All the PP patients (20/20, 100%) showed homogenous uniform red globules on a red background with white scales (Fig. 1e). On comparing these findings in all the examined patients, these findings were found to be highly specific for PP (P<0.0001).
In LP, the disease duration ranged from 6 months to 3 years. All the LP patients (20/20, 100%) showed pinkish homogenous backgrounds with projections of whitish structures of various sizes that corresponded to Wickham striae (Fig. 1h). On comparing these findings in all the examined patients, these findings were found to be highly specific for LP (P<0.0001). Table 2 summarizes the dermoscopic findings of all the patients.
Our results showed that fine short linear vessels and spermatozoa-like blood vessels are highly suggestive of early-stage erythematous MF, which agreed with the results of Lallas et al.4. Moreover, our results showed that light brown multifocal pigmentation and dark globules on a pink homogenous background are highly suggestive of hyperpigmented MF. These features have not been described before. One observation that could be of interest is that the vascular structures were seen more often in recent-onset MF (disease duration ≤2 months) and skin type III, whereas the pigmentary lesions were in older MF lesions and skin type IV patients.
Moreover, our results showed that PP patients showed characteristic homogenous red globules on a reddish background and whitish scales, which agreed with the results of many research groups 6,7. Interestingly, these features were absent in MF, chronic dermatitis, and LP patients.
In contrast, a reddish homogenous background with patchy red dots and globules in the presence of yellowish scales is highly suggestive of chronic dermatitis. This agrees with the results of previous studies 9.
Moreover, the presence of whitish projections was found only in LP. However, we did not detect red lines or red dots in our LP patients as reported in some studies 7. One explanation could be that cutaneous LP may resolve spontaneously and these lesions might be subsiding and therefore may have lost their vascular element.
The limitation of this work is that we had only one poikilodermatous MF patient and therefore we could not compare the dermoscopic features between classic and poikilodermatous MF. Moreover, it would be interesting to compare the dermoscopic features between classic MF and other clinicopathological variants.
Finally, we can conclude that fine short linear vessels, spermatozoa-like vessels, dark globules, and light brown multifocal pigmentation on a pink homogenous background are highly suggestive of MF. Although the dermoscope proved to be useful in distinguishing early-stage MF from other inflammatory mimics, further large-scale studies are needed to confirm the specificity of the current study on dermoscopic features of MF in our Egyptian skin type.
The authors are grateful to Dr Masaru Tanaka (Tokyo Women’s Medical University, Japan) for his valuable discussion.
There are no conflicts of interest.
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