From direct to confocal microscopy for tinea nigra: Time to shift towards in vivo imaging?

Abstract

Dear Editor, We read with great interest the clinical case by Di Cristo et al. 1 reporting tinea nigra on the right palm of a 4-year-old white girl. In the clinical case, traditional diagnostic laboratory methods including microscopic examination of scraping and fungal culture were not performed, and tinea nigra was diagnosed by dermoscopy alone. We agree with the pragmatic approach adopted by the authors and herein we would like to highlight the diagnostic potential of an additional non-invasive imaging tool, that is, reflectance confocal microscopy (RCM), which have expanded the diagnostic armamentarium, for an in-vivo evaluation of numerous skin infections and infestations. 2 The diagnosis of tinea nigra is usually straightforward by dermoscopy: in one study of 50 consecutive cases, Piliouras et al. 3 reported that dermoscopy significantly improves diagnosis of tinea nigra, with a correct diagnosis suggested in case of dermoscopic evaluation, as compared to clinical assessment. Hallmarks of this condition are represented by dots and pigmented spicules arranged in parallel and curvilinear lines, commonly producing a reticular-like appearance. Pigmentation does not conform to the dermatoglyphic furrow and ridges of the volar skin, as is typically seen for acral melanocytic lesions. 2,[4][5][6]