The combined role of clinical, reflectance confocal microscopy and dermoscopy applied to chronic discoid cutaneous lupus and subacutus lupus erythematosus: A case series and literature review

Abstract

Main subtypes of cutaneous lupus erythematosus are represented by acute, subacute cutaneous, intermittent and chronic cutaneous lupus erythematosus. Discoid lupus erythematosus represents the most common phenotype of chronic cutaneous lupus erythematosus. The spectrum of clinical manifestations mirrors that of several and distinct histopathological features. Such variability among different CLE subtypes is also observed at dermoscopy. Dermoscopy is nowadays considered an additional valuable method for skin lesions assessment in general dermatology, following and completing the well-known clinical diagnostic steps, such as medical history and clinical examination. In vivo reflectance confocal microscopy (RCM) is a non-invasive imaging tool able to assess the epidermis and upper dermis producing high resolution (horizontal ∼1.25 μm, vertical ∼5 μm), en face tissue sections used for melanocytic and inflammatory evaluation. In this study, we reported dermoscopic and RCM features about 9 patients affected by subacute and chronic lupus erythematosus retrospectively analyzed.

Dermoscopic Features of Acute, Subacute, Chronic and Intermittent Subtypes of Cutaneous Lupus Erythematosus in Caucasians

“…Nevertheless, it is worth highlighting that many of the reports concerned DLE localized on the scalp, and the anatomical distinctiveness of this location may affect the dermoscopic (trichoscopic) findings [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. In addition, a substantial percentage of studies on the dermoscopy of CLE were conducted in dark-skinned individuals [ 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 20 , 21 ]. Undoubtedly, the skin color may influence the clinical and dermoscopic presentation of many entities.…”

“…Dermoscopic findings reflect epidermal and upper-mid dermal changes and correlate directly to histopathological features [ 6 ]. Of all the clinical subtypes of CLE, the dermoscopic characteristics of CCLE, or in fact DLE, have been studied the most extensively [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. On the other hand, data are scarce in the literature on the dermoscopic findings in ACLE [ 3 , 6 , 7 , 21 ] and SCLE [ 4 , 7 , 22 , 23 ].…”

“…On the other hand, data are scarce in the literature on the dermoscopic findings in ACLE [ 3 , 6 , 7 , 21 ] and SCLE [ 4 , 7 , 22 , 23 ]. Moreover, many of these reports concerned patients with dark skin phototypes (Fitzpatrick phototype III—V), and it remains unknown whether the results can be directly applied to the white population [ 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 20 , 21 ]. To the best of our knowledge, there are no reports in the English literature on the dermoscopic characteristics of LET.…”

Application of reflectance confocal microscopy in the diagnosis of pemphigus vulgaris and pemphigus foliaceus

“…Obecnie refleksyjna mikroskopia konfokalna wykorzystywana jest przede wszystkim w diagnostyce melanocytowych i niemelanocytowych nowotworów skóry [4][5][6][7]. Ponadto istnieją również coraz liczniejsze publikacje dotyczące zastosowania RCM w diagnostyce chorób zapalnych, takich jak alergiczne kontaktowe zapalenie skóry, łuszczyca [8], ogniskowy toczeń rumieniowaty [9] oraz podostry toczeń rumieniowaty [10]. Ostatnio opublikowano także liczne artykuły na temat możliwości zastosowania RCM w diagnostyce pęcherzycy [11,12].…”

Machine Learning Based Prediction of Squamous Cell Carcinoma in Ex Vivo Confocal Laser Scanning Microscopy

“…In addition, the lately introduced digital staining (DS) software can effectively simulate the conventional hematoxylin and eosin (H&E) staining that most dermatopathologists are trained to interpret [ 17 , 18 ]. Ex vivo CLSM shall be distinguished from its in vivo counterpart, which is based on a single near-infrared laser source and is used in the daily practice for bedside, non-invasive and painless diagnosis of cutaneous malignancies and several skin diseases, from mite infestations to lupus [ 19 , 20 , 21 ]. Its images are displayed as grey scale and in horizontal section, so that their comparison to vertical histological sections requires a dedicated training [ 22 , 23 ].…”