Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2025;15(1):5075 1 Misdiagnosis of Skin Vasculitis Easily Avoided Thanks to Dermoscopy Vittorio Tancredi1, Gaetano Licata2, Caterina Mariarosaria Giorgio1, Eugenia Veronica Di Brizzi1, Elvira Moscarella1, Giuseppe Argenziano1 1 Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy 2 Dermatology Unit, San Antonio Abate Hospital, Trapani, Italy Citation: Tancredi V, Licata G, Giorgio CMR, Di Brizzi EV, Moscarella E, Argenziano G. Misdiagnosis of Skin Vasculitis Easily Avoided Thanks to Dermoscopy. Dermatol Pract Concept. 2025;15(1):5075. DOI: https://doi.org/10.5826/dpc.1501a5075 Accepted: October 16, 2024; Published: January 2025 Copyright: © Tancredi 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: Vittorio Tancredi, MD, Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Via Sergio Pansini, 5, 80131 Naples, Italy. E-mail: tancredivittorio@ymail.com Case Presentation A 70-year-old man was referred to our department due to a subacute onset of a diffuse purpuric burning and itching rash primarily affecting his lower limbs (Figure 1A). The initial clinical diagnosis was cutaneous vasculitis. Given the purple, partially ulcerated, palpable nature of the lesions, a diagnosis of vasculitis appeared plausible, prompting us to proceed with our usual diagnostic protocol, including skin biopsy. However, in recent years, the use of dermoscopy has become more and more diffuse, not only for suspected ma- lignant lesions but also for inflammatory conditions (inflam- moscopy) [1]. In this case, dermoscopic assessment proved to be of paramount importance. Upon closer examination, we identified a purpuric background and a scabies furrow (Figure 1B). Consequently, we promptly revised the diagno- sis, and subsequently the management, to scabies. Teaching Point Previous studies have described vasculitis-like scabies. Histological examinations have revealed leukocytoclastic vasculitis in patients with concurrent scabies infestation, suggesting a hypersensitivity reaction mediated by the im- mune system against mite antigens [2]. However, we posit that hemorrhagic and purpuric manifestations could also result from vigorous scratching in elderly patients who are under antiplatelet or anticoagulant treatment rather than indicating true histological vasculitis. In any case, most clin- ical manifestations resolve with appropriate antiparasitic treatment. In conclusion, dermoscopy plays a crucial role in inflam- matory conditions, particularly proving highly effective in diagnosing scabies and distinguishing it from clinical mim- ickers, including cutaneous vasculitis 2 Image Letter | Dermatol Pract Concept. 2025;15(1):5075 References 1. Errichetti E. Dermoscopy of Inflammatory Dermatoses (Inflammoscopy): An Up-to-Date Overview. Dermatol Pract Concept. 2019 Jul 31;9(3):169-180. DOI: 10.5826/dpc.0903a01. PMID: 31384489; PMCID: PMC6659598. 2. Alabbadi A, Alalwi S, Alkhalifah R, et al. Scabies-Associated LeukocytoclasticVasculitis: A Case Report and Review of Literature. Cureus. 2021 Dec 26;13(12):e20725. DOI: 10.7759 /cureus.20725. PMID: 34976550; PMCID: PMC8711789. Figure 1. (A) Diffuse purpuric skin eruption of the lower limbs. (B) Dermoscopic observation shows a scabies furrow on a purplish background.