Dermoscopic clues of palmoplantar hyperkeratotic eczema and palmoplantar psoriasis: A prospective, comparative study of 90 patients

Abstract

Diagnosis can be difficult in isolated palmar and plantar lesions in patients with psoriasis and eczema. The purpose of our study is to compare the dermoscopic findings in patients with palmoplantar psoriasis and palmoplantar hyperkeratotic eczema. This prospective, comparative study included 90 patients histopathologically diagnosed with eczema or psoriasis (35 psoriasis and 55 eczema). The age range was 18-75 years. The most common vessel type was dot vessel in psoriasis. Red globular ring vessels were seen in five patients with psoriasis, but not in any with eczema (P = 0.007). The most common vascular distribution pattern was regular in psoriasis (40%). Patchy vascular pattern was significant in eczema. The most common background color was light red in psoriasis (48.6%) (P < 0.001). Brownish-orange globules were observed in 25.7% of patients with eczema and 5.7% in patients with psoriasis (P = 0.02). There is only one study in the published work about dermoscopy of palmoplantar psoriasis and eczema. In our study, yellow crusts, patchy scale distribution, patchy vascular pattern, yellow scale color, dull red background color and brownish-orange globules were significant in patients with palmoplantar eczema. On the other hand, patients with psoriasis had light red background color, regular vascular distribution pattern and white scale color. We observed globule structures with a pale center and dark peripheral rim only in patients with eczema, which was not identified in previous studies. This globule structure may be a new finding in eczema.

Dermatoscopic Findings in Palmoplantar Dermatoses

“…Although dotted vessels are a hallmark of trunk and extremity plaque psoriasis [6], as well as palmoplantar involvement [2], it should be remarked that this finding is not specific for psoriasis vulgaris. It could also be seen in eczema [2,3], Bowen's disease [7], lichen nitidus [8], lichen simplex chronicus [15] and PRP [5,9,16].…”

“…Although dotted vessels are a hallmark of trunk and extremity plaque psoriasis [6], as well as palmoplantar involvement [2], it should be remarked that this finding is not specific for psoriasis vulgaris. It could also be seen in eczema [2,3], Bowen's disease [7], lichen nitidus [8], lichen simplex chronicus [15] and PRP [5,9,16]. Based on these findings, it can be suggested that dotted vessels may not be useful to distinguish psoriasis from other dermatoses, but the vascular distribution pattern may be beneficial in the differential diagnosis [2,3,17,18].…”

“…Dermatoscopy has been shown to be a useful supportive tool to assist the diagnosis of inflammatory skin diseases [2][3][4][5][6][7][8][9][10].…”

“…There are few studies in the literature regarding the use of dermatoscopy in palmoplantar psoriasis [2][3][4]. Dermatoscopy of palmoplantar plaque psoriasis shows a characteristic pattern consisting of diffuse white scales and symmetrically, regularly distributed dotted vessels on a light or dull red background [1][2][3][4][5][6]. It has been reported that the scale distribution pattern is rarely central or patchy [2,5].…”

“…Dermatoscopy of palmoplantar plaque psoriasis shows a characteristic pattern consisting of diffuse white scales and symmetrically, regularly distributed dotted vessels on a light or dull red background [1][2][3][4][5][6]. It has been reported that the scale distribution pattern is rarely central or patchy [2,5].…”