Dermatology: Practical and Conceptual


Editorial | Dermatol Pract Concept. 2023;13(4)S1:e2023305S 1

Dermoscopy in Skin of Color: The Journey So Far
Enzo Errichetti1, Aimilios Lallas2, Giuseppe Argenziano3

1 Institute of Dermatology, “Santa Maria della Misericordia” University Hospital, Udine, Italy

2 First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece

3 Unit of Dermatology, Luigi Vanvitelli University of Campania, Naples, Italy

Key words: dermoscopy, dermatoscopy, epiluminescence, skin of color, dark skin, black skin, ethnic skin, dark phototype, african skin, 
systematic review

Citation: Errichetti E, Lallas A, Argenziano G. Dermoscopy in Skin of Color: The Journey So Far. Dermatol Pract Concept. 2023;13(4)
S1:e2023305S. DOI: https://doi.org/10.5826/dpc.1304S1a305S

Accepted: June 19, 2023; Published: October 2023

Copyright: ©2023 Errichetti 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: Enzo Errichetti, MD, Institute of Dermatology, “Santa Maria della Misericordia” University Hospital, 
Piazzale Santa Maria della Misericordia, 15. 33100-Udine, Italy. Email: enzoerri@yahoo.it

Diagnosis in dermatology is a fascinating but also challeng-

ing process as it mostly relies on physician’s ability to identify 

morphological details of elementary lesions [1, 2]. In the past, 

patients’ evaluation was mainly based on naked-eye clini-

cal analysis, yet over the last few decades the additional use 

of the dermatoscope has been showed to increase diagnos-

tic accuracy, thereby deserving the epithet “dermatologist’s 

stethoscope” [3]. Although initially used for supporting the 

diagnosis of skin tumors, dermoscopic examination has been 

extended to non-neoplastic conditions, especially inflamma-

tory and infectious dermatoses as well as hair diseases [4].  

Of note, albeit its use is wider in light phototypes (I-III), 

dermoscopy has gained popularity also in dark-skinned pa-

tients, in which patterns may significantly differ because of 

the darker background and specific reactions typical of skin 

of color (e.g. lability of pigment and tendency to follicular or 

sclerotic reactions) [5]. However, literature evidence on dark 

phototypes is still limited (<3% of all published papers on 

dermoscopy) and sparse [6-9].

This special issue of Dermatology Practical & Concep-

tual (DPC) provides the readers with an up-to-date literature 

overview about the use of dermoscopy in dark skin. Most of 

included data comes from four systematic reviews (one each 

for inflammatory, infectious, neoplastic and hair diseases) by 

the “Imaging in Skin of Color” Task Force of the Interna-

tional Dermoscopy Society (IDS) [6-9], that has recently been 

created. Inflammatory and infectious dermatoses turned out 

to have the highest number of published articles (85 and 66, 

respectively), encompassing a total of 78 and 41 different 

conditions, likely as the result of the wider number of entities 

in these fields and their high prevalence in dark-skinned pop-

ulations [6,7]. Interestingly, trichoscopy showed the highest 

ratio between published studies and number of diseases  

(60 and 19, respectively) with consequent more data on re-

producibility of the findings [8], unlike skin tumors that were 

investigated by a limited number of studies (20 for a total  

of 46 neoplasms) possibly due to their lower prevalence in 

skin of color [9]. Figure 1 depicts clinical subcategories of de-

scribed dermatoses for each field (inflammatory, infectious, 

hair and neoplastic disorders), with the following conditions 

being the most represented ones: (I) papulosquamous and 

pigmentary dermatoses; (II) parasitoses (including bites and 



2 Editorial | Dermatol Pract Concept. 2023;13(4)S1:e2023305S

stings), bacterial and fungal diseases; (III) adnexal, kerati-

nocytic and vascular tumors; and (IV) cicatricial and non- 

cicatricial alopecias [6-9].

Moving to the temporal distribution of published articles 

(Figure 2), while a more stable publication ratio per year was 

observed over the time for both hair diseases and tumors, 

the number of articles on inflammatory and infectious der-

matoses showed a remarkable leap over the last few years, 

with most papers being published during the last six years 

[6-9]. Regarding the number of newly described diseases 

(Figure 3), a significant increase was found in recent times, 

with peaks in 2017 and 2021 for tumors, in 2019 for infec-

tious dermatoses, and in 2020 for inflammatory disorders 

[6-9]. This is due to the increase of the absolute number of 

articles during such years but also to the publication of more 

comprehensive studies including a wider number of entities, 

such as the multicentric controlled study on dermoscopy in 

general dermatology promoted by the IDS in 2020 [5].

Notably, most of the available studies on dermoscopy of 

dark phototypes showed a low level of evidence (V based 

on The Oxford 2011 Levels of Evidence), with a prevalence 

of case-series and single case-reports and only a limited 

Figure 1. Clinical subcategories of described dermatoses for each dermoscopic field (inflammatory, infectious, hair and neoplastic disorders); 

the most represented ones include: (I) papulosquamous and pigmentary dermatoses; (II) parasitoses (including bites and stings), bacterial and 

fungal diseases; (III) adnexal, keratinocytic and vascular tumors; and (IV) cicatricial and non-cicatricial alopecias.



Editorial | Dermatol Pract Concept. 2023;13(4)S1:e2023305S 3

Figure 2. Temporal distribution of published articles on dermoscopy of dark-skinned patients; while a more stable publi-

cation ratio per year was observed over the time for both hair diseases and tumors, the number of articles on inflammatory 

and infectious dermatoses showed a remarkable leap over the last few years, with most papers being published during the 

last six years.

Figure 3. Temporal distribution of the number of dermatoses whose dermoscopic features were described for the first time; 

a significant increase was found in recent times, with peaks in 2017 and 2021 for tumors, in 2019 for infectious dermatoses, 

and in 2020 for inflammatory disorders.



4 Editorial | Dermatol Pract Concept. 2023;13(4)S1:e2023305S

homogeneous standardized nomenclature was provided in 

the reviews based on the IDS dermoscopic criteria for tu-

mors and non-neoplastic dermatoses validated for skin of 

color [10,11]

In conclusion, there is a growing interest towards the use 

of dermoscopy in skin of color as testified by the recent in-

crease of the number of studies published in the literature on 

this topic. Such a supportive tool may have a relevant role in 

the context of the diagnostic process of dermatological dis-

eases, that is even more complex in dark phototypes due to 

due to the lack of some important clinical clues, such as er-

ythema, lesion shade or surface changes (e.g., pigmentation 

and telangiectasias) [2]. However, analyses designed accord-

ing to a systematic approach are needed to better validate the 

accuracy of this technique in skin of color and the present 

issue of DPC is intended to be the starting point to set new 

studies aiming at filling the highlighted gaps.

number of studies displaying a higher level of evidence, in-

cluding case-control and cross-sectional analyses (IV and 

III level of evidence, respectively) [6-9]. Interestingly, when 

comparing the four included fields (Figure 4), inflamma-

tory and hair diseases turned out to have the greatest num-

ber of studies with a higher level of evidence (11 and 21 

studies, respectively, taking into account both case-control 

and cross-sectional analyses), while articles on infectious 

and neoplastic dermatoses had a level of evidence of V (case 

 series/reports) in 98% (65 out of 66) and 90% (18 out of 20) 

of cases, respectively [6-9].

Finally, a poor consistency of used terminology among 

the studies was also highlighted, especially for infectious/

inflammatory dermatoses and tumors, with consequent 

limitations in terms of reproducibility of described find-

ings [6, 7, 9]. To deal with such an issue, an alignment of 

dermoscopic terminology of reported features following a 

Figure 4. Number of published articles according to the study type (cohort, case-control, case-series, and case-reports); inflammatory and 

hair diseases display the greatest number of studies with a higher level of evidence (case-control and cross-sectional analyses), while articles 

on infectious and neoplastic dermatoses are mainly case series and case reports



Editorial | Dermatol Pract Concept. 2023;13(4)S1:e2023305S 5

review by the International Dermoscopy Society “Imaging 

in Skin of Color” Task Force. Dermatol Pract Concept. DOI: 

10.5826/dpc.1304S1a309S

8. Khare S, Behera B, Ding DD, et al. Dermoscopy of Hair and 

Scalp Disorders (Trichoscopy) in Skin of Color – a systematic re-

view by the International Dermoscopy Society “Imaging in Skin 

of Color” Task Force. Dermatol Pract Concept. DOI: 10.5826 

/dpc.1304S1a310S

9. Enechukwu NA, Behera B, Ding DD, et al. Dermoscopy of 

Cutaneous Neoplasms in Skin of Color – a systematic review 

by the International Dermoscopy Society “Imaging in Skin of 

Color” Task Force. Dermatol Pract Concept. DOI: 10.5826 

/dpc.1304S1a308S

10. Errichetti E, Ankad BS, Jha AK, et al. International Dermoscopy 

Society criteria for non-neoplastic dermatoses (general dermatol-

ogy): validation for skin of color through a Delphi expert con-

sensus. Int J Dermatol 2022;61:461-71.

11. Ankad BS, Behera B, Lallas A, et al. International Dermoscopy 

Society (IDS) Criteria for Skin Tumors: Validation for Skin of 

Color Through a Delphi Expert Consensus by the “Imaging 

in Skin of Color” IDS Task Force. Dermatol Pract Concept 

2023;13:e2023067.

References

1. Lallas A, Errichetti E, Ioannides D. Dermoscopy in General 

 Dermatology. Boca Raton, FL: CRC Press; 2018.

2. Errichetti E, Lallas A. Dermoscopy in General Dermatology for 

Skin of Color. Boca Raton, FL: CRC Press; 2021.

3. Lallas A, Argenziano G. Dermatoscope--the dermatologist’s 

stethoscope. Indian J Dermatol Venereol Leprol 2014;80:493-4.

4. Errichetti E. Dermoscopy in General Dermatology (Non- 

Neoplastic Dermatoses): The Journey So Far. Dermatol Ther 

(Heidelb) 2021;11:1871-7.

5. 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;30:688-98.

6. Sławińska M, Żółkiewicz J, Behera B, et al. Dermoscopy of 

 Inflammatory Dermatoses (Inflammoscopy) in Skin of Color – 

a systematic review by the International Dermoscopy Society 

 “Imaging in Skin of Color” Task Force. Dermatol Pract Concept. 

DOI: 10.5826/dpc.1304S1a297S

7. Chauhan P, Behera B, Ding DD, et al. Dermoscopy of Infectious 

Dermatoses (Infectiouscopy) in Skin of Color – a systematic