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

Abstract

Dermoscopic patterns of inflammatory dermatoses (inflammoscopy) have been extensively studied in the recent years, though data on patients with darker phototypes (IV-VI) are sparse. The aims of this systematic review were to summarize the current state of knowledge on inflammoscopy applied to skin of color and provide a standardized nomenclature of reported findings. Besides dermoscopic features, type of setting and magnification, number of cases, and histopathological correlation were analyzed. Eighty-five papers addressing 76 different dermatoses (25 papulosquamous dermatoses, 19 hyperpigmented dermatoses, seven hypopigmented dermatoses, four granulomatous dermatoses, two sclerotic dermatoses, five facial inflammatory dermatoses, and 14 miscellaneous conditions) for a total of 2073 instances were retrieved. Only one study showed a level of evidence of III (cross-sectional study), whereas 10 and 74 displayed a level of evidence of IV (case-control studies) and V (case-series and case-reports), respectively. Moreover, our analysis also highlighted that most of papers focalized on a limited number of dermatoses, with several conditions having only single dermoscopic descriptions. Additionally, few studies compared findings among phototypes belonging to the “skin of color” spectrum. Further studies designed according to a systematic approach and considering the above-mentioned issues are therefore needed.

Dermoscopy in Skin of Color: The Journey So Far

“…lability of pigment and tendency to follicular or sclerotic reactions) [ 5 ]. However, literature evidence on dark phototypes is still limited (<3% of all published papers on dermoscopy) and sparse [ 6 – 9 ].…”

“…This special issue of Dermatology Practical & Conceptual (DPC) provides the readers with an up-to-date literature overview about the use of dermoscopy in dark skin. 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 ].…”

“…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 ].…”

“…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 ]. Figure 1 depicts clinical subcategories of described dermatoses for each field (inflammatory, infectious, hair and neoplastic disorders), with the following conditions being the most represented ones: (I) papulosquamous and pigmentary dermatoses; (II) parasitoses (including bites and stings), bacterial and fungal diseases; (III) adnexal, keratinocytic and vascular tumors; and (IV) cicatricial and non-cicatricial alopecias [ 6 – 9 ].…”

“…Moving to the temporal distribution of published articles ( Figure 2 ), while a more stable publication ratio per year was observed over the time for both hair diseases and tumors, the number of articles on inflammatory and infectious dermatoses showed a remarkable leap over the last few years, with most papers being published during the last six years [ 6 – 9 ]. Regarding the number of newly described diseases ( Figure 3 ), a significant increase was found in recent times, with peaks in 2017 and 2021 for tumors, in 2019 for infectious dermatoses, and in 2020 for inflammatory disorders [ 6 – 9 ]. This is due to the increase of the absolute number of articles during such years but also to the publication of more comprehensive studies including a wider number of entities, such as the multicentric controlled study on dermoscopy in general dermatology promoted by the IDS in 2020 [ 5 ].…”