10.5826/dpc.1302a74
text/xml
2160-9381
2608
en
Elisa Cinotti
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Optical Super-High Magnification Dermoscopy: A Complementary Means in the Diagnosis of Trombiculosis
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-04-29
2022-05-23
2023-04-29
2023-06-05
e2023074
Dermatol Pract Concept
Elisa Cinotti
2023/04/29
10.5826/dpc.1302a74
e2023074
Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
2160-9381
en
e2023074
Nasca MR, Lacarrubba F, Micali G. Diagnosis of Trombiculosis by Videodermatoscopy. Emerg Infect Dis. 2014 Jun;20(6):1059–60. doi:10.3201/eid2006.130767
Optical Super-High Magnification Dermoscopy: A Complementary Means in the Diagnosis of Trombiculosis
https://dpcj.org/index.php/dpc/article/download/2608/2105
      Optical Super-High Magnification Dermoscopy:
        a Complementary Means in the Diagnosis
                     of Trombiculosis
               Corinne Orsini1, Giulio Cortonesi1, Arianna Lamberti1, Marco Campoli1,
                                    Pietro Rubegni1, Elisa Cinotti1


1 Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital,
  Siena, Italy



Citation: Orsini C, Cortonesi G, Lamberti A, Campoli M, Rubegni P, Cinotti E. Optical Super-High Magnification Dermoscopy:
A Complementary Means in the Diagnosis of Trombiculosis. Dermatol Pract Concept. 2023;13(2):e2023074. DOI: https://doi.org/10.5826
/dpc.1302a74
Accepted: August 3, 2022; Published: April 2023
Copyright: ©2023 Orsini 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: Corinne Orsini, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, 53100 Siena, Italy.
Tel: 0039-0577 585481. Fax: 0039 0577 585488, Email: corinne.orsini@student.unisi.it




Case Presentation                                                        infestation of the larval stage of Neotrombicula Autumna-
                                                                         lis, a mite involved in the underestimated and misdiagnosed
In October 2021, a 27-year-old man working in the                        trombiculosis.
­countryside of Tuscany (Italy) presented with a 3-day ­history
of diffuse intense pruritus. Dermatological ­
                                            examination
revealed multiple, erythematous macules localized on his
­
                                                                         Teaching Point
right side of the trunk, the genitals, and the right popliteal
fossa (Figure 1, A and B). A 10x dermoscopy examination                  Trombiculosis is a common but underreported ectoparasit-
revealed in the center of each macula the presence of a                  osis caused in Europe by the larval stage of Neotrombicula
tiny bright yellow mite, hard to recognize due to its small              Autumnalis.
size (Figure 1C). Videodermoscopy at 40x (Figure 1D) and                      Diagnosis of trombiculosis can be difficult: clinical
400x (Figure 1E) magnification (Medicam 1000, Fotofinder                 presentation is extremely vague, mainly asymptomatic, oc-
­System(R)) allowed to observe six-legged golden colored par-            casionally consists of multiple pruritic papules due to par-
asites, strongly attached to the skin, and thus to identify an           asite biting.




Image Letter | Dermatol Pract Concept. 2023;13(2):e2023074                                                                             1
Figure 1. (A, B) Multiple, erythematous macules scattered on the right side of the trunk and right popliteal fossa. (C) Conventional
­dermoscopy 10x showed a tiny golden mite in the center of each macula. (D, E) videodermoscopy at 40x (D) and 400x (E) magnification of
 Neotrombicula Autumnalis (Medicam 1000, Fotofinder System(R)).




    Futhermore, larvae show tiny dimensions (200-400 µm)             References
and can easily be missed at conventional 10 x dermoscopy,
so high-magnification dermoscopy could represent an useful            1. di Meo N, Fadel M, Trevisan G. Pushing the edge of dermoscopy
                                                                         in new directions: entomodermoscopy of Trombicula autumnalis.
means in the diagnosis of trombiculosis.
                                                                         Acta Dermatovenerol Alp Pannonica Adriat. 2017;26(2):45–46.
    Only one case of Neotrombicula Autumnalis described
                                                                         DOI: 10.15570/actaapa.2017.14. PMID: 28632887
by using high-magnification videodermoscopy was found in              2. Nasca MR, Lacarrubba F, Micali G. Diagnosis of Trombicu-
literature [1, 2]. In particular, under optical 400 x magnifica-         losis by Videodermatoscopy. Emerg Infect Dis. 2014;20(6):
tion, the color, the entire contour of the body and the details          1059–1060. DOI:10.3201/eid2006.130767. PMID: 24856873.
of the legs of the parasite are better visible, allowing a precise       PMCID: PMC4036784.

diagnosis.




2                                                                           Image Letter | Dermatol Pract Concept. 2023;13(2):e2023074
