|THROUGH THE DERMOSCOPE
|Year : 2019 | Volume
| Issue : 4 | Page : 500-501
Dermoscopy of erythrodermic pityriasis rubra pilaris
Sheetanshu Kumar1, Keshavamurthy Vinay1, Bishan D Radotra2
1 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||28-Jun-2019|
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumar S, Vinay K, Radotra BD. Dermoscopy of erythrodermic pityriasis rubra pilaris. Indian Dermatol Online J 2019;10:500-1
|How to cite this URL:|
Kumar S, Vinay K, Radotra BD. Dermoscopy of erythrodermic pityriasis rubra pilaris. Indian Dermatol Online J [serial online] 2019 [cited 2020 Jun 6];10:500-1. Available from: http://www.idoj.in/text.asp?2019/10/4/500/255527
Dermatology consultation was sought for an elderly female with erythroderma. On examination, diffuse erythema with loosely adherent greyish-white scales, discrete follicular keratotic papules, and multiple islands of sparing was observed [Figure 1]a. Diffuse palmoplantar keratoderma of palms and soles was also present. On histopathology (H and E, ×200), psoriasiform acanthosis, alternating bands of orthokeratosis and parakeratosis, and follicular keratinous plugs were seen [Figure 1]b. Dermoscopic evaluation performed using a Dermlite II Hybrid M Dermoscope at 10× magnification in polarized mode revealed whitish keratotic follicular plugs surrounded by yellowish-red areas and multiple linearly arranged and dotted vessels arranged in an irregular pattern [Figure 2]. A definite diagnosis of erythroderma secondary to pityriasis rubra pilaris (PRP) was established based on the above features.
|Figure 1: (a) Diffuse erythema with loosely adherent greyish-white scales, discrete follicular keratotic papules, and multiple islands of sparing. (b) Histopathology (H and E, ×200) demonstrating psoriasiform acanthosis, alternating bands of orthokeratosis, and parakeratosis and follicular keratinous plugs|
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|Figure 2: Dermatoscopy (Dermlite II Hybrid M Dermatoscope at ×10 magnification in polarized mode) revealing whitish keratotic follicular plugssurrounded by yellowish-red (blue arrow) background and multiple, peripheral, linearly arranged (red arrow), and dotted (black arrow) vessels|
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Erythroderma secondary to PRP is often difficult to differentiate from other causes of erythroderma, especially psoriasis. Whitish keratotic plugs, yellowish red background, and linearly arranged and dotted peripheral vessels are dermoscopic features of PRP and differs from that of psoriasis which shows silvery white scales, uniformly distributed red dots on a background of salmon red erythema. The keratotic plugs and perifollicular scaling seen on dermoscopy corresponds to the follicular plugs along with hyperkeratosis and parakeratosis in the perifollicular areas seen on histopathology. The linear and dotted vessels seen on dermoscopy corresponds to the dilatation of dermal capillaries observed on histopathology.
Dermoscopic findings may aid in differentiating among the underlying causes of erythroderma, which can be a mammoth task otherwise. Dermoscopy of erythroderma secondary to atopic dermatitis exhibits yellowish scales or crusts along with patchy distribution of dotted vessels on a pinkish background, where as erythroderma secondary to mycosis fungoides demonstrates sparse whitish scales, numerous dotted vessels along with serpiginous vessels which typically have spermatozoon-like shape.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Abdel-Azim NE, Ismail SA, Fathy E. Differentiation of pityriasis rubra pilaris from plaque psoriasis by dermoscopy. Arch Dermatol Res 2017;309:311-4.
Errichetti E, Piccirillo A, Stinco G. Dermoscopy as an auxiliary tool in the differentiation of the main types of erythroderma due to dermatological disorders. Int J Dermatol 2016;55:e616-e8.
[Figure 1], [Figure 2]