10.5826/dpc.1401a7
text/xml
2160-9381
3194
en
Piergiacomo Calzavara-Pinton
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
non-invasive tools
Line-Field Confocal Optical Coherence Tomography of a Suspected Case of Galli-Galli Disease
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2024-01-31
2023-02-16
2024-01-31
2024-02-21
e2024007
Dermatol Pract Concept
Piergiacomo Calzavara-Pinton
2024/01/31
10.5826/dpc.1401a7
e2024007
Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia; Faculty of Medicine and Surgery, University of Brescia, Brescia, Italy
2160-9381
non-invasive tools
en
e2024007
El Shabrawi-Caelen L, Rütten A, Kerl H. The expanding spectrum of Galli-Galli disease. J Am Acad Dermatol. 2007;56(5 Suppl):S86-S91. DOI: 10.1016/j.jaad.2006.10.987. PMID: 17434047.
Line-Field Confocal Optical Coherence Tomography of a Suspected Case of Galli-Galli Disease
https://dpcj.org/index.php/dpc/article/download/3194/2451
 Line-Field Confocal Optical Coherence Tomography
      of a Suspected Case of Galli-Galli Disease
               Vincenzo Maione1, Francesco Tonon1, Simone Soglia1, Anna Venturuzzo1,
                        Marina Venturini1,2, Piergiacomo Calzavara-Pinton1,2


1 Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
2 Faculty of Medicine and Surgery, University of Brescia, Brescia, Italy



Key words: Galli-Galli, LC-OCT, reflectance confocal microscopy, non-invasive tools.
Citation: Maione V, Tonon F, Soglia S, Venturuzzo A, Venturini M, Calzavara-Pinton P. Line-Field Confocal Optical Coherence
Tomography of a Suspected Case of Galli-Galli Disease. Dermatol Pract Concept. 2024;14(1):e2024007. DOI: https://doi.org/10.5826/
dpc.1401a7
Accepted: May 14, 2023; Published: January 2024
Copyright: ©2024 Maione 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: Dr. Francesco Tonon, Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, P. Le Spedali
Civili 1 , 25123, Brescia, Italy. Phone: +390303995302 Email: f.tonon@unibs.it




Introduction                                                             Case Presentation
Galli-Galli disease (GGD) is a rare genodermatosis. Histology            A 64-year-old woman presented to our clinic showing asymp-
shows acantholysis at suprabasal level, hyperkeratosis and               tomatic brown papules and lentigo-like macules on the trunk
a downward finger-like proliferation of the rete ridges into             and extremities (Figure 1). Dermoscopy of a papule showed
the papillary dermis [1,2]. When histology is only partially             a central yellowish/brownish area with polygonal shape sur-
conclusive and/or the patient refuses invasive investigations,           rounded by a whitish halo overlying a pinkish homogeneous
non-invasive imaging techniques could assist the diagnosis.              structureless area with harpin and linear vessels (Figure 1).
Coelho de Sousa et al made the first reflectance confocal mi-            These findings were similar to the acantholytic Darier and
croscopy (RCM) evaluation of GGD [3]. Line-field confocal                Grover diseases[4]. Lentigo-like macules showed a pseu-
optical coherence tomography (LC-OCT) offers additional                  doreticular pattern similar to adenoid seborrheic keratosis.
features compared to RCM, such as a superior penetration                 Histological sections from a skin biopsy exhibited hyperker-
in depth (up to 500 μm), a dermoscopic view of the analyzed              atosis, dyskeratosis and suprabasal acantholysis (Figure 1).
tissue, and the possibility to obtain vertical histology-like            Since the patient refused to undergo a second biopsy, we
sections and 3D reconstructions of the examined tissue. To               used non-invasive techniques for further investigations.
date, there are no LC-OCT descriptions of GGD.                           We examined several papular and pigmented lesions with




Research Letter | Dermatol Pract Concept. 2024;14(1):e2024007                                                                         1
                    Figure 1. (A) Clinical image of our patient showing brown macules and papules distributed on
                    the trunk and upper extremities. (B) Dermoscopy image of a papule of the upper trunk showing
                    a central yellow area surrounded by white halo and harpin and linear vessels. (C) ­Dermoscopy
                    image of a lentigo-like macule showing a pseudoreticular pattern. (D) Histological sections
                    from a skin biopsy showing areas of hyperkeratosis and suprabasal acantholysis.


RCM (Vivascope 3000®, Caliber Imaging and Diagnos-                   trunk, acantholysis and dyskeratosis without elongation of
tics): our findings were in accordance with the description          the rete ridges on histology. Dowling-Degos disease was
of Coelho de Sousa et al (Figure 2) [3]. At LC-OCT evalua-           excluded because of the presence of acantholysis and the
tion (DeepLive®, DAMAE Medical) several lesions showed               absence of comedo-like lesions and pitted perioral acnei-
intraepidermal dark areas with hyper refractile roundish             form scars.
elements within correlating respectively to acantholysis and
dyskeratotic cells, a downward finger-like proliferation of
                                                                     Conclusions
the rete ridges into the papillary dermis and basal hyper-
pigmentation (Figure 2). These images were reviewed by an            An advantage of LC-OCT in diagnosing GGD is that several
interdisciplinary group composed of dermatologists and pa-           lesions can be studied in a relatively short time without caus-
thologists; combining these findings with the clinical aspects,      ing discomfort to patients; this could be particularly useful
GGD was deemed to be the most likely diagnosis. Darier               given that identifying features such as acantholysis on histol-
disease has earlier onset, seborrheic distribution of crusted        ogy can be difficult and often several histological sections are
yellow-brown papules rather than lentigo-like macules, nail          needed to appreciate them [5]. Indeed, examining different
changes and mucous membrane involvement. Grover’s dis-               cutaneous lesions can identify the most suitable sites for bi-
ease usually presents with pruritic keratotic papules on the         opsy thus avoiding the need for multiple biopsies.




2                                                                         Research Letter | Dermatol Pract Concept. 2024;14(1):e2024007
Figure 2. (A,B) Reflectance confocal microscopy RCM images of a hyperkeratotic papule of the trunk showing dark clefts in the epidermis
with bright roundish cells within (yellow circle) (A) and branched deer antler-like refractile structure at junctional level (red arrows) (B).
(C) Line-field confocal optical coherence tomography (LC-OCT) horizontal section showing an hypo-refractile area of suprabasal acanthol-
ysis with dyskeratotic cells within (blue star). (D) LC-OCT 3D reconstruction of the analyzed tissue section showing downward bud-like
proliferation of rete ridges into the papillary dermis (yellow line). (E) Dermoscopic view of the pigmented macule analyzed with LC-OCT.


    Non-invasive techniques represent a diagnostic tool, yet                 disorders of the skin. J Cutan Pathol. 2009;36(1):44-48. DOI:
to be fully discovered, that could allow in a more conserva-                 10.1111/j.1600-0560.2008.00995.x. PMID: 18564280.
                                                                          3. Coelho de Sousa V, El-Shabrawi-Caelen L, Mendes-Bastos P,
tive approach to selected cases.
                                                                             Oliveira A. Reflectance confocal microscopy for the diagnosis
                                                                             of Galli-Galli disease. Int J Dermatol. 2017;56(12):1501-1504.
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Research Letter | Dermatol Pract Concept. 2024;14(1):e2024007                                                                                3
