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| LETTER TO EDITOR |
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| Year : 2020 | Volume
: 7
| Issue : 2 | Page : 102-103 |
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Dermoscopy of actinic keratosis in skin of color
Yasmeen Jabeen Bhat1, Safia Bashir1, Rohi Wani2, Najamu Saqib1
1 Department of Dermatology, Government Medical College, Srinagar, Jammu and Kashmir, India
2 Department of Pathology, Government Medical College, Srinagar, Jammu and Kashmir, India
| Date of Submission | 25-Aug-2020 |
| Date of Decision | 18-Sep-2020 |
| Date of Acceptance | 03-Oct-2020 |
| Date of Web Publication | 22-Dec-2020 |
Correspondence Address:
Yasmeen Jabeen Bhat
Department of Dermatology, Government Medical College, Srinagar, Jammu and Kashmir
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijdpdd.ijdpdd_98_20
How to cite this article:
Bhat YJ, Bashir S, Wani R, Saqib N. Dermoscopy of actinic keratosis in skin of color. Indian J Dermatopathol Diagn Dermatol 2020;7:102-3 |
How to cite this URL:
Bhat YJ, Bashir S, Wani R, Saqib N. Dermoscopy of actinic keratosis in skin of color. Indian J Dermatopathol Diagn Dermatol [serial online] 2020 [cited 2021 Jun 19];7:102-3. Available from: https://www.ijdpdd.com/text.asp?2020/7/2/102/304344 |
Sir,
Two female patients previously diagnosed with xeroderma pigmentosum presented to our department with photosensitivity, xerosis, and freckle-like pigmentation on the sun exposed areas. In addition, multiple asymptomatic, scaly, erythematous to hyperpigmented macules with a rough surface were present on the face in both cases [Figure 1] and [Figure 2]. | Figure 1: Diffuse freckling with multiple erythematous to hyperpigmented macules over face. Blue arrow shows the lesion scoped
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 | Figure 2: Multiple, hyperpigmented, scaly lesions over face. Blue arrow shows the lesion scoped
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Dermoscopy of the lesions in the first patient, with Fitzpatrick skin type IV, revealed discrete whitish veil with asymmetric pigmented dots and coiled vessels around the dilated follicles [Figure 3]. In the second patient, with Fitzpatrick skin type III, crusts and scales were noted. Furthermore, asymmetric pigmented clods around dilated hair follicles with vessels surrounding them, erythematous background intermingled by white to yellow, keratotic, and enlarged follicular openings was seen [Figure 4] and [Figure 5]. Histopathology of the lesions was consistent with actinic keratosis [Figure 6]. | Figure 3: Discrete whitish veil (yellow arrow), surface scales (green arrow), pigmented pseudonetwork with asymmetric dots and faint coiled vessels around the dilated follicles (blue arrow) (Polarized mode, Dermlite DL3N, California USA, ×10)
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 | Figure 4: Pigmented pseudonetwork with asymmetric pigmented clods around dilated hair follicles (yellow arrow) with vessels surrounding them (blue arrow). Strawberry appearance-Erythematous background intermingled with white to yellow, keratotic, and enlarged follicular openings and surface scales (green arrow) are seen (Polarized mode, Dermlite DL3N, California USA, ×10)
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 | Figure 5: Higher magnification showing erythematous background (blue arrows) with dilated follicles (yellow arrows) surrounded by a white rosette (green arrows) and pigmented dots and granules (white arrows) in asymmetrical pattern around follicular openings (Polarized mode, Dinolite ×75)
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 | Figure 6: Photomicrograph showing parakeratosis, acanthosis, and basal cell atypia (blue arrow) (H and E, ×100)
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Actinic keratosis is an ultraviolet light-induced cutaneous lesion that has a tendency to progress to invasive squamous cell carcinoma. It is the most common premalignant lesion to arise on the skin.[1] Actinic keratosis results from atypical keratinocyte proliferation chiefly in the areas of chronic sun exposure in adults and elderly with fair skin. It is estimated that 0.1%–10% of actinic keratosis may subsequently progress to cutaneous squamous cell carcinoma.[2] Clinically, actinic keratosis appears as erythematous, skin colored or pigmented, scaly lesions with a rough, sandpaper like texture and are often easier to feel than to see. Dermoscopy of actinic keratosis is largely well-known, especially in fair-skinned individuals. However, in skin of color, the entity seems to be underdiagnosed. On dermoscopy, a typical feature of actinic keratosis is the “strawberry pattern” characterized by a background erythema with unfocussed, large vessels located between hair follicles associated with prominent follicular openings surrounded by a white halo.[3] In dark skin, the vessels may not be prominent; hence, the typical strawberry pattern cannot be seen. Pigmented actinic keratosis demonstrates slate gray to brown dots and globules around follicular ostia and annular granular and rhomboid structures[4] and needs to be differentiated from lentigo maligna melanoma. Typical dermoscopic signs like inner gray halo (highly sensitive and specific for pigmented actinic keratosis), rhomboidal pattern and jelly sign (superficial pigmentation extending like a liquid around follicular openings) appear to be more common in fair-skinned individuals and may not be appreciated well in the skin of color.[5]
Clinical diagnosis of actinic keratosis is often difficult, and thus dermoscopy can be a useful aid to the same. Furthermore, for larger facial lesions, dermoscopy may be useful to determine the most suspicious area to be biopsied.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Frost CA, Green AC. Epidemiology of solar keratosis.Br J Dermatol 1994;131:455-64.  |
| 2. | Glogau RG. The risk of progression to invasive disease. J Am Acad Dermatol 2000;42:23-4. |
| 3. | Peris K, Micantonio T, Piccolo D, Fargnoli MC. Dermoscopic features of actinic keratosis. J Dtsch Dermatol Ges 2007;5:970-6. |
| 4. | Akay BN, Kocyigit P, Heper AO, Erdem C. Dermatoscopy of flat pigmented facial lesions: Diagnostic challenge between pigmented actinic keratosis and lentigo maligna. Br J Dermatol 2010;163:1212-7. |
| 5. | Kelati A, Baybay H, Moscarella E, Argenziano G, Gallouj S, Mernissi FZ. Dermoscopy of pigmented actinic keratosis of the face: A study of 232 cases. Actas Dermosifiliogr 2017;108:844-51. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
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