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fissured&#44; crusted&#44; or erythrodermic lesions&#44; variable pruritus&#44; and the presence of millions of mites&#44; being highly contagious&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The diagnosis is usually established based on the clinical picture&#44; but it can be complemented by dermoscopy&#44; videodermoscopy&#44; or confocal microscopy&#44; and is confirmed by direct examination or biopsy&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> The authors report a case of crusted scabies with an emphasis on dermoscopic findings&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A female patient&#44; 29 years of age&#44; native Brazilian&#44; presented with erythematous papules and lichenified plaques&#44; some of which were hyperkeratotic&#44; in the acral&#44; flexural&#44; and abdominal regions&#44; associated with mild pruritus for eight months &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Dermoscopy was performed with immersion&#44; under polarized light &#40;10&#215;&#44; DermLite DL4&#44; California&#44; United States&#41; of an unscathed lesion on the arm&#44; and the images were captured with a camera &#40;12<span class="elsevierStyleHsp" style=""></span>Mp&#44; iPhone 7&#44; Apple Inc&#46;&#44; California&#44; United States&#41; with 2&#215; optical zoom allowing the observation of the millipede-like structures and the hang-glider appearance &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Subsequently&#44; image amplification demonstrated a translucent rounded structure &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Direct examination confirmed the diagnosis of crusted scabies &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41; and&#44; after treatment&#44; the patient evolved with resolution of the lesions&#46;<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&#46; It allows the observation of a brownish triangular structure with a hang-glider appearance&#44; corresponding to the anterior portion of the body and the front legs of the mite&#44; and a tunnel&#44; which can assume a millipede-like conformation&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> In crusted scabies&#44; the literature features reports of a tunnel-over-tunnel pattern&#44; described as a noodle pattern&#44; which corresponds to tunnels dug by various parasites&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Observation of the mite&#39;s body is reported when using videodermoscopy&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;8</span></a> In 2016&#44; Cinotti et al&#46; compared 20&#215; and 70&#215; magnifications&#44; and only saw the body of the mite in the latter&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">However&#44; in 2019&#44; Scanni demonstrated this structure through digital dermoscopy&#44; defined as acquisition and storage of images obtained by dermoscopy&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> That author associated dermoscopy &#40;10&#215;&#41;&#44; optical zoom of the camera &#40;3&#8211;5&#215;&#41;&#44; and image amplification&#44; and demonstrated some structures that make up what he defined as &#8220;the mite-gallery unit&#46;&#8221;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> This unit consists of the head&#44; which corresponds to the mite with the hang-glider structure&#44; the body&#44; which contains the tunnel with eggs and feces&#44; and the tail&#44; the end of the tunnel composed of keratin collars&#44; viewed only with dermoscopy without immersion&#46; Through image amplification&#44; the translucent body of the mite with several scattered dark spots &#40;termed ladybird sign&#41; can also be observed&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> In the present report&#44; using this technique&#44; it was possible to demonstrate the hang-glider appearance&#44; the ovoid body&#44; and the tunnel&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">It is known that the observation of the mite body&#44; eggs&#44; and feces is the best with videodermoscopy&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;8</span></a> However&#44; when unavailable&#44; the use of the technique described by Scanni and applied in the present report can allow a more accurate diagnosis of scabies&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors&#39; contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Elaine Dias Melo&#58; Conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Carla Barros da Rocha Ribas&#58; Approval of the final version of the manuscript&#59; elaboration and writing of the manuscript&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the manuscript&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Isabel Cristina Lima Incarnation&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the manuscript&#46;</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&#46;</p></span></span>"
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Tropical/Infectoparasitary Dermatology
Digital dermoscopy: a complementary method in the diagnosis of scabies
Elaine Dias Meloa,
Autor para correspondência
e.dmelo@yahoo.com

Corresponding author.
, Carla Barros da Rocha Ribasb, Isabel Cristina Lima Encarnaçãob
a Teaching and Research Department, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil
b Pediatric Dermatology Clinic, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil
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fissured&#44; crusted&#44; or erythrodermic lesions&#44; variable pruritus&#44; and the presence of millions of mites&#44; being highly contagious&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The diagnosis is usually established based on the clinical picture&#44; but it can be complemented by dermoscopy&#44; videodermoscopy&#44; or confocal microscopy&#44; and is confirmed by direct examination or biopsy&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> The authors report a case of crusted scabies with an emphasis on dermoscopic findings&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A female patient&#44; 29 years of age&#44; native Brazilian&#44; presented with erythematous papules and lichenified plaques&#44; some of which were hyperkeratotic&#44; in the acral&#44; flexural&#44; and abdominal regions&#44; associated with mild pruritus for eight months &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Dermoscopy was performed with immersion&#44; under polarized light &#40;10&#215;&#44; DermLite DL4&#44; California&#44; United States&#41; of an unscathed lesion on the arm&#44; and the images were captured with a camera &#40;12<span class="elsevierStyleHsp" style=""></span>Mp&#44; iPhone 7&#44; Apple Inc&#46;&#44; California&#44; United States&#41; with 2&#215; optical zoom allowing the observation of the millipede-like structures and the hang-glider appearance &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Subsequently&#44; image amplification demonstrated a translucent rounded structure &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Direct examination confirmed the diagnosis of crusted scabies &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41; and&#44; after treatment&#44; the patient evolved with resolution of the lesions&#46;<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&#46; It allows the observation of a brownish triangular structure with a hang-glider appearance&#44; corresponding to the anterior portion of the body and the front legs of the mite&#44; and a tunnel&#44; which can assume a millipede-like conformation&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> In crusted scabies&#44; the literature features reports of a tunnel-over-tunnel pattern&#44; described as a noodle pattern&#44; which corresponds to tunnels dug by various parasites&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Observation of the mite&#39;s body is reported when using videodermoscopy&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;8</span></a> In 2016&#44; Cinotti et al&#46; compared 20&#215; and 70&#215; magnifications&#44; and only saw the body of the mite in the latter&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">However&#44; in 2019&#44; Scanni demonstrated this structure through digital dermoscopy&#44; defined as acquisition and storage of images obtained by dermoscopy&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> That author associated dermoscopy &#40;10&#215;&#41;&#44; optical zoom of the camera &#40;3&#8211;5&#215;&#41;&#44; and image amplification&#44; and demonstrated some structures that make up what he defined as &#8220;the mite-gallery unit&#46;&#8221;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> This unit consists of the head&#44; which corresponds to the mite with the hang-glider structure&#44; the body&#44; which contains the tunnel with eggs and feces&#44; and the tail&#44; the end of the tunnel composed of keratin collars&#44; viewed only with dermoscopy without immersion&#46; Through image amplification&#44; the translucent body of the mite with several scattered dark spots &#40;termed ladybird sign&#41; can also be observed&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> In the present report&#44; using this technique&#44; it was possible to demonstrate the hang-glider appearance&#44; the ovoid body&#44; and the tunnel&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">It is known that the observation of the mite body&#44; eggs&#44; and feces is the best with videodermoscopy&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;8</span></a> However&#44; when unavailable&#44; the use of the technique described by Scanni and applied in the present report can allow a more accurate diagnosis of scabies&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors&#39; contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Elaine Dias Melo&#58; Conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Carla Barros da Rocha Ribas&#58; Approval of the final version of the manuscript&#59; elaboration and writing of the manuscript&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the manuscript&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Isabel Cristina Lima Incarnation&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the manuscript&#46;</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&#46;</p></span></span>"
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