Tropical/Infectoparasitary Dermatology
Digital dermoscopy: a complementary method in the diagnosis of scabies
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(Digital dermoscopy, ×10 with immersion, under polarized light, optical zoom, ×2, and image amplification.)</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Scabies is an ectoparasitosis caused by the mite <span class="elsevierStyleItalic">Sarcoptes scabiei var. hominis</span>, whose transmission occurs through interpersonal contact and occasionally through fomites.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> Clinically, it is characterized by erythematous papules or vesicles and tunnels located in the interdigital spaces, flexor surfaces of the wrists, umbilical region, and flexural areas.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The crusted form is considered a rare presentation; immunodepression and mental and/or motor deficits are the main risk factors.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> It manifests with hyperkeratotic, fissured, crusted, or erythrodermic lesions, variable pruritus, and the presence of millions of mites, being highly contagious.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The diagnosis is usually established based on the clinical picture, but it can be complemented by dermoscopy, videodermoscopy, or confocal microscopy, and is confirmed by direct examination or biopsy.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> The authors report a case of crusted scabies with an emphasis on dermoscopic findings.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A female patient, 29 years of age, native Brazilian, presented with erythematous papules and lichenified plaques, some of which were hyperkeratotic, in the acral, flexural, and abdominal regions, associated with mild pruritus for eight months (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Dermoscopy was performed with immersion, under polarized light (10×, DermLite DL4, California, United States) of an unscathed lesion on the arm, and the images were captured with a camera (12<span class="elsevierStyleHsp" style=""></span>Mp, iPhone 7, Apple Inc., California, United States) with 2× optical zoom allowing the observation of the millipede-like structures and the hang-glider appearance (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Subsequently, image amplification demonstrated a translucent rounded structure (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Direct examination confirmed the diagnosis of crusted scabies (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) and, after treatment, the patient evolved with resolution of the lesions.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Dermoscopy has been widely reported in recent years as an aid in the diagnosis of scabies. It allows the observation of a brownish triangular structure with a hang-glider appearance, corresponding to the anterior portion of the body and the front legs of the mite, and a tunnel, which can assume a millipede-like conformation.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> In crusted scabies, the literature features reports of a tunnel-over-tunnel pattern, described as a noodle pattern, which corresponds to tunnels dug by various parasites.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Observation of the mite's body is reported when using videodermoscopy.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,8</span></a> In 2016, Cinotti et al. compared 20× and 70× magnifications, and only saw the body of the mite in the latter.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">However, in 2019, Scanni demonstrated this structure through digital dermoscopy, defined as acquisition and storage of images obtained by dermoscopy.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> That author associated dermoscopy (10×), optical zoom of the camera (3–5×), and image amplification, and demonstrated some structures that make up what he defined as “the mite-gallery unit.”<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> This unit consists of the head, which corresponds to the mite with the hang-glider structure, the body, which contains the tunnel with eggs and feces, and the tail, the end of the tunnel composed of keratin collars, viewed only with dermoscopy without immersion. Through image amplification, the translucent body of the mite with several scattered dark spots (termed ladybird sign) can also be observed.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> In the present report, using this technique, it was possible to demonstrate the hang-glider appearance, the ovoid body, and the tunnel.</p><p id="par0040" class="elsevierStylePara elsevierViewall">It is known that the observation of the mite body, eggs, and feces is the best with videodermoscopy.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,8</span></a> However, when unavailable, the use of the technique described by Scanni and applied in the present report can allow a more accurate diagnosis of scabies.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors' contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Elaine Dias Melo: Conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Carla Barros da Rocha Ribas: Approval of the final version of the manuscript; elaboration and writing of the manuscript; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the manuscript.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Isabel Cristina Lima Incarnation: Approval of the final version of the manuscript; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres1410357" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1290406" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 5 => array:2 [ "identificador" => "xack490831" "titulo" => "Acknowledgements" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-08-09" "fechaAceptado" => "2019-11-30" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1290406" "palabras" => array:3 [ 0 => "Dermoscopy" 1 => "Diagnosis by image" 2 => "Scabies" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Scabies is an ectoparasitosis caused by <span class="elsevierStyleItalic">Sarcoptes scabiei var. hominis</span>, characterized clinically by pruritic lesions in typical locations; the crusted form is a rare manifestation. The diagnosis is usually established based on the clinical picture, but dermoscopy can be an important complementary method, as it allows the observation of a brownish triangular structure with a hang-glider appearance. A case of crusted scabies is reported; the magnification of the images obtained by digital dermoscopy allowed the demonstration of a structure usually observed only with videodermoscopy.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Melo ED, Ribas CBR, Encarnação ICL. Digital dermoscopy: a complementary method in the diagnosis of scabies. An Bras Dermatol. 2020. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.abd.2019.11.014">https://doi.org/10.1016/j.abd.2019.11.014</span></p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brasil.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 793 "Ancho" => 2083 "Tamanyo" => 237368 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Erythematous papules and lichenified plaques, some hyperkeratotic, located mainly on the limbs, flexural areas (A), and abdomen (B).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1125 "Ancho" => 1500 "Tamanyo" => 274525 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Demonstration of the structures: (i) hang-glider: anterior portion of the body and front legs of the mite; (ii) millipede-like: scabies tunnel; (iii) rounded translucent: mite body. (Digital dermoscopy, ×10 with immersion, under polarized light and optical zoom, ×2.)</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1240 "Ancho" => 1500 "Tamanyo" => 153656 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Demonstration of the structures: (i) hang-glider: anterior portion of the body and front legs of the mite; (ii) millipede-like: scabies tunnel; (iii) rounded translucent: mite body. (Digital dermoscopy, ×10 with immersion, under polarized light, optical zoom, ×2, and image amplification.)</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1565 "Ancho" => 2083 "Tamanyo" => 473017 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Observation of the mite (a) and eggs (b) in the direct examination (KOH 20%, ×100).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Scabies, crusted (Norwegian) scabies and the diagnosis of mite sensitisation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. 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| Year/Month | Html | Total | |
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