Dermoscopy in Facilitating the Recognition of Poikiloderma of Civatte
We analyzed the dermoscopic findings of 8 consecutive instances (6 women/2 men—average age 51 years, range 42–73 years) of PC diagnosed according to clinical criteria1 by 2 independent expert clinicians (E.E. and G.S.); sides of neck were involved in all cases, whereas central chest and face were affected in 5 and 4 cases, respectively. Dermoscopic evaluation was performed by an expert dermoscopist (E.E.) to detect specific features according to standard criteria used in dermoscopy of nonproliferative skin conditions2; in all cases, the authors used a manual polarized light device (DermLite DL3 ×10; 3Gen, San Juan Capistrano, CA). In all instances (8/8; 100.0%), the authors observed a combination of dotted/globular vessels and linear irregular vessels, giving rise to a sort of “spaghetti and meatballs” aspect, along with perifollicular whitish (spared) areas (Figure 1); additional findings included follicular keratotic plugs (2/8; 25%) (Figure 1) and delicate reticular (2/8; 25%) or structureless brownish areas (1/8; 12.5%).
The constant detection of the “spaghetti and meatballs” vascular pattern, along with perifollicular whitish (spared) areas, has never been reported in similar dermatoses which may enter the differential diagnosis of PC, including erythematotelangiectatic rosacea, Riehl's melanosis, erythromelanosis follicularis faciei et colli, and dyskeratosis congenita,3 thus making such features potentially useful in facilitating the noninvasive recognition of this condition. Indeed, erythematotelangiectatic rosacea is dermoscopically characterized by the presence of linear purple vessels arranged in a polygonal network (vascular polygons)2; Riehl's melanosis constantly displays telangiectatic vessels, gray dots/granules, and pigmented pseudonetwork4; erythromelanosis follicularis faciei et colli usually shows whitish scales, perifollicular/interfollicular gray-blue granules (peppering), and whitish follicular keratotic plugs over a reddish brown background (personal observations); and dyskeratosis congenita typically features hypopigmented “holes” surrounded by pigmented lines consisting of pepper-like dark brown dots/globules arranged in a net-like pattern and diffuse reddish pigmentation in the pigmented lines.5
The authors' analysis was performed on a relatively small number of patients and did not take into account variables such as age, sex, and location; future studies are, therefore, needed to confirm our preliminary observations.