10.5826/dpc.1401a21
text/xml
2160-9381
3490
en
Mario Vaccaro
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
pthirus
Super-High Magnification Entodermoscopy: The New Era of Dermoscopy in the Field of Skin Parasitoses
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2024-01-31
2023-04-30
2024-01-31
2024-02-21
e2024021
Dermatol Pract Concept
Mario Vaccaro
2024/01/31
10.5826/dpc.1401a21
e2024021
Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
2160-9381
pthirus
en
e2024021
Di Bartolomeo L, Argenziano G, Borgia F, Vaccaro F, Vaccaro M. Efficacy evaluation of scabies treatment through super high mag¬nification dermoscopy. Ital J Dermatol Venerol. 2023;158(2):161-162. DOI: 10.23736/S2784-8671.22.07447-3. PMID: 37153952.
Super-High Magnification Entodermoscopy: The New Era of Dermoscopy in the Field of Skin Parasitoses
https://dpcj.org/index.php/dpc/article/download/3490/2547
       Super-High Magnification Entodermoscopy:
     The New Era of Dermoscopy in the Field of Skin
                      Parasitoses
             Luca Di Bartolomeo1, Federico Vaccaro2, Francesco Borgia3, Laura Macca3,
                               Stefano Portuese3, Mario Vaccaro3


1 Dermatology, ASL Salerno, Salerno, Italy
2 Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
3 Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy



Key words: entodermoscopy, super-high magnification dermoscopy, scabies, pediculus, pthirus
Citation: Di Bartolomeo L, Vaccaro F, Borgia F, Macca L, Portuese S, Vaccaro M. Super-High Magnification Entodermoscopy: The New
Era of Dermoscopy in the Field of Skin Parasitoses. Dermatol Pract Concept. 2024;14(1):e2024021. DOI: https://doi.org/10.5826
/dpc.1401a21
Accepted: June 8, 2023; Published: January 2024
Copyright: ©2024 Di Bartolomeo 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: Luca Di Bartolomeo, Viale della Repubblica, 23 – 84047 Capaccio-Paestum, Salerno, Italy; E-mail:
lucadibartolomeo@live.it




Introduction                                                             inguinal folds and proximal lower limbs, some of which
                                                                         are centered by linear escoriations. Dermoscopy at 20x
Super-high magnification dermoscopy (SHMD) is dermos-                    ­magnification and SHMD with the videodermoscope Foto-
copy at 400x magnification. Its use in the study of skin par-            finder Medicam 1000 (Fotofinder System, Bad Birnbach) al-
asitoses is still limited to scabies and demodicosis [1,2]. We           lowed us to recognize infestation by Pthirus pubis in the first
report four cases of skin parasitoses studied with SHMD,                 patient, by Pediculus capitis in the second and by Sarcoptes
including infestations by Pthirus pubis and Pediculus capitis.           scabiei in the third (Figure 1 and Figure 2, A and B). In addi-
                                                                         tion to traditional dermoscopy, SHMD allowed us to study

Case Presentation                                                        all body parts of lice and to recognize scabies mites in nod-
                                                                         ular scabies lesions where no traditional dermoscopic signs
Three patients presented 2-weeks history of persistent itch.             were visible. We report also a case of a 65-year-old female
The patients were respectively a 50-year-old man, an 8-year-             with a two year history of facial erythema. Clinical examina-
old child and a 40-year-old man. In the first patient, the itch          tion showed erythema and telangiectasia of the left cheek,
was diffuse on all body and clinical examination revealed                on which follicular spicules are barely noticeable to the
only isolated reddish-gray spots on the trunk. The child                 naked eye. Super-high magnification dermoscopy revealed
suffered from scalp itching and his mother said that other               several elongated white structures emerging from dilated
children in his school suffered from similar condition. The              hair follicles, suggesting the presence of Demodex mites
last patient presented itchy skin bumps, mainly located on               (Figure 2, B and C).


Research Letter | Dermatol Pract Concept. 2024;14(1):e2024021                                                                           1
Figure 1. (A) Pthirus pubis observed by SHMD (videodermoscope Fotofinder Medicam 1000, Fotofinder System, Bad Birnbach); the red
letters indicate the components of louse body: M, mouthparts with antennae; D, the digestive system; S, spiracles; TC, terminal claws; H,
hair on the dorsal surface; T, air tubes; (B) Close-up of terminal claws attached to patient body’s hair; (C) A second stage nymph of Pediculus
capitis observed by SHMD; the red letters indicate the components of louse body: A, antennae; M, mouthparts; E, eyes; D, digestive tract, L,
legs; (D): vital nit presenting the dome-shaped operculum (O).




Figure 2. (A) Excoriated nodules of nodular scabies visible on inner thigh of the patient; (B) Dorsal view of Sarcoptes scabiei mite with
mouthparts and anterior legs, spines on abdomen and posterior legs visible through transparent body; (C) Barely noticeable follicular spicules
with erythema and telangiectasia on the left cheek of the patient; (D) Demodex folliculorum tails emerging from dilated follicle as elongated
white structures (videodermoscope Fotofinder Medicam 1000, Fotofinder System, Bad Birnbach).


2                                                                             Research Letter | Dermatol Pract Concept. 2024;14(1):e2024021
Conclusions                                                        and can be useful for several purposes in skin infestation
                                                                   study, such as the detection of parasites or determination of
For over 20 years, dermoscopy has proven its usefulness in         parasite vitality and efficacy of therapy [1,6]. SHMD can be
the diagnosis of parasitoses and in the distinction between        considered a kind of in vivo microscopy and implementing
various species of lice, based on body features, which has         its use in clinical practice could help us to better understand
been improved by the use of SHMD [3,4]. Moreover, SHMD             our skin.
allows us the study of parasite vitality by dynamic observa-
tions of peristaltic activity based on blood movements inside
the digestive tract of adult lice and by the visualization of      References
the operculum on the end of the eggs, which is absent in            1. Winkler JK, Toberer F, Enk AH, Haenssle HA. Super-high
empty nits [5]. Moreover, the study of operculum shape may             magnification dermatoscopy for in-vivo imaging of scabies mites.
distinguish the different lice species: Pthirus pubis presents a       J Dtsch Dermatol Ges. 2022;20(2):216-217. DOI: 10.1111
conoidal operculum, while Pediculus capitis a dome-shaped              /ddg.14651. PMID: 34914169.
                                                                    2. Cinotti E, Bertello M, Donelli C et al. Super-high magnification
operculum [4], as in our patient.
                                                                       dermoscopy can detect Demodex folliculorum. J Eur Acad Der-
   SMDH has been already used to assess the vitality of sca-
                                                                       matol Venereol. 2023;37(1):e96-e97. DOI: 10.1111/jdv.18496.
bies mites and the effectiveness of treatments. It is useful in        PMID: 35964306.
cases where traditional dermoscopy fails to distinguish frag-       3. Argenziano G, Fabbrocini G, Delfino M. Epiluminescence micros-
ments of mites from viable mites [1,6]. Moreover, as in our            copy. A new approach to in vivo detection of Sarcoptes scabiei.
patient, SHMD may be useful in cases of scabies difficult to           Arch Dermatol. 1997;133(6):751-3. DOI: 10.1001/archderm.
                                                                       133.6.751. PMID: 9197830.
diagnoses as nodular scabies, in which the burrows are not
                                                                    4. Scanni G. Human phthiriasis. Can dermoscopy really help
clinically evident, so the dermoscopic “delta wing jet with
                                                                       dermatologists? Entodermoscopy: a new dermatological dis-
contrail” sign is not clearly detected.                                cipline on the edge of entomology. G Ital Dermatol Venereol.
   As already demonstrated by Cinotti et al, SHMD may                  2012;147(1):111-7. PMID: 22370575.
avoid skin biopsies on the face where traditional dermos-           5. Scanni G., Bonifazi E. Viability of the head louse eggs in pe-
copy fails to detect Demodex. Moreover, SHMD may allow                 diculosis capitis. A dermoscopy study. Eur J Pediat Dermatol.
                                                                       2006;16:201-204.
a measurement of the degree of parasitosis based on the
                                                                    6. Di Bartolomeo L, Argenziano G, Borgia F, Vaccaro F, ­Vaccaro M.
amount of mites found.
                                                                       Efficacy evaluation of scabies treatment through super
   We report a study of lice infestation by SHMD, in ad-               high mag­  nification dermoscopy. Ital J Dermatol Venerol.
dition to our experience in other skin parasitoses. SHMD               2023;158(2):161-162. DOI: 10.23736/S2784-8671.22.07447-3.
allows to view more details than traditional 20x dermoscopy            PMID: 37153952.




Research Letter | Dermatol Pract Concept. 2024;14(1):e2024021                                                                        3
