Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(2):e2022047 1

Dermatology Practical & Conceptual

Case Presentation

A 13-year-old female patient was referred to our department 

for a thoracic lesion present since birth. The physical exam-

ination reveals grouped vesicles with clear and hematic con-

tent similar to “frog roe”, with a subcutaneous component 

and a zosteriform distribution (Figure 1A). She referred ep-

isodes of pain and increased soft tissue associated for a few 

months ago. The polarized light dermoscopy showed pink 

lacunae divided by white septa and polymorphic vessels. 

Besides, the “hypopyon sign” was shown inside the lacunae 

(Figure 1B). The magnetic resonance imaging study reported 

mixed veno-lymphatic vascular malformation.

Thoracic Frog Roes With Zosteriform Distribution
Leopoldo Fernández Domper, Manuel Ballesteros Redondo, José María Martín Hernández, 

Esmeralda Silva Diaz

1 Dermatology Department, Hospital Clínico Universitario, Valencia, Spain.

Citation: Fernández Domper L, Ballesteros Redondo M, Hernández JMM, Silva Diaz E. Thoracic frog roes with zosteriform distribution. 
Dermatol Pract Concept. 2022;12(2):e2022047. DOI: https://doi.org/10.5826/dpc.1202a47

Accepted: July 23, 2021; Published: April 2022

Copyright: ©2022 Fernández Domper et al. This is an open-access article distributed under the terms of the Creative Commons 
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted 
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication

Corresponding author: Leopoldo Fernández Domper, Dermatology Department, Hospital Clínico Universitario, Valencia, Spain. Avenida 
Blasco Ibañez 17, 46010, Valencia, Spain. E-mail: lfernandezdomper@gmail.com

Teaching point

“Hypopyon sign” is referred to the 2 shades of colors inside 

the lacunae (corresponding to dilated, thin-walled lymphatic 

vessels located in the papillary dermis) due to the blood de-

posited at the lower side of them, due to the gravity effect, 

and it is a well described finding in circumscribed lymphan-

gioma [1,2]. Nevertheless, it is useful for the diagnosis of any 

vascular malformation with lymphatic component, as show 

in our case.



2 Image Letter | Dermatol Pract Concept. 2022;12(2):e2022047

References

1. Gencoglan G, Inanir I, Ermertcan AT. Hypopyon-like features: 

New dermoscopic criteria in the differential diagnosis of cu-

taneous lymphangioma circumscriptum and haemangiomas?  

J Eur Acad Dermatology Venereol. 2012;26(8):1023–1025. 

DOI: 10.1111/j.1468-3083.2011.04136.x. PMID: 21645121.

Figure 1. (A) Clinical presentation as grouped vesicles with clear and hematic content similar to “frog roe” with a zosteriform distribution. 

(B) Dermoscopy (polarised, 25x) of reddish lesions showing half-and-half lacunae demonstrating hypopyon-like features.

2. Zaballos P, del Pozo LJ, Argenziano G, et al. Dermoscopy of 

lymphangioma circumscriptum: A morphological study of 

45 cases. Australas J Dermatol. 2018;59(3):e189–e193. DOI: 

10.1111/ajd.12668. PMID: 28752523.