10.5826/dpc.1303a243
text/xml
2160-9381
3354
en
Enzo Errichetti
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
diagnostics
Pink-Red Fluorescence Observed in Ultraviolet-Induced Fluorescence Dermoscopy of Psoriatic Plaques
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-07-31
2023-03-23
2023-07-31
2023-08-24
e2023243
Dermatol Pract Concept
Enzo Errichetti
2023/07/31
10.5826/dpc.1303a243
e2023243
Institute of Dermatology, Santa Maria della Misericordia University Hospital, Udine, Italy
2160-9381
diagnostics
en
e2023243
Pietkiewicz P, Navarrete-Dechent C, Goldust M, Korecka K, Todorovska V, Errichetti E. Differentiating Fordyce Spots from Their Common Simulators Using Ultraviolet-Induced Fluorescence Dermatoscopy-Retrospective Study. Diagnostics (Basel). 2023;13(5):985. DOI: 10.3390/diagnostics13050985. PMID: 36900129. PMCID: PMC10000991.
Pink-Red Fluorescence Observed in Ultraviolet-Induced Fluorescence Dermoscopy of Psoriatic Plaques
https://dpcj.org/index.php/dpc/article/download/3354/2213
                        Pink-Red Fluorescence Observed
                      in Ultraviolet-Induced Fluorescence
                        Dermoscopy of Psoriatic Plaques
               Paweł Pietkiewicz1,2, Cristian Navarrete-Dechent3,4, Herman Mayisoğlu5,
                           Gursharan Jolly6, Ömer Kutlu7, Enzo Errichetti8


1 Dermatology Private Practice, Poznań, Poland
2 Polish Dermatoscopy Group, Poznań, Poland
3 Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
4 Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
5 Department of Dermatology, Private Medicana Hospitals Bahçelievler, Istanbul,Turkey
6 Independent scholar, Poznań, Poland
7 Department of Dermatology & Venereology, Tokat Gaziosmanpasa University, School of Medicine, Tokat, Turkey
8 Institute of Dermatology, Santa Maria della Misericordia University Hospital, Udine, Italy



Key words: dermatoscopy, ultraviolet radiation, psoriasis, porphyrins, diagnostics
Citation: Pietkiewicz P, Navarrete-Dechent C, Mayisoğlu H, Jolly G, Kutlu Ö, Errichetti E. Pink-Red Fluorescence Observed
in Ultraviolet-Induced Fluorescence Dermoscopy of Psoriatic Plaques. Dermatol Pract Concept. 2023;13(3):e2023243.
DOI: https://doi.org/10.5826/dpc.1303a243
Accepted: May 26, 2023; Published: July 2023
Copyright: ©2023 Pietkiewicz 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: Paweł Pietkiewicz, Centrum Medyczne Zwierzyniecka, Zwierzyniecka Street 30/28, Poznań 60-814.
Telephone: +48 602 133 503 E-mail: pietkiewicz.pp@gmail.com




Introduction                                                             psoriasis severity [1,2]. Through the Stokes shift phenom-
                                                                         enon, ­ultraviolet-induced fluorescence dermoscopy (UVFD)
Psoriasis is a prevalent erythematous-desquamative derma-                offers a novel non-invasive diagnostic approach that visual-
tosis with a substantial global mental and socioeconomic                 izes the UV-induced fluorescence of skin chromophores [5],
impact, affecting individuals of all ages. Among the pri-                with red fluorescence reported to be associated with the
mary risk factors are genetic susceptibility, metabolic syn-             presence of protoporphyrin IX in the stratum corneum [3].
drome, trauma, and stress. When examined under Wood’s                    To date, the fluorescence patterns in psoriasis under Wood
lamp (peak wavelength 365nm), certain psoriatic plaques                  lamp have been mostly limited to clinical naked-eye exam-
exhibit a red fluorescence [1-4]. Previous studies have re-              ination [1-3]. Here, we report pink-reddish fluorescence of
ported an association between this finding and increased                 psoriasis under UVFD.




Research Letter | Dermatol Pract Concept. 2023;13(3):e2023243                                                                         1
Case Presentation                                                        fibers under UVFD, a distinctive pink-red fluorescence was
                                                                         identified in the central part of the lesion (Figure 1). In the
A 51-year-old man (Psoriasis Area Severity Index score 2.8)              reported case, this neon-like luminescence appeared to ema-
presented to the dermatology outpatient clinic with a soli-              nate from the scale near the elongated dermal papillae. Mi-
tary psoriatic plaque on his thigh present for a few weeks. In           crobiological culture collected from the patch was negative.
addition to the bright blue-greenish fluorescence of keratin             The patient was treated with topical clobetasol and emol-
and the blue background fluorescence of collagen and elastin             lients with excellent response.




Figure 1. (A) Clinical presentation of plaque psoriasis in a 51-year-old patient with a single lesion on a left thigh present for a few weeks.
(B) Non-contact polarized dermoscopy of a suspect lesion reveals a silvery white-yellowish diffuse scale strongly adhering to the skin sur-
face. Single hemorrhagic dots can be appreciated. (C) Ultraviolet-induced fluorescence dermoscopy (UVFD) reveals bright blue-greenish
fluorescence of keratin, black centered hemorrhagic dots (high UV-absorbance of hemoglobin) and pink-red fluorescence of protoporphyrin
IX within the stratum corneum. Blue stain is an artifact, likely associated with an emollient applied the other day. (D) Magnified image of
non-contact polarized dermoscopy shows diffuse white-yellowish scale with roundish clods. Some of them enclose a centered hemorrhagic
dot - a remnant of a dermal papillary vessel. (E) Magnified image with UVFD displays pink-red dots and clods surrounding the perivascular
areas of elongated dermal papillae. Areas with greenish tint might correspond to serous deposits within the hyperkeratotic and parakeratotic
scale.



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Conclusions                                                         References
We have confirmed red fluorescence of psoriatic plaques             1. Wang B, Xu YT, Zhang L, et al. Protoporphyrin IX fluores-
                                                                       cence as potential indicator of psoriasis severity and pro-
observed with UVFD by Xie et al [2]. The exact source of
                                                                       gression. ­Photodiagnosis Photodyn Ther. 2017;19:304-307.
epidermal porphyrins (protoporphyrin IX) remains unclear.
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have either bacterial or non-bacterial origin. Despite a nega-         features of psoriasis vulgaris under the ultraviolet dermos-
tive microbiological culture, we cannot confidently exclude            copy. P ­ hotodiagnosis Photodyn Ther. 2022;40:103100.
an infectious origin as the cause of fluorescence. The latter          DOI: 10.1016/j.pdpdt.2022.103100. PMID: 36055625.
                                                                    3. Bissonnette R, Zeng H, McLean DI, Schreiber WE, Roscoe DL,
hypothesis might be supported by the previously unreported
                                                                       Lui H. Psoriatic plaques exhibit red autofluorescence that is due
deposition of chromophores around the tortuous elongated
                                                                       to protoporphyrin IX. J Invest Dermatol. 1998;111(4):586-591.
vessels of acanthotic papillae (Figure 1E). Wang et al. re-            DOI: 10.1046/j.1523-1747.1998.00345.x. PMID: 9764837.
ported that red fluorescence was positively correlated with         4. Klatte JL, van der Beek N, Kemperman PM. 100 years of Wood’s
psoriasis severity. Accordingly, besides diagnostic purposes,          lamp revised. J Eur Acad Dermatol Venereol. 2015;29(5):842-
UVFD evaluation might also be helpful in assessing dis-                847. DOI: 10.1111/jdv.12860. PMID: 25428804.
                                                                    5. Pietkiewicz P, Navarrete-Dechent C, Goldust M, Korecka K,
ease outcomes/prognosis. However, further investigation is
                                                                       Todorovska V, Errichetti E. Differentiating Fordyce Spots
required to understand the mechanism of porphyrin depo-
                                                                       from Their Common Simulators Using Ultraviolet-Induced
sition in psoriatic lesions, the spatial distribution of fluores-      Fluorescence Dermatoscopy-Retrospective Study. Diagnostics
                                                                       ­
cence patterns, and how these phenomena relate to disease              (Basel). 2023;13(5):985. DOI: 10.3390/diagnostics13050985
variants, severity and prognosis.                                      . PMID: 36900129. PMCID: PMC10000991.Research Letter




Research Letter | Dermatol Pract Concept. 2023;13(3):e2023243                                                                         3
