Dermatology: Practical and Conceptual Review | Dermatol Pract Concept. 2023;13(4)S1:e2023309S 1 Dermoscopy of Infectious Dermatoses (Infectiouscopy) in Skin of Color – A Systematic Review by the International Dermoscopy Society “Imaging in Skin of Color” Task Force Payal Chauhan1, Biswanath Behera2, Delaney D Ding3, Aimilios Lallas4, Soumil Khare5, Nkechi Anne Enechukwu6, Martyna Sławińska7, Bengu Nisa Akay8, Balachandra S Ankad9, Yasmeen J Bhat10, Abhijeet Kumar Jha11, Feroze Kaliyadan12, Awatef Kelati13, Shekhar Neema14, Nisha V Parmar15, Jennifer Stein16, Richard P Usatine17, Keshavamurthy Vinay18, Enzo Errichetti19 1 Department of Dermatology, All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, India 2 Department of Dermatology and Venereology, AIIMS, Bhubaneswar, India 3 University of Florida College of Medicine, Gainesville, FL, USA 4 First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece 5 Department of Dermatology, Venereology and Leprosy, AIIMS, Raipur, India 6 Nnamdi Azikiwe University/Nnamdi Azikiwe Teaching Hospital Nnewi, Anambra State, Nigeria 7 Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Poland 8 Department of Dermatology, School of Medicine, Ankara University, Ankara, Turkey 9 Department of Dermatology, Venereology and Leprosy, SN Medical College, Bagalkot, Karnataka, India 10 Department of Dermatology, Venereology and Leprology, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India 11 Department of Dermatology & STD, Patna Medical College & Hospital, Patna, India 12 Department of Dermatology, Sree Narayana Institute of Medical Sciences, Ernakulum, India 13 Dermatology Department, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco 14 Department of Dermatology, Venereology and Leprology, Armed Force Medical College, Pune, Maharashtra, India 15 Department of Dermatology, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates 16 The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA 17 Department of Dermatology and Cutaneous Surgery, Department of Family and Community Medicine, University of Texas Health San Antonio, San Antonio, TX, USA 18 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India 19 Institute of Dermatology, “Santa Maria della Misericordia” University Hospital, Udine, Italy Key words: dermoscopy, dermatoscopy, entodermoscopy, entomodermoscopy, epiluminescence, infections, skin of color, dark skin, black skin, ethnic skin, dark phototype, african skin, systematic review Citation: Chauhan P, Behera B, Ding DD, et al. Dermoscopy of Infectious Dermatoses (Infectiouscopy) in Skin of Color – a systematic review by the International Dermoscopy Society “Imaging in Skin of Color” Task Force. Dermatol Pract Concept. 2023;13(4) S1:e2023309S. DOI: https://doi.org/10.5826/dpc.1304S1a309S Accepted: September 26, 2023; Published: October 2023 Copyright: ©2023 Chauhan 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. 2 Review | Dermatol Pract Concept. 2023;13(4)S1:e2023309S Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Enzo Errichetti, MD, Institute of Dermatology, “Santa Maria della Misericordia” University Hospital, Udine, Italy. Email: enzoerri@yahoo.it Dermoscopy has been showed to facilitate the non-invasive recognition of several infectious disorders (infectiouscopy) thanks to the detection of peculiar clues. Although most of the knowledge on this topic comes from studies involving light-skinned patients, there is growing evidence about its use also in dark phototypes. This systematic literature review summarizes published data on dermoscopy of parasitic, bacterial, viral and fungal dermatoses (dermoscopic findings, used setting, pathological correlation, and level of evidence of studies) and provides a homogeneous terminology of reported dermoscopic features according to a standardized methodology. A total of 66 papers addressing 41 different dermatoses (14 bacterial, 5 viral, 11 fungal infections, and 11 parasitoses/bites and stings) and involving a total of 1096 instances were included in the analysis. The majority of them displayed a level of evidence of V (44 single case reports and 21 case series), with only 1 study showing a level of evidence of IV (case-control analysis). Moreover, our analysis also highlighted a high variability in the terminology used in the retrieved studies. Thus, although promising, further studies designed accord- ing to a systematic and standardized approach are needed for better characterization of dermoscopy of infectious skin infections. ABSTRACT Introduction The group of infectious skin disorders encompass a wide number of conditions due to parasitic, bacterial, viral and fungal agents [1-3]. Whereas the use of dermoscopy was initially conceived for parasitoses and insect bites/stings, there has been a significant increase of publication also on non-parasitic cutaneous infections [3]. Thanks to the detec- tion of peculiar clues, dermoscopic assessment may help the clinician promptly recognize some infectious dermatoses without the use of time-consuming and expensive investi- gations (e.g., microbiological, laboratory, or imaging tests) [1-3]. Of note, most of studies dealing with dermoscopy of infectious dermatoses involved light-skinned patients [1-3], yet there is a growing trend in publications focusing on dark phototypes (Fitzpatrick’s phototypes IV-VI) [3,4]. This systematic review, performed on behalf of the Inter- national Dermoscopy Society (IDS) Task Force on “Imaging in Skin of Color”, aimed at providing for the first time an up-to-date systematic analysis on dermoscopy of infectious dermatoses (infectiouscopy) in skin of color, also trying to align dermoscopic terminology of reported findings follow- ing a homogeneous standardized nomenclature. Methods This systematic review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Re- views and MetaAnalyses) guidelines. A search of the arti- cles published up to 30th June 2022 was performed through the PubMed electronic database using the following search terms: “dermoscopy” OR “epiluminescence” OR “derma- toscopy” AND “skin of color” OR “dark skin” OR “black skin” OR “ethnic skin” OR “dark phototype” OR “african skin” OR “indian skin”. Titles and abstracts were screened by two independent reviewers to identify papers reporting dermoscopic findings of skin infestations, insect bites/stings, bacterial, viral and fungal skin infections; articles dealing with hair, nail, and mucosal conditions were not considered and non-English articles, reviews, personal opinions/editori- als and duplicates were excluded. A manual search was also performed by assessing the reference sections of all signifi- cant studies or reviews on this topic. Articles deemed not relevant and those not mentioning dermoscopic structures according to specific dermatosis/ number of patients with particular dermoscopic structures were excluded after full-text reading. Only articles specif- ically dealing with Fitzpatrick’s phototypes IV-VI were in- cluded. In case information on the skin phototype was not provided, decision on inclusion was made based on a title/ abstract/full text showing that the manuscript concerned “dark skin” or “skin of color” and for single cases also based on the attached figures. We also included papers from Afri- can, Indian subcontinent, and Caribbean countries as most of patients from these areas feature IV-VI skin phototype. Notably, studies grouping light and dark phototypes without dedicated subanalyses were excluded. All of the retrieved studies were classified based on stan- dard definitions for diagnostic accuracy studies [5,6] and their level of evidence was assigned according to The Oxford Review | Dermatol Pract Concept. 2023;13(4)S1:e2023309S 3 2011 Levels of Evidence [7]. Dermoscopic findings, histo- pathological background (if available), dermoscopic setting (polarized vs non-polarized/magnification degree), skin type of the patient (if specified), and number of cases were as- sessed and summarized. Additionally, standardized terminol- ogy based on the IDS dermoscopic criteria for non-neoplastic dermatoses validated for skin of color was specified for each dermoscopic finding reported in the literature [8]. Results The initial PubMed search showed 1287 publications, whereas 49 were added following additional reference screening, with a total of 82 items admitted to the full-text reading after title and abstract screening and excluding du- plicates. Of these, 16 papers were ruled out based on the exclusion criteria, with 66 articles being eventually in the review process. The flow chart showing the study selection procedure in depicted in Figure 1. The full-text review included 44 single case-reports, 21 case-series, and one case-control study, with the last one be- ing the only analysis with a higher level of evidence (IV), while the rest of the studies had the lowest level of evidence (V). Forty-one different dermatoses (also accounting for rele- vant disease variants with clinical/dermoscopic peculiarities) were analyzed, including 14 bacterial, 5 viral, 11 fungal in- fections, and 11 parasitoses/bites and stings; a total of 1096 instances were retrieved. Table 1 shows the number of stud- ies and total number of included patients for each condition. Dermoscopic setting (polarized vs non-polarized) was reported in 46/66 records (40 polarized; 1 non- polarized; 5 both), magnification in 49/66 records (31: x10 magnification; 4: x16 magnification; 5: x20 magnification; 4: x50 magnification; 2: x200 magnification; 3: variable magnification), and dermoscopic-pathological correlation in 33/66 records. Supplemental Table summarizes all such data, along with analytical description of each of the study evaluated in the review (number of patients, type of study and level of evidence), dermoscopic features, skin phototype, and corresponding terminology according to the IDS der- moscopic criteria for non-neoplastic dermatoses validated for skin of color. Table 1 also shows the general prevalence (calculated from all data reported in the literature) of dermo- scopic findings of included conditions for which a standard- ized terminology was available. Relevant findings for each dermatosis are reported as follows; for practical purpose, we have grouped them according to the etiological agent. Figures 2-6 show dermoscopic clues of such conditions. Bacterial Infections Leprosy Leprosy is the bacterial disease with the greatest amount of data about the use of dermoscopy for diagnostic purposes, with a total of 12 published studies (1 case-control analysis, 6 case-series, and 5 single case-reports) [9-20]. Dermoscopic patterns of the entire spectrum of leprosy has been described in skin of color, with the commonest findings (reported in all subtypes) including yellow/yellowish-orange areas, pau- city of appendageal structures (eccrine dots and hairs), and vessels (mainly linear vessels with branches) [9-20]. Addi- tionally, Ankad et al found white structureless areas to be another frequent feature in borderline tuberculoid leprosy in a cohort of 12 patients [11]. Reduced pigment network was also observed in all subtypes, apart from lepromatous Figure 1. PRISMA flowchart displaying the selection process for study inclusion in the systematic review. 4 Review | Dermatol Pract Concept. 2023;13(4)S1:e2023309S Ta b le 1 . T ot al N um be r of S tu di es , I ns ta nc es a nd o f St an da rd iz ed D er m os co pi c Fi nd in gs o f In fe ct io us D er m at os es in S ki n of C ol or . D er m at o se s To ta l N u m b er o f St u d ie s To ta l N u m b er o f In st an ce s (I n st an ce s W it h D er m o sc o p y Pr ev al en ce D at a) D er m o sc o p ic F in d in g s* ( To ta l P re va le n ce )* * B ac te ri al in fe ct io ns L ep ro sy B or de rl in e tu be rc ul oi d T ub er cu lo id B or de rl in e le pr om at ou s L ep ro m at ou s T yp e 1 re ac ti on T yp e 2 re ac ti on H is to id le pr os y H yp op ig m en te d le pr os y L ep ro sy ( no n- sp ec ifi ed va ri an ts ) 4 2 2 5 4 4 5 1 1 63 ( 12 ) 6 (0 ) 27 ( 0) 35 ( 2) 34 ( 14 ) 23 ( 1) 12 ( 6) 11 ( 11 ) 13 ( 13 ) C om m on fi nd in gs : W hi te s tr uc tu re le ss a re as ( 10 0% ); Y el lo w g lo bu le s (6 7% ); R ed uc ti on o f ec cr in e gl an d op en in gs ( 50 % ) L es s co m m on fi nd in gs : L in ea r ve ss el s w it h br an ch es ( 33 % ) - - C om m on fi nd in gs : P er ip he ra l l in ea r ve ss el s w it h br an ch es ( 10 0% ); Y el lo w s tr uc tu re le ss a re as ( 50 % ); O ra ng e/ br ow n gl ob ul es ( 50 % ) L es s co m m on fi nd in gs : - C om m on fi nd in gs : V es se ls : l in ea r w it h br an ch es ( 71 % ); O ra ng e st ru ct ur el es s ar ea s (5 7% ) L es s co m m on fi nd in gs : Y el lo w -o ra ng e st ru ct ur el es s ar ea s (4 3% ); V es se ls : l in ea r (2 9% ) C om m on fi nd in gs : B ro w n do ts a nd g lo bu le s (1 00 % ) L es s co m m on fi nd in gs : - C om m on fi nd in gs : V es se ls : l in ea r w it h br an ch es ( 83 % ); Y el lo w /o ra ng e st ru ct ur el es s ar ea s (6 7% ) L es s co m m on fi nd in gs : W hi te s ca le s (3 3% ); F ol lic ul ar p lu gs ( 33 % ); W hi te s tr uc tu re le ss a re as ( 17 % ); V es se ls : l in ea r cu rv ed (1 7% ); W hi te -y el lo w s tr uc tu re le ss a re as ( 17 % ); P er ip he ra l b ro w n st ru ct ur el es s ar ea s (1 7% ); P er ip he ra l l in ea r ve ss el s w it h br an ch es ( 17 % ) C om m on fi nd in gs : R ed uc ti on o f sk in a pp en da ge s (8 2% ); W hi te s tr uc tu re le ss a re as ( 73 % ); B ro w n lin es , b ro w n re ti cu la r lin es ( 73 % ) L es s co m m on fi nd in gs : P er if ol lic ul ar w hi te c ol or ( 36 % ) C om m on fi nd in gs : S tr uc tu re le ss a re as : f oc al w hi te ( 92 % ); R ed uc ti on o f sk in a pp en da ge s (8 5% ) L es s co m m on fi nd in gs : S ca le s: w hi te p at ch y (4 6% ); V es se ls : l in ea r w it h br an ch es ( 31 % ); B ro w n do ts ( 31 % ); S tr uc tu re le ss a re as : o ra ng e (2 3% ); L in es : b ro w n (2 3% ); V es se ls : l in ea r (2 3% ); V es se ls : d ot te d (1 5% ); S tr uc tu re le ss a re as : b ro w n (8 % ); V es se ls : l in ea r cu rv ed (8 % ); L in es : w hi te ( 8% ); B ro w n gl ob ul es ( 8% ) L ic he n sc ro fu lo so ru m 2 3 (3 ) C om m on fi nd in gs : P er if ol lic ul ar w hi te c ol ou r (1 00 % ); F ol lic ul ar p lu g (6 7% ); P er ip he ra l w hi te s ca le s (6 7% ) L es s co m m on fi nd in gs : D if fu se w hi te s ca le s (3 3% ); P er if ol lic ul ar h yp er pi gm en ta ti on ( 33 % ) Review | Dermatol Pract Concept. 2023;13(4)S1:e2023309S 5 D er m at o se s To ta l N u m b er o f St u d ie s To ta l N u m b er o f In st an ce s (I n st an ce s W it h D er m o sc o p y Pr ev al en ce D at a) D er m o sc o p ic F in d in g s* ( To ta l P re va le n ce )* * L up us v ul ga ri s 2 31 ( 31 ) C om m on fi nd in gs : L in ea r ve ss el s (7 7% ); D ot te d ve ss el s (7 1% ); Y el lo w /w hi te g lo bu le s (6 1% ); W hi te s tr uc tu re le ss a re as ( 61 % ); Sc al es : w hi te , y el lo w ( 61 % ) L es s co m m on fi nd in gs : W hi te li ne s (3 9% ); S tr uc tu re le ss a re as : b ri gh t w hi te f oc al ( 36 % ) Sc al es : w hi te p at ch y (2 6% ); S tr uc tu re le ss a re as : o ra ng e fo ca l ( 23 % ); Y el lo w s ca le s/ cr us ts ( 19 % ); F ol lic ul ar p lu gs ( 16 % ); St ru ct ur el es s ar ea s: b ro w n fo ca l ( 13 % ); G lo bu le s: w hi te ( 13 % ), br ow n (1 3% ); V es se ls : l in ea r w it h br an ch es ( 10 % ); B ro w n do ts (1 0% ); L in es : b ro w n (1 0% ); W hi te c ir cl es ( 10 % ); B lu e st ru ct ur el es s ar ea s (6 % ); V es se ls : l in ea r cu rv ed ( 3% ) Sy ph ili s (s ec on da ry ) 1 1 (1 ) C om m on fi nd in gs : W hi te s ca le s (1 00 % ); P er ip he ra l s ca le s (1 00 % ); O ra ng e st ru ct ur el es s ar ea ( 10 0% ) L es s co m m on fi nd in gs : - T ri ch om yc os is a xi lla ri s 1 1 (1 ) C om m on fi nd in gs : Y el lo w c on cr et io ns a ro un d ha ir s ha ft s (1 00 % ) L es s co m m on fi nd in gs : - T ub er cu lo si s ve rr uc os a cu ti s 1 1 (1 ) C om m on fi nd in gs : Y el lo w s tr uc tu re le ss a re a (d if fu se ) (1 00 % ); W hi te s ca le s (1 00 % ); Y el lo w /o ra ng e gl ob ul es a nd s tr uc tu re le ss ar ea s (1 00 % ) L es s co m m on fi nd in gs : - V ir al in fe ct io ns M ol lu sc um c on ta gi os um 4 32 ( 12 ) C om m on fi nd in gs : W hi te g lo bu le s (8 3% ) L es s co m m on fi nd in gs : V es se ls : p er ip he ra l d ot te d (4 2% ); L in ea r ve ss el s w it h br an ch es , p er ip he ra l ( 33 % ); W hi te t o ye llo w f oc al st ru ct ur el es s ar ea ( 8% ); P er ip he ra l l in ea r ve ss el s w it h br an ch es a nd d ot te d ve ss el s (8 % ) W ar ts P la ne w ar ts Pa lm op la nt ar w ar ts C om m on w ar ts G en it al w ar ts 2 4 4 1 12 ( 12 ) 19 7 (1 51 ) 12 3 (1 23 ) 2 (2 ) C om m on fi nd in gs : B ro w n st ru ct ur el es s ar ea ( di ff us e) ( 83 % ); D ot te d ve ss el s (8 3% ) L es s co m m on fi nd in gs : B ro w n do ts o ve r a w hi te b ac kg ro un d (1 7% ); I nt er ru pt io n of s ki n m ar ki ng s (1 7% ) C om m on fi nd in gs : I nt er ru pt io n of s ki n m ar ki ng s (1 00 % ); D ot te d ve ss el s (5 2% ); P ap ill ae ( 47 % ); Y el lo w , b ro w n st ru ct ur el es s ar ea ( di ff us e) ( 39 % ) L es s co m m on fi nd in gs : P ur pl e do ts ( 13 % ); L in ea r ve ss el s (1 3% ) C om m on fi nd in gs : - L es s co m m on fi nd in gs : P ap ill ae ( 34 % ); B ro w n do ts ( 24 % ); D ot te d ve ss el s (1 9% ); B ro w n st ru ct ur el es s ar ea ( di ff us e) ( 17 % ); D ot te d or c ur ve d lin ea r ve ss el s (1 1% ); V es se ls : th ro m bo se d (1 1% ); P ur pl e do ts ( 11 % ); Y el lo w s tr uc tu re le ss a re a (9 % ); I nt er ru pt io n of s ki n m ar ki ng s (7 % ); W hi te s tr uc tu re le ss ar ea ( 7% ); B lu e st ru ct ur el es s ar ea ( 4% ); L in ea r ve ss el s (3 % ); L in ea r cu rv ed v es se ls ( 2% ) C om m on fi nd in gs : V es se ls : d ot te d (1 00 % ), lin ea r (5 0% ); B lu e st ru ct ur el es s ar ea ( di ff us e) ( 50 % ) L es s co m m on fi nd in gs : - T ab le 1 co nt in ue s 6 Review | Dermatol Pract Concept. 2023;13(4)S1:e2023309S D er m at o se s To ta l N u m b er o f St u d ie s To ta l N u m b er o f In st an ce s (I n st an ce s W it h D er m o sc o p y Pr ev al en ce D at a) D er m o sc o p ic F in d in g s* ( To ta l P re va le n ce )* * Fu ng al in fe ct io ns C hr om ob la st om yc os is 4 4 (4 ) C om m on fi nd in gs : Y el lo w -o ra ng e st ru ct ur el es s ar ea s (5 0% ); W hi te s ca le s (5 0% ); Y el lo w c ru st s (5 0% ); W hi te li ne s (5 0% ) L es s co m m on fi nd in gs : Y el lo w s ca le s (2 5% ); D ot te d ve ss el s (2 5% ); L in ea r- cu rv ed v es se ls ( 25 % ); B ro w n do ts /g lo bu le s (2 5% ); Y el lo w s tr uc tu re le ss a re as ( 25 % ); W hi te s tr uc tu re le ss a re as ( 25 % ) M yc et om a 3 3 (3 ) C om m on fi nd in gs : W hi te s ca le s (6 7% ) L es s co m m on fi nd in gs : Y el lo w g lo bu le s (3 3% ); W hi te s tr uc tu re le ss a re as ( 33 % ); D ot te d ve ss el s (3 3% ); Y el lo w s tr uc tu re le ss a re as (3 3% ); B ro w n/ w hi te g lo bu le s (3 3% ); S m al l b la ck g ra in s (3 3% ); B lu e- w hi te s tr uc tu re le ss a re as ( 33 % ) P it yr ia si s ve rs ic ol or H yp op ig m en te d H yp er pi gm en te d 3 3 19 9 (1 99 ) 54 ( 54 ) C om m on fi nd in gs : - L es s co m m on fi nd in gs : W hi te s ca le s: p at ch y (4 8% ); W hi te s ca le s: in s ki n fu rr ow s (2 4% ); W hi te s ca le s: p er if ol lic ul ar ( 10 % ); W hi te s ca le s (1 0% ); W hi te s ca le s: d if fu se ( 7% ); V es se ls : l in ea r br an ch in g (7 % ); W hi te s ca le s: p at ch y in s ki n fu rr ow s (5 % ); W hi te sc al es : pe ri ph er al ( 5% ); P er if ol lic ul ar w hi te c ol or ( 3% ); V es se ls : d ot te d (2 % ) C om m on fi nd in gs : W hi te s ca le s (6 3% ) L es s co m m on fi nd in gs : S ca le s (2 8% ): w hi te d if fu se /p at ch y (2 6% ); S tr uc tu re le ss a re as : b ro w n (1 9% ); W hi te s ca le s: in s ki n fu rr ow s (1 3% ); S tr uc tu re le ss a re as : f oc al ( 11 % ); W hi te s ca le s: d if fu se ( 9% ); L in es : b ro w n (9 % ); W hi te s ca le s: p at ch y (7 % ); St ru ct ur el es s ar ea s: d if fu se ( 7% ); P er if ol lic ul ar w hi te c ol or ( 4% ); W hi te s ca le s: p er if ol lic ul ar ( 2% ) P it yr os po ru m f ol lic ul it is 2 60 ( 60 ) C om m on fi nd in gs : F ol lic ul ar p ap ul es /p us tu le s (1 00 % ); V es se ls : d ot te d, li ne ar w it h br an ch es , l in ea r cu rv ed ( 67 % ); H yp op ig m en ta ti on o f ha ir s ha ft ( 63 % ); D if fu se w hi te s ca le s (5 8% ); C oi le d to lo op ed h ai rs ( 57 % ) L es s co m m on fi nd in gs : P er if ol lic ul ar w hi te s ca le s (1 8% ) R hi no fa ci al en to m op ht ho ro m yc os is 1 1 (1 ) C om m on fi nd in gs : F oc al y el lo w /o ra ng e st ru ct ur el es s ar ea s (1 00 % ); D ot te d an d lin ea r ve ss el s (1 00 % ); W hi te s tr uc tu re le ss a re as (1 00 % ); S ca le s (1 00 % ); Y el lo w d ot s (1 00 % ) L es s co m m on fi nd in gs : - Sp or ot ri ch os is 2 5 (5 ) C om m on fi nd in gs : Y el lo w -o ra ng e st ru ct ur el es s ar ea s (8 0% ); L in ea r ve ss el s (6 0% ) L es s co m m on fi nd in gs : Y el lo w s tr uc tu re le ss a re as ( 20 % ); L in ea r ve ss el s w it h br an ch es (2 0% ); W hi te s tr uc tu re le ss a re as ( fo ca l) ( 20 % ); P er ip he ra l- ra di at in g w hi te li ne s (2 0% ); F ol lic ul ar p lu gs ( 20 % ) Ta b le 1 . T ot al N um be r of S tu di es , I ns ta nc es a nd o f St an da rd iz ed D er m os co pi c Fi nd in gs o f In fe ct io us D er m at os es in S ki n of C ol or . ( co nt in ue d) T ab le 1 co nt in ue s Review | Dermatol Pract Concept. 2023;13(4)S1:e2023309S 7 D er m at o se s To ta l N u m b er o f St u d ie s To ta l N u m b er o f In st an ce s (I n st an ce s W it h D er m o sc o p y Pr ev al en ce D at a) D er m o sc o p ic F in d in g s* ( To ta l P re va le n ce )* * T in ea c or po ri s 2 43 ( 43 ) C om m on fi nd in gs : W hi te s ca le s (1 00 % ) L es s co m m on fi nd in gs : S ca ly b ro ke n ha ir s (3 7% ); W hi te s ca le s: p er ip he ra l ( ja gg ed o ut er f re e ed ge ) (2 3% ); S tr uc tu re le ss a re as : br ow n (2 1% ) fo ca l ( 14 % )/ di ff us e (7 % ); B ro w n do ts ( 14 % ); B ro w n sc al es : p er ip he ra l ( 12 % ); B ro ke n ha ir s (9 % ); W hi te s ca le s: ja gg ed m ix ed f re e ed ge ( 7% ); V es se ls : d ot te d (5 % ); W hi te s ca le s: p er if ol lic ul ar ( 5% ); Y el lo w s ca le s/ cr us ts : p er ip he ra l ( 5% ); St ru ct ur el es s ar ea s: f oc al w hi te ( 2% ) T in ea in co gn it o 3 53 ( 53 ) C om m on fi nd in gs : L es s co m m on fi nd in gs : M or se c od e ve llu s ha ir s (3 4% ); F ol lic ul ar p us tu le s (2 6% ); P er ip he ra l w hi te s ca le s (2 6% ); M ic ro pu st ul es at t he b or de rs ( 22 % ); L in ea r, lin ea r cu rv ed , d ot te d ve ss el s (2 0% ); P ur pl e ar ea s (1 8% ); P er if ol lic ul ar s ca le s (2 % ); B la ck d ot s (2 % ); D ys tr op hi c br ok en h ai rs ( 2% ); D ot te d ve ss el s (2 % ) T in ea m an uu m /p ed is 2 11 ( 11 ) C om m on fi nd in gs : W hi te s ca le s (9 1% ) L es s co m m on fi nd in gs : W hi te s ca le s in t he s ki n fu rr ow s (9 % ); D ot te d ve ss el s in t he s ki n fu rr ow s (9 % ) W hi te p ie dr a 1 1 (1 ) C om m on fi nd in gs : C re am y ye llo w n od ul es d is tr ib ut ed a lo ng t he h ai r at ir re gu la r in te rv al ( 10 0% ) L es s co m m on fi nd in gs : - Pa ra si to se s/ bi te s an d st in gs B ed b ug b it es 1 1 (1 ) C om m on fi nd in gs : P ur pl e do t (1 00 % ) L es s co m m on fi nd in gs : - C yd ni da e pi gm en ta ti on 4 4 (4 ) C om m on fi nd in gs : B ro w n lin es ( 50 % ) L es s co m m on fi nd in gs : B ro w n do ts /g lo bu le s (2 5% ); B ro w n do ts ( 25 % ); B ro w n do ts /li ne s (2 5% ); B ro w n st ru ct ur el es s ar ea (d if fu se ) (2 5% ); P er if ol lic ul ar p ig m en ta ti on ( 25 % ) C ut an eo us la rv a m ig ra ns 1 1 (1 ) C om m on fi nd in gs : W el l- de fin ed , s eg m en te d ye llo w -w hi te li ne ar s tr uc tu re ( 10 0% ); B ro w n do ts w it h pe ri ph er al w hi te s ca le s (1 00 % ) L es s co m m on fi nd in gs : - C ut an eo us le is hm an ia si s 3 17 ( 17 ) C om m on fi nd in gs : F ol lic ul ar p lu gs ( 71 % ); W hi te li ne s (6 5% ); U lc er at io n (5 3% ) L es s co m m on fi nd in gs : V es se ls : d ot te d (3 5% ), lin ea r (3 5% ); S tr uc tu re le ss a re as : f oc al o ra ng e (3 5% ); S tr uc tu re le ss a re as : w hi te (2 4% ); V es se ls : l in ea r w it h br an ch es ( 18 % ); P er ip he ra l- ra di at in g w hi te li ne s (1 2% ); V es se ls ( 12 % ): li ne ar , l in ea r- cu rv ed T ab le 1 co nt in ue s 8 Review | Dermatol Pract Concept. 2023;13(4)S1:e2023309S D er m at o se s To ta l N u m b er o f St u d ie s To ta l N u m b er o f In st an ce s (I n st an ce s W it h D er m o sc o p y Pr ev al en ce D at a) D er m o sc o p ic F in d in g s* ( To ta l P re va le n ce )* * G am as id os is 1 1 (1 ) C om m on fi nd in gs : M it e re d to b la ck in c ol or e ng or ge d w it h bl oo d (1 00 % ) L es s co m m on fi nd in gs : - Pe di cu lo si s Pe di cu lo si s ca pi ti s Pe di cu lo si s pu bi s 1 3 1 (1 ) 3 (3 ) C om m on fi nd in gs : E m pt y ni ts ( gr ey , t ra ns lu ce nt , o vo id e gg s w it h fla tt en ed f re e en ds ) at ta ch ed t o th e ha ir s ha ft ( 10 0% ) L es s co m m on fi nd in gs : - C om m on fi nd in gs : N it s co nt ai ni ng u nh at ch ed n ym ph s, t ra ns lu ce nt e m pt y ca se s (3 3% ); A ct iv e lic e (3 3% ); N it s at ta ch ed t o ey el as he s (3 3% ); C ra b- sh ap ed p ub ic li ce w it h th ic k cl aw s gr as pi ng h ai r sh af t (3 3% ) L es s co m m on fi nd in gs : - Po st -k al a az ar le is hm an ia si s 3 3 (2 ) C om m on fi nd in gs : F ol lic ul ar p lu gs ( 50 % ); Y el lo w s tr uc tu re le ss a re as ( 50 % ) L es s co m m on fi nd in gs : - T ic k bi te 1 1 (1 ) C om m on fi nd in gs : T ic k w it h fo ur p ai rs o f lim bs ( 10 0% ) L es s co m m on fi nd in gs : - T un gi as is 1 1 (1 ) C om m on fi nd in gs : C en tr al b ro w n ri ng , c en tr al p or e, a nd f ai nt p ig m en te d pe ri ph er al r in g (1 00 % ); P er ip he ra l w hi te s tr uc tu re le ss ar ea ( 10 0% ) L es s co m m on fi nd in gs : - W ou nd m yi as is 1 1 (1 ) C om m on fi nd in gs : L ar va e, c au da l l ar va l e nd w it h tw o ov al o pe ni ng s, in co m pl et e pe ri tr em e an d pr om in en t sl it s (1 00 % ) L es s co m m on fi nd in gs : - *D er m os co pi c fi nd in gs f or w hi ch a s ta nd ar di ze d te rm in ol og y w as a va ila bl e; t he se a re d iv id ed in to c om m on ( pr ev al en ce ≥ 5 0% ) an d le ss c om m on ( p re va le nc e < 50 % ) ** To ta l p re va le nc e is c al cu la te d on ly c on si de ri ng s tu di es f or w hi ch p re va le nc e da ta o f de rm os co pi c fi nd in gs w as a va ila bl e Ta b le 1 . T ot al N um be r of S tu di es , I ns ta nc es a nd o f St an da rd iz ed D er m os co pi c Fi nd in gs o f In fe ct io us D er m at os es in S ki n of C ol or . Review | Dermatol Pract Concept. 2023;13(4)S1:e2023309S 9 Figure 2. Examples of dermoscopic clues of bacterial diseases in dark-skinned patients: White structureless areas and reduction of eccrine gland openings in borderline tuberculoid leprosy (Courtesy of Matilde Krisha Montenegro, MD and Katherine Joy Sayo, MD – Manila, Philippines) (A); Yellow structureless areas along with white structureless areas, faint peripheral linear vessels with branches (arrow), and re- duction of skin appendages (hairs/eccrine glands openings) in borderline lepromatous leprosy (B); Loss of pigment network along with white areas and reduction of eccrine glands openings and hair follicles in lepromatous leprosy (C); Reduction of skin appendages, erythema, white scales and follicular plugs in Type-1 lepromatous reaction (D); Homogenous white-pink area and brown-gray dots in Type-2 lepromatous reaction (Courtesy of Matilde Krisha Montenegro, MD and Katherine Joy Sayo, MD – Manila, Philippines) (E); Elongated linear vessels with branches and multiple white structureless areas in histoid leprosy (F). Figure 3. Examples of dermoscopic clues of bacterial diseases in dark-skinned patients: Ill-defined white structureless area and reduction of skin appendages in hypopigmented leprosy (A); Follicular plugs with perifollicular white color in lichen scrofulosorum (B); Orange-yellow and bright white globules/structureless areas along with diffuse white scaling in lupus vulgaris (C); Peripheral white collarette scaling in palmar secondary syphilis (D); Yellow concretions around the hair shafts in trichomycosis axillaris (E); Multiple white globules (papillae) centered by dotted vessels in tuberculosis verrucosa cutis (F). 10 Review | Dermatol Pract Concept. 2023;13(4)S1:e2023309S structures (structureless or linear areas), yellowish-brown to pink structureless areas, peripheral hyperpigmentation, scaling, follicular plugs and vessels (linear with branches or linear-curved) [10,12,18-20]. Finally, regarding hypopig- mented forms of leprosy, Errichetti et al reported that reduc- tion of skin appendages was a clue to differentiate them from other hypopigmented dermatoses in a case-control study [9]. Lichen Scrofulosorum Dermoscopy of lichen scrofulosorum has been investigated in two reports and described findings included monomor- phic, grouped, brown follicular plugs along with pale halos as well as a peripheral white scales, marginal hyperpigmen- tation, and dilated vessels [21,22]. Lupus Vulgaris Data about dermoscopy of lupus vulgaris (LV) comes from a case-control analysis by Errichetti et al involving 12 patients [9] and a case-series on 19 instances by Ankad et al [23]. Yellow-orange structureless areas (mainly focal), linear vessels (mainly with an unspecific distribution), white scales, and fo- cal bright white (fibrotic) structureless areas were the most fre- quent findings. Of note, Errichetti et al found that the presence of focal bright white areas was typical of LV when compared with other granulomatous diseases, including sarcoidosis. leprosy, in which an accentuation of pigment network sec- ondary to basal layer pigmentation was described [10,12]. Finally, Mohta et al found relative sparing of vellus hair in tuberculoid pole, whereas focal areas of hyperpigmentation with loss of pigment network were seen in borderline lepro- matous cases [12]. Moving to lepromatous reactions, four studies (case-series/reports) exist for both type-1 reaction (T1R) [10,12,13,16] and type-2 reaction (T2R) [10,12,13,17]. The most common dermoscopic features of T1R were di- lated vessels (mainly linear with branches), white scales, follicular plugs, and white/yellow-orange structureless areas [10,13,16], while T2R has been described to show mainly hyperpigmentation (shape/color not specified) and dilated linear vessels with branches [10,12,13,17]. Recently, homog- enous white-pink structureless area with irregular border having a crumpled fabric appearance with peripheral brown- gray dots/globules was noted in an instance of bullous T2R [17]. Notably, dermoscopic findings characteristic of under- lying leprosy subtype have also been described in reactional states [10,12,13,16,17]. Considering histoid leprosy, five studies have been re- ported (case-series/reports), with white/white-yellow and yellowish orange structureless areas being the main dermo- scopic features. Additional findings included shiny white Figure 4. Examples of dermoscopic clues of viral diseases in dark-skinned patients: Multiple yellow-white globules and peripheral linear vessels with branches in molluscum contagiosum (A); Central pore surrounded by white globules/dots along with peripheral dotted vessels in molluscum contagiosum (B); Brown dots and dotted vessels over a white background in a plane wart (C); Brown structureless area (diffuse) and few dotted vessels in plane warts (D); Interruption of skin markings, dotted vessels and diffuse brown pigmentation in a common wart (E); Multiple grey papillae in a genital wart (F). Review | Dermatol Pract Concept. 2023;13(4)S1:e2023309S 11 yellow-orange globules and structureless areas, papillated surface, dirty white thick scales, and irregularly dilated ves- sels being observed [26]. Viral Infections Molluscum Contagiosum Four studies are available when it comes dermoscopy of mol- luscum contagiosum (one case-control study, one case series and two single reports) [9,27-29]. Most data comes from the case-control study by Errichetti et al involving 10 instances that showed white globules to be the main feature [9], in line with other reports [27,28]. Additional findings included peripheral dotted or linear vessels with branches [9,27,28]. Of note, white globules with visible vessels running across the surface were also reported by Daruwalla et al, who per- formed extraction dermoscopy in 20 patients [29]. Syphilis A single report on dermoscopy of syphilis is available for skin of color [24]. The authors evaluated an instance of second- ary syphilis and found ill-defined, brown structureless area fading towards the periphery along with white scaling in the skin furrows in body lesions, while an orange structureless area and white scaling were reported in palmar lesions [24]. Trichobacteriosis Axillaris A single dermoscopic description of trichobacteriosis axil- laris does exist, with detection of golden yellow concretions encasing multiple hair shafts along their length [25]. Tuberculosis Verrucosa Cutis Only a single report describing dermoscopy of tubercu- losis verrucosa cutis is available in the literature, with Figure 5. Examples of dermoscopic clues of fungal diseases in dark-skinned patients: White and yellow scaling/crusting, dotted vessels and purple (hemorrhagic) dots/globules along with yellow structureless areas and brown dots (better visible in the inset) in chromoblastomycosis (A); White scales, yellow and white structureless areas, and black grains (dots) (arrow) in mycetoma (B); Perifollicular white color along with white scales in the skin furrows in hypopigmented pityriasis versicolor (C); Folliculocentric pale papule in Pityrosporum folliculitis (D); Focal orange and white structureless areas and white scales in rhinofacial entomophthoromycosis (E); Follicular plugs and unfocused linear vessels over an orange-erythematous background in sporotrichosis (adapted from Dermoscopy in General Dermatology for Skin of Color, Errichetti E, Lallas A, eds. CRC Press 2021) (F); White peripheral collarette scaling with a jagged mixed (outer and inner) free edge in tinea corporis (G); Follicular pustules, perifollicular scaling/crusting and dystrophic broken hairs in tinea incognito (H); White scales in the skin furrows in tinea manuum (I). 12 Review | Dermatol Pract Concept. 2023;13(4)S1:e2023309S Fungal Infections Chromomycosis Dermoscopy of chromomycosis has been described in four single reports, with brown/black dots and yellow-orange structureless areas, and white scales/crusts being constantly reported [35-38]. Additionally, white reticular lines [35-38] and polymorphic vessels [36,38] were also observed in half of published instances. Mycetoma Three single reports describing dermoscopic pattern of mycetoma are available in the literature [39-41]. The most typical feature reported was the presence of white-yellow/ yellow globules/structureless areas and grains (globules cor- responding to microbial masses), whose color varied based on the subtype (red/white in actinomycetoma and black in eumycetoma) [39-41]. Warts Six studies (one case-control study, four case-series and one single report) assessed dermoscopic patterns of warts (including common, palmoplantar, plane and genital sub- types) [9,30-34]. In detail, the main findings of common warts included brown dots, dotted vessels and black dots/ globules (thrombosed vessels) over a white background. Pal- moplantar warts showed a similar pattern, though they were also commonly reported to display papillary projections, in- terruption of skin markings, and perivascular white halos besides the aforementioned findings. With regard to plane warts, brown background was a constantly reported feature, while dotted vessels were described in a minority of cases. Finally, dotted vessels were the most commonly described findings in genital warts, followed by linear vessels and blu- ish background. Figure 6. Examples of dermoscopic clues of skin bites/stings and parasitoses in dark-skinned patients: purple dots and crusting in bedbug bites (A); Brown structureless areas and lines (in the skin furrows) in cydnidae pigmentation (B); Well-defined, segmented brown/white linear structures in cutaneous larva migrans (C); Multiple follicular plugs in cutaneous leishmaniasis (D); Empty nits (translucent elongated struc- tures with flat ending) and head lice in pediculosis capitis (E); Crab-shaped pubic lice with thick claws grasping hair shaft in pediculosis pubis (F); Central crusting with peripheral brown structureless area surrounded by a white halo in tick bite (G); Central pore with a faint pigmented peripheral ring and peripheral white structureless area containing blue globules in tungiasis (Courtesy of Elizabeth Leocadia Fernandes, MD – Mogi das Cruzes, Brazil) (H); Myasis larva (I). Review | Dermatol Pract Concept. 2023;13(4)S1:e2023309S 13 the case-series by Bhat et al on ten instances that found white scales along creases to be a constant clue [51], in line with another single report [52]. Moving to TC, in their case-series involving 30 patients, Bhat et al found white scales (not specified arrangement) to be the most frequent finding (all cases), followed by scaly broken hair (half of the cases) [51]. Whereas, in a case- control study by Errichetti et al including 13 instances, peripheral white scales showing a jagged outer free edge turned out to be specific for TC when compared to other papulosquamous dermatoses [9]. Additionally, although less frequent, also pe- ripheral yellow and brown scales were peculiar of TC. With regard to tinea incognito, in the first report on a single instance, Sonthalia et al reported follicular findings to be the main clues, including perifollicular scales, black dots, and hair-shaft changes (i.e., broken/bent deformable hairs, “morse code” hairs, and transparent hairs) [53]. These dermoscopic features were subsequently validated by two case-series on a total of 52 patients [51,54]. White Piedra Dermoscopy of white piedra has been investigated in a single report, that showed creamy yellow nodules distributed along the hair at irregular intervals [55], differently from tricho- bacteriosis axillaris that tends to feature yellow concretions along the entire length of the hair shaft [55]. Skin Parasitoses and Insect Bites/Stings Bed Bug Bites A single report describing dermoscopy of bed bug bites has been retrieved, with evidence of a central hemorrhagic punc- tum surrounded by erythema [56]. The authors also performed ex vivo dermoscopic examination showing multiple bed bugs and their empty eggs (appearing white and translucent) [56]. Cydnidae Pigmentation Four single reports described dermoscopic features of cyd- nidae pigmentation [57-60].The main feature consisted of brown dots/globules and/or lines [57,59,60]. Additionally, Jindal et al observed the presence of orange-brown structure- less areas with ridge enhancement over the sole, thereby sug- gesting that the pigment released by the bug seeps through the skin dermatoglyphics [58]. Cutaneous Larva Migrans Only a single report describing dermoscopic pattern of cu- taneous larva migrans is available in the literature [61]. The authors observed well-defined segmented yellowish-white lines (corresponding to larval body), along with brown dots and peripheral white scales (representing empty larval tract) in the central part and multiple yellowish lines (reflecting pustules over the larval tract secondary to inflammation) in the distal half of the lesion [61]. Pityriasis Versicolor Pityriasis versicolor (PV) is the most studied fungal derma- tosis from a dermoscopic point of view, with a case-control study, two case-series and two case-report for a total of 184 patients [9,42-45]. The main finding of both hypo- and hyper-pigmented variants was the presence of white scales in the skin furrows (over a dull diffuse white or brown back- ground, respectively); notably, such a pattern of scaling was reported to be specific of PV when compared to other pig- mentary disorders in the study by Errichetti et al [9]. Sim- ilarly, although less frequent, the detection of perifollicular white scaling was found to be peculiar of PV over the other analyzed conditions. Further characteristic findings described by Kaur et al included the so-called “contrast halo sign” (ring of alternate pigmentation surrounding the primary lesion) and folliculocentricity [43]. The latter feature (reported as perifollicular white halo) was found to be specific in the com- parative analysis by Errichetti et al in achromic PV [9]. Pityrosporum Folliculitis Two case-series involving a total of 60 cases have analyzed dermoscopy of pityrosporum (Malassezia) folliculitis (PF), with folliculocentricity and perilesional erythema reported to be constant findings [46-47]. Additional common (>75% of the analyzed instances) findings included (dotted, linear or linear-curved) in and around lesions and diffuse/peripheral white scales [46,47]. Rhinofacial Entomophthoramycosis A single dermoscopic report on rhinofacial entomophthora- mycosis does exist, with focal yellow-orange structureless areas and dotted/linear vessels being reported as the main features [48]. Additional findings included white structure- less areas, scaling, and follicular plugs [48]. Sporotrichosis Dermoscopy of sporotrichosis has mainly been described in a case-series on four patients (including cutaneous and lymphocutaneous subtypes) by Vinay et al, that reported yellow-orange areas and hemorrhagic crusting as constant findings [49]. Of note, the presence of yellow areas was also described in another single case of disseminated cutaneous sporotrichosis [50]. Vinay et al also found dermoscopic vari- ability based on lesions localization and duration, with fa- cial involvement also featuring follicular plugs and early and healing lesions respectively showing yellow-orange struc- tureless areas along with variable dilated vessels and white (fibrotic) structureless areas with linear vessels [50]. Tinea Infections Information on dermoscopic patterns of tinea manuum/pe- dis, tinea corporis (TC) and tinea incognito is available. Re- garding tinea manuum/pedis, most knowledge comes from 14 Review | Dermatol Pract Concept. 2023;13(4)S1:e2023309S Conclusions The present review analysis underlines that dermoscopic knowledge on infectious dermatoses mainly comes from sin- gle reports, with a limited number of larger studies showing a high level of evidence. Moreover, the reproducibility of re- ported findings may also be limited by the highly variable terminology used in the retrieved studies. Hence, even though infectiouscopy is a promising aid for dermatologist, as it may facilitate the detection of subclinical findings strictly related to specific histological and/or microbiological features, fur- ther studies designed according to a systematic and stan- dardized approach are needed for better characterization. References 1. Chauhan P, Jindal R, Errichetti E. Dermoscopy of skin parasit- oses, bites and stings: a systematic review of the literature. J Eur Acad Dermatol Venereol. 2022;36:1722-1734. 2. Chauhan P, Meena D, Errichetti E. Dermoscopy of Bacterial, Viral, and Fungal Skin Infections: A Systematic Review of the Literature. Dermatol Ther (Heidelb). 2023;13:51-76. 3. Errichetti E. Dermoscopy of Infectious Dermatoses: is it Time to Replace the Terms “Entodermoscopy” and “Entomodermos- copy” with “Infectiouscopy”? Dermatol Pract Concept. 2023;13: e2023021. 4. Chatterjee M, Neema S. Dermatoscopy of infections and infesta- tions. Indian Dermatol Online J. 2021;12:14-23. 5. Campbell JM, Kulgar M, Ding S, et al. Chapter 9: diagnostic test accuracy systematic reviews. In: Joanna Briggs Institute re- viewer’s manual (Aromataris E, Munn Z, eds). The Joanna Briggs Institute, 2017. https://reviewersmanual.joannabriggs.org. Ac- cessed 13 April 2023. 6. Rutjes AW, Reitsma JB, Vandenbroucke JP, et al. Case–control and two-gate designs in diagnostic accuracy studies. Clin Chem. 2005;51:1335-1341. 7. Oxford Centre for Evidence-Based Medicine. The Oxford 2011 levels of evidence. https://www.cebm.net/wp-content /uploads/2014/06/CEBM-Levels-of-Evidence-2.1.pdf. Accessed 13 April 2023. 8. Errichetti E, Ankad BS, Jha AK, et al. International Dermos- copy Society criteria for non-neoplastic dermatoses (general dermatology): validation for skin of color through a Delphi ex- pert consensus. Int J Dermatol. 2022;61:461-471. 9. Errichetti E, Ankad BS, Sonthalia S, et al. Dermoscopy in gen- eral dermatology (non-neoplastic dermatoses) of skin of colour: a comparative retrospective study by the International Dermos- copy Society. Eur J Dermatol. 2020;30:688-698. 10. Vinay K, Kamat D, Chatterjee D, Narang T, Dogra S. Dermatos- copy in leprosy and its correlation with clinical spectrum and histopathology: a prospective observational study. J Eur Acad Dermatol Venereol. 2019;33:1947-1951 11. Ankad BS, Sakhare PS. Dermoscopy of borderline tuberculoid leprosy. Int J Dermatol. 2018;57:74-76. 12. Mohta A, Jain SK, Agrawal A, et al. Dermoscopy in Leprosy: A Clinical and Histopathological Correlation Study. Dermatol Pract Concept. 2021;11:e2021032. 13. Chopra A, Mitra D, Agarwal R, Saraswat N, Talukdar K, Solanki A. Correlation of Dermoscopic and Histopathologic Cutaneous Leishmaniasis Most evidence on dermoscopy of cutaneous leishmaniasis (CL) comes from the case-control study by Errichetti et al including 14 instances that found follicular plugs, white lines (mainly peripheral-radiating), and ulceration (especially cen- tral) to be specific clues over other granulomatous derma- toses [9]. Such findings were also observed in two reports involving a total of 3 cases [62,63]. Gamasidosis In a single report on gamasidosis (avian mite dermatitis), Toukabri et al utilized dermoscopy to identify the mite, which appeared red to black colored and replete with blood [64]. Pediculosis Only four single reports have been retrieved (one each for pe- diculosis capitis, pediculosis pubis, pediculosis of facial hair, and phthiriasis palpebrarum) [65-68]. Badri et al found der- moscopy to be helpful in differentiating pediculosis capitis from scalp seborrheic dermatitis by showing grey, translucent, ovoid eggs, adherent firmly to the hair shafts (corresponding to nits) [65]. Dermoscopy of pediculosis pubis, pediculosis of facial hair, and phthiriasis palpebrarum has been found to show nits (viable containing unhatched nymphs and empty translucent casings) as well as crab-shaped lice having broad bodies and thick claws [66-68]. Post-Kala-Azar Dermal Leishmaniasis Three reports have investigated dermoscopy of post- kala- azar dermal leishmaniasis (PKDL) [69-71]. The first de- scription by Jha et al reported erythema and follicular plugs [70]. The presence of the latter finding was confirmed by Swarnkar et al, who observed it in hypopigmented macules, papules and nodules.71 In line with another report, Swarnkar et al also found yellow-orange structureless areas, thought to correspond to dermal granulomas [69, 71]. Tick Bites Only a single report on dermoscopy of tick bites is available from the literature. In this instance a pink-red area at the center of tick-induced lesion was reported [72]. Tungiasis A single case report on dermoscopy of tungiasis does exist, with brown pigmented ring around a central pore with sur- rounding whitish area and faint pigmented peripheral ring being described [73]. Wound Myiasis Only one instance describing dermoscopic findings of wound myiasis has been retrieved [74]. In their report, the authors observed caudal end of larvae (spiracles having two oval openings with incomplete peritreme and prominent slits) [74]. Review | Dermatol Pract Concept. 2023;13(4)S1:e2023309S 15 34. Barkat MT, Abdel-Aziz RTA, Mohamed MS. Evaluation of in- tralesional injection of bleomycin in the treatment of plantar warts: clinical and dermoscopic evaluation. Int J Dermatol. 2018;57:1533-1537. 35. Katoch S, Barua TN, Barua KN. The Curious Case of an Elusive Solitary Plaque. Indian Dermatol Online J. 2020;11:288-290. 36. Chauhan P, Jindal R, Shirazi N. Dermoscopy of Chromoblasto- mycosis. Indian Dermatol Online J. 2019;10:759-760. 37. Subhadarshani S, Yadav D. Dermoscopy of chromoblastomyco- sis. Dermatol Pract Concept. 2017;7:23-24. 38. Jayasree P, Malakar S, Raja H, Gopinathan Nair N. Dermo- scopic features in nodular chromoblastomycosis. Int J Dermatol. 2019;58:e107-e109. 39. Ankad BS, Manjula R, Tejasvi T, Nikam BP. Dermoscopy of eumycotic mycetoma: A case report. Dermatol Pract Concept. 2019;9:297-299. 40. Litaiem N, Midassi O, Zeglaoui F. Detecting subclinical myceto- ma’s black grains using dermoscopy. Int J Dermatol. 2019;58: 231-232. 41. Ankad BS, Beergoudar SL, Nikam BP. Dermatoscopy in actino- mycetoma: An observation. Indian Dermatol Online J. 2019; 10:330-331. 42. Mathur M, Acharya P, Karki A, Kc N, Shah J. Dermoscopic pattern of pityriasis versicolor. Clin Cosmet Investig Dermatol. 2019;12:303-309. 43. Kaur I, Jakhar D, Singal A. Dermoscopy in the Evaluation of Pityriasis Versicolor: A Cross Sectional Study. Indian Dermatol Online J. 2019;10:682-685. 44. Thomas N, Malakar S. Dermoscopy: An easy way to solve the diagnostic puzzle in pityriasis versicolor. Indian J Dermatol Venereol Leprol. 2019;85:664-665. 45. Kapadia F, Kharkar V, Vishwanath T. Dermoscopy to the Res- cue in an Annular Enigma: A Rare Case of Annular Pityriasis Versicolor Presenting in an Unusual Location. Dermatol Pract Concept. 2022;12:e2022057. 46. Jakhar D, Kaur I, Chaudhary R. Dermoscopy of pityrosporum folliculitis. J Am Acad Dermatol. 2019;80:e43-e44. 47. Jakhar D, Bhatia V, Gupta RK, Kaur I. Dermoscopy as an Auxil- iary Tool in the Assessment of Malassezia Folliculitis: An Obser- vational Study. Actas Dermosifiliogr. 2022;113:T78-T81. 48. Chauhan P, Jindal R, Shirazi N. Dermoscopy of Rhinofacial En- tomophthoromycosis in Skin of Color: First Report. Dermatol Pract Concept. 2022;12:e2022051. 49. Dabas G, Kaur H, Vinay K, Kumaran MS, Shivaprakash MR, Saikia UN, Dogra S. Dermoscopy in disseminated sporotrichosis. J Eur Acad Dermatol Venereol. 2019;33:e33-e35. 50. Vinay K, Bhattacharjee R, Bishnoi A, Chatterjee D, Rudramurthy S, Dogra S. Dermatoscopic features of cutaneous sporotrichosis. J Eur Acad Dermatol Venereol. 2020;34:e718-e720. 51. Bhat YJ, Keen A, Hassan I, Latif I, Bashir S. Can Dermoscopy Serve as a Diagnostic Tool in Dermatophytosis? A Pilot Study. Indian Dermatol Online J. 2019;10:530-535. 52. Jakhar D, Kaur I, Sonthalia S. Dermoscopy of Tinea Manuum. Indian Dermatol Online J. 2019;10:210-211. 53. Sonthalia S, Ankad BS, Goldust M, Jha AK. Dermoscopy - a sim- ple and rapid in vivo diagnostic technique for tinea incognito. An Bras Dermatol. 2019;94:612-614. 54. Singal A, Jakhar D, Kaur I, Pandhi D, Das S. Tinea Pseudoim- bricata as a Unique Manifestation of Steroid Abuse: A Clinico- Mycological and Dermoscopic Study from a Tertiary Care Hospital. Indian Dermatol Online J. 2019;10:422-425. Patterns in Leprosy - A Pilot Study. Indian Dermatol Online J. 2019;10:663-668. 14. Kansal NK, Joshi PP, Dhanta A, Hazarika N, Divyalakshmi C. A Masquerading Solitary Skin Lesion: Unusual Presentation of Multibacillary Leprosy with Dermoscopic Assistance in Diagno- sis. Indian Dermatol Online J. 2020;11:632-634. 15. Miola AC, Bicudo NP, Tsutsui GM, Miot HA. Leproma’s dermoscopy. An Bras Dermatol. 2020;95:383-385. 16. Jha AK, Zeeshan MD, Tiwary P, Singh A, Roy PK, Chaudhary RKP. Dermoscopy of Type 1 Lepra Reaction in Skin of Color. Dermatol Pract Concept. 2020;10:e2020083. 17. Vashisht D, Neema S, Tripathy DM, Sengupta P. Bullous Ery- thema Nodosum Leprosum Through the Dermoscope. Dermatol Pract Concept. 2022;12:e2022027. 18. Ankad BS, Sakhare PS. Dermoscopy of histoid leprosy: a case report. Dermatol Pract Concept. 2017;7:63-65. 19. Acharya P, Mathur MC. Clinicodermoscopic study of histoid lep- rosy: a case series. Int J Dermatol. 2020;59:365-368. 20. Mathur M, Acharya P, Karki A. Visual Dermatology: Crown Vessels in Dermoscopy of Histoid Leprosy. J Cutan Med Surg. 2019;23:333. 21. Jassi R, Yadav A, Chander R. Dermoscopy of Lichen Scrofuloso- rum. Indian Dermatol Online J. 2020;11:876-877. 22. Garg T, Kumar P, Das S, Singh S, Madan S. Lichen Scrofuloso- rum Coexisting with Phlyctenular Keratoconjuctivitis: Dermos- copy and Ocular Findings. Indian Dermatol Online J. 2021; 12:941-943. 23. Ankad BS, Adya KA, Gaikwad SS, Inamadar AC, Manjula R. Lupus Vulgaris in Darker Skin: Dermoscopic and Histopatho- logic Incongruity. Indian Dermatol Online J. 2020;11:948-952. 24. Mathur M, Acharya P, Karki A, Shah J, Kc N. Dermoscopic clues in the skin lesions of secondary syphilis. Clin Case Rep. 2019;7:431-434. 25. Gupta V, Sharma VK. Four views of trichomycosis axillaris: Clin- ical, Wood’s lamp, dermoscopy and microscopy. Indian J Derma- tol Venereol Leprol. 2018;84:748-749. 26. Jakhar D, Gupta RK, Sarin N. Dermoscopy of Tuberculosis Ver- rucosa Cutis. Indian Dermatol Online J. 2020;12:206-207. 27. Sil A, Bhanja DB, Chandra A, Biswas SK. BOTE sign in mollus- cum contagiosum. BMJ Case Rep. 2020;13:e239142. 28. Kumar S, Aggarwal D, Chatterjee D, Vinay K. Atypical presenta- tion of genital molluscum contagiosum mimicking genital warts. Int J STD AIDS. 2020;31:1420-1422. 29. Daruwalla SB, Dhurat RS, Agrawal S, Mahobia S, Naidu Kona S. “Extraction Dermoscopy”: Expanding the Utility of Epilumi- nescence Microscopy. Skin Appendage Disord. 2020;6:220-223. 30. Agarwal M, Khunger N, Sharma S. A Dermoscopic Study of Cutaneous Warts and Its Utility in Monitoring Real-Time Wart Destruction by Radiofrequency Ablation. J Cutan Aesthet Surg. 2021;14:166-171. 31. Albalat W, Attwa E, Ebrahim HM. Intralesional cryotherapy versus cryotherapy spray for the treatment of recalcitrant plan- tar warts: a prospective, randomized study. J Dermatolog Treat. 2020;26:1-7. 32. Hassan SNE, Hussein TM, Eldeeb ME. Photodynamic therapy using methylene blue and intense pulsed light versus intense pulsed light alone in treatment of verruca: A randomized con- trolled study. Photodiagnosis Photodyn Ther. 2021;36:102541. 33. Nirmal B, George R, Kodiatte TA. Dermatoscopy of palmar wart with falooda seed appearance. Australas J Dermatol. 2018;59: 155-156. 16 Review | Dermatol Pract Concept. 2023;13(4)S1:e2023309S 65. Badri T, Hammami H, Benmously R, Mokhtar I, Fenniche S. Der- moscopic diagnosis of pediculosis capitis. Acta Dermatovenerol Alp Pannonica Adriat. 2010;19:45-46. 66. Marwah M, Gautam M, Patil S, Nadkarni N, Godse K. Migra- tory “moles” - dermoscopic diagnosis. Indian J Dermatol Vene- reol Leprol. 2012;78:665. 67. Sanaa K, Zahra MF. Dermoscopy in atypical phthiriais eyelash. Pan Afr Med J. 2016;23:11. 68. Jayasree P, Kaliyadan F, Ashique KT. Pubic Lice in Facial Hair. Dermatol Pract Concept. 2020;10:e2020042. 69. Thakur V, Gupta P, Vinay K. Dermoscopic features of post kala azar dermal leishmaniasis. J Eur Acad Dermatol Venereol. 2021;35:e460-e462. 70. Jha AK, Sonthalia S, Lallas A. Dermoscopy of Post Kala-Azar Dermal Leishmaniasis. Indian Dermatol Online J. 2018;9:78-79 71. Swarnkar B, Sathyan A, Gupta S, Arava SK. Dermoscopy find- ings of various cutaneous morphologies of post-kala-azar dermal leishmaniasis. Int J Dermatol. 2022;61:e493-e496. 72. Mathur M, Acharya P, Karki A. Dermoscopy-Assisted Tick Extraction. Indian Dermatol Online J. 2019;11:682-683. 73. Sendagorta E, Vidaurrázaga C, Mulekyo R. Hyperpigmented plaque on the foot of a Kenyan patient. Actas Dermosifiliogr. 2012;103:633-634. 74. Vinay K, Handa S, Khurana S, Agrawal S, De D. Dermatoscopy in Diagnosis of Cutaneous Myiasis Arising in Pemphigus Vul- garis Lesions. Indian J Dermatol. 2017;62:440. 55. Zhuang K, Ran X, Dai Y, et al. An Unusual Case of White Piedra Due to Trichosporon inkin Mimicking Trichobacteriosis. Mycopathologia. 2016;181:909-914. 56. Jakhar D, Kaur I. Entomodermoscopy: A tool for hunting bed bug. Indian J Dermatol Venereol Leprol. 2019;85:615-616. 57. Sonthalia S. Dermoscopy of Cydnidae Pigmentation: A Novel Disorder of Pigmentation. Dermatol Pract Concept. 2019;9: 228-229. 58. Jindal R, Chauhan P, Chugh R. Sudden Onset Acral Pigmented Macules: An Innocuous Diagnosis. Dermatol Pract Concept. 2021; 11:e2021054 59. Amrani A, Das A. Cydnidae pigmentation: unusual location on the abdomen and back. Br J Dermatol. 2021;184:e125. 60. Amrani A, Sil A, Das A. “Transient pseudo-lentigines sign” in burrowing bug pigmentation. Pediatr Dermatol. 2021;38: 1338-1339. 61. Sandhu S, Bhatnagar A, Suhag D. Dermoscopy of cutaneous larva migrans. Indian J Dermatol Venereol Leprol. 2022:1-2. 62. Bhat YJ, Yaseen A, Sheikh S, Hassan I. Dermoscopy of Two Cases of Cutaneous Leishmaniasis. Indian J Dermatol. 2020;65: 232-234. 63. Kumar Jha A, Sinha B, Zeeshan M. Unilateral periorbital swell- ing: a diagnostic dilemma. Clin Exp Dermatol. 2018;43:828-829. 64. Toukabri N, Souissi A, Abidi H, Mokni M. Dermoscopy aspects in Dermanyssus gallinae infestation. Int J Dermatol. 2019;58: e159-e160.