Videodermatoscopy: Beyond pigmented lesions

"Videodermatoscopy is a non-invasive technique that consists of in vivo skin observation by a video camera equipped with lenses that currently allow image magnification ranging from 4X to 1000X,"says Dr. Micali, chief, Dermatology Clinic, University of Catania, Catania, Italy. "The images obtained are visualized on a high-definition monitor and may be stored on a personal computer in order to recognize and compare changes over time. This visual documentation with its ever growing implementation spectrum can facilitate a quicker, cleaner and more meticulous method of reaching diagnosis and decisions on treatment."

False negative results are very rare and are mostly due to the physician's lack of experience or to the presence of superficial infections. Especially at high magnification, the images obtained by VD are definitive, allowing a high specificity with no chance of false positive results. A non-invasive diagnostic tool, VD also eliminates the risk of accidental infections from blood-transmissible viruses during scraping.

"An important advantage of VD is its high compliance. While skin scraping may be discomforting - especially when repeated tests are necessary for a conclusive diagnosis - and may cause fear of pain or bleeding, especially in children, VD does not cause physical or psychological discomfort. In the latter case, especially when itch persists, it may easily rule out a persistent infection, thus providing important therapeutic indications," Dr. Micali says.

VD enhances the monitoring of clinical response to treatment and allows optimal timing of drug application. This may be particularly important in minimizing risk of overtreatment, reducing the potential for side effects and enhancing patient compliance, Dr. Micali says.

In patients with head and pubic lice, both mites and their eggs are detectable with close examination. VD may be used for a more detailed identification for residual eggs in cases of treatment resistance. Additionally, VD does not require hair pulling.

Hair loss The clinical diagnosis of alopecia areata (AA), androgenic alopecia (AGA) and scarring alopecia is not difficult when some typical clues are appreciable at standard clinical observation or by magnification lenses. In these disorders, useful noninvasive investigations include the daily count of hairs, the wash test and the pull test. Yet, in some cases, the clinical diagnosis may not be straightforward, either because different hair disorders may sometimes coexist or because the typical features may be difficult to appreciate at first glance. In the latter cases, semi-invasive (standardized trichograms) or invasive techniques (punch biopsy) are often required, although they are frequently not well accepted by patients. Here, VD proves to be a useful and noninvasive tool able to provide diagnostic and prognostic information.