis. The majority of them displayed a level of evidence of V (44 single case reports and 21 case series), with only 1 study showing a level of evidence of IV (case-control analysis). Moreover, our analysis also highlighted a high variability in the terminology used in the retrieved studies. Thus, although promising, further studies designed according to a systematic and standardized approach are needed for better characterization of dermoscopy of infectious skin infections.

Dermoscopy in Skin of Color: The Journey So Far

“…Most of included data comes from four systematic reviews (one each for inflammatory, infectious, neoplastic and hair diseases) by the “Imaging in Skin of Color” Task Force of the International Dermoscopy Society (IDS) [ 6 – 9 ], that has recently been created. Inflammatory and infectious dermatoses turned out to have the highest number of published articles (85 and 66, respectively), encompassing a total of 78 and 41 different conditions, likely as the result of the wider number of entities in these fields and their high prevalence in dark-skinned populations [ 6 , 7 ]. Interestingly, trichoscopy showed the highest ratio between published studies and number of diseases (60 and 19, respectively) with consequent more data on reproducibility of the findings [ 8 ], unlike skin tumors that were investigated by a limited number of studies (20 for a total of 46 neoplasms) possibly due to their lower prevalence in skin of color [ 9 ].…”

“…Finally, a poor consistency of used terminology among the studies was also highlighted, especially for infectious/inflammatory dermatoses and tumors, with consequent limitations in terms of reproducibility of described findings [ 6 , 7 , 9 ]. To deal with such an issue, an alignment of dermoscopic terminology of reported features following a homogeneous standardized nomenclature was provided in the reviews based on the IDS dermoscopic criteria for tumors and non-neoplastic dermatoses validated for skin of color [ 10 , 11 ]…”