Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2025;15(4):5245 1 Dermoscopic Features of Morbilliform Rash in Dengue Fever: A Clinical Insight Caterina Mariarosaria Giorgio1, Eugenia Veronica Di Brizzi1, Giuseppe Argenziano1, Claudia Di Sarno2, Raffaele di Sarno3, Gaetano Licata4 1 Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy 2 Medical Student of University of Campania Luigi Vanvitelli, Naples, Italy 3 Emergency Room Infection Disease Cotugno Hospital AORN dei Colli, Naples, Italy 4 Dermatology Unit, San Antonio Abate Hospital, Trapani, Italy Citation: Giorgio CM, Di Brizzi EV, Argenziano G, Di Sarno C, Di Sarno R, Licata G. Dermoscopic Features of Morbilliform Rash in Dengue Fever: A Clinical Insight. Dermatol Pract Concept. 2025;15(4):5245. DOI: https://doi.org/10.5826/dpc.1504a5245 Accepted: January 7, 2025; Published: October 2025 Copyright: ©2025 Giorgio 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: Gaetano Licata, MD, Dermatology Unit, San Antonio Abate Hospital, Via Cosenza 82, 91016, Erice (TP), Italy. E-mail gaetano.licata89@gmail.com Case Presentation A 30-year-old malecame to our department with a history of high fever (39°C), asthenia, headache ,and myalgia four days after a trip to a tropical area; he presented with er- ythematous macules confined to the hands and feet. Clin- ically well-demarcated macular, non-pruritic, erythematous areas primarily affecting the hands and feetwere observed (Figures 1A and B).Dengue fever was confirmed via serologi- cal tests. Considering the diagnosis of dengue and the atypical clinical presentation, dermoscopic examination was per- formed, and the following dermoscopic features were observed (Figures 1C and D): shiny white structures, visible under po- larized light,potentially indicative of acute inflammation and dermal fibrosis;red hemorrhagic dots and globules, indica- tive of capillary fragility. Teaching Point Dengue fever typically manifests with a generalized rash in- volving the trunk and sometimes the face[1]. The observed shiny white structures may reflect acute dermal changes, while red dots/globules could be markers of thrombocytopenia. Current literature contains few studies describing the dermo- scopic patterns of exanthematous diseases[2]. Measles may exhibit an intensely erythematous background due to con- fluent macules, rubella may show a pinkish-red background corresponding to its non-confluent maculopapular rash, and parvovirus B19 mayreveal a moderately erythematous reticu- lated pattern. These dermoscopic differences underscore the potential of this tool in differential diagnosis. Interestingly, a comparison with other viral exanthems revealed the absence of shiny white structures, suggesting that this finding couldbe 2 Image Letter | Dermatol Pract Concept. 2025;15(4):5245 characteristic of dengue fever. Moreover, red hemorrhagic dots and globules are instead present in other exanthematous diseases [2]. However, further studies are necessary to validate their diagnostic relevance and specificity in dengue. Ethics Statement: The patients in this manuscript have given written informed consent to the publication of their case de- tails. This study follows the ethics guidelines. References 1. Khan MB, Yang ZS, Lin CY, et al. Dengue overview: An up- dated systemic review. J Infect Public Health.2023 Oct;16(10): 1625-1642. doi: 10.1016/j.jiph.2023.08.001. Epub 2023 Aug 3. PMID: 37595484. 2. Errichetti E, Stinco G. How to differentiate skin rash in covid, mononucleosis, chickenpox, sixth disease and measles. Curr Opin Infect Dis. 2023 Apr 1;36(2):109-113. doi: 10.1097 /QCO.0000000000000904. Epub 2023 Jan 25. PMID: 36718910. Figure 1. A-B: Clinical images of a 30-year-old maleaffected by dengue fever extending to the palms and soles.C-D: Dermoscopic images of dengue fever where it is highlighted theaspecific presence of red dots/globules (square) and shiny white structures ( arrows).