Dermoscopy for Infectious Diseases

  • Sean Ekinde
  • Elisa Cinotti


Dermoscopy can be applied to the clinical practice as a tool to improve the diagnostic accuracy and to monitor the treatment of the most commonly known skin infections and infestations. This chapter summarizes the main dermoscopic features of several parasitic, viral, and fungal infections according to the most recent studies.


Dermoscopy Dermatoscopy Entomodermoscopy Ectoparasites Skin infection Skin infestation Scabies Pediculosis Phthiriasis Larva Migrans Tungiasis Tick Wart Molluscum Contagiosum Tinea Capitis and nigra 


  1. 1.
    Verzì AE, Lacarrubba F, Dinotta F, Micali G. Dermatoscopy of Parasitic and Infectious Disorders. Dermatol Clin. 2018;36:349–58.PubMedGoogle Scholar
  2. 2.
    Chosidow O. Scabies. N Engl J Med. 2006;354:1718–27.PubMedGoogle Scholar
  3. 3.
    Dupuy A, Dehen L, Bourrat E, et al. Accuracy of standard dermoscopy for diagnosing scabies. J Am Acad Dermatol. 2007;56:53–62.PubMedGoogle Scholar
  4. 4.
    Park JH, Kim CW, Kim SS. The Diagnostic Accuracy of Dermoscopy for Scabies. Ann Dermatol. 2012;24:194.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Argenziano G, Fabbrocini G, Delfino M. Epiluminescence microscopy. A new approach to in vivo detection of Sarcoptes scabiei. Arch Dermatol. 1997;133:751–3.PubMedGoogle Scholar
  6. 6.
    Zalaudek I, Giacomel J, Cabo H, et al. Entodermoscopy: A New Tool for Diagnosing Skin Infections and Infestations. Dermatology. 2008;216:14–23.PubMedGoogle Scholar
  7. 7.
    Rubegni P, Mandato F, Risulo M, Fimiani M. Non-invasive diagnosis of nodular scabies: The string of pearls sign: The string of pearls. Australas J Dermatol. 2011;52:79.PubMedGoogle Scholar
  8. 8.
    Lacarrubba F, D’Amico V, Nasca MR, et al. Use of dermatoscopy and videodermatoscopy in therapeutic follow-up: a review: Dermatoscopy and therapeutic monitoring. Int J Dermatol. 2010;49:866–73.PubMedGoogle Scholar
  9. 9.
    Hamm H, Beiteke U, Höger PH, et al. Treatment of scabies with 5% permethrin cream: results of a German multicenter study. J Dtsch Dermatol Ges. 2006;4:407–13.PubMedGoogle Scholar
  10. 10.
    Cinotti E, Labeille B, Cambazard F, et al. Videodermoscopy compared to reflectance confocal microscopy for the diagnosis of scabies. J Eur Acad Dermatol Venereol. 2016;30:1573–7.PubMedGoogle Scholar
  11. 11.
    Cinotti E, Perrot J-L, Labeille B, Cambazard F. Diagnostic de la gale par épimicroscopie à fort grossissement : l’aspect « en deltaplane » de Sarcoptes scabiei. Ann Dermatol Vénéréologie. 2013;140:722–3.Google Scholar
  12. 12.
    Lacarrubba F, Musumeci ML, Caltabiano R, et al. High-magnification videodermatoscopy: a new noninvasive diagnostic tool for scabies in children. Pediatr Dermatol. 2001;18:439–41.PubMedGoogle Scholar
  13. 13.
    Walter B, Heukelbach J, Fengler G, et al. Comparison of dermoscopy, skin scraping, and the adhesive tape test for the diagnosis of scabies in a resource-poor setting. Arch Dermatol. 2011;147:468.PubMedGoogle Scholar
  14. 14.
    Devore CD, Schutze GE. AAP, Council on school health, committee on infectious dises. Head lice. Pediatrics. 2015;135(5):e1355–e1365. Pediatrics. 2015;136:781–2.Google Scholar
  15. 15.
    Paller A, Mancini AJ, Hurwitz S. Hurwitz clinical pediatric dermatology: a textbook of skin disorders of childhood and adolescence. New York: Elsevier/Saunders; 2011. Accessed 2 Nov 2018.
  16. 16.
    Martins LG, Bernardes Filho F, Quaresma MV, et al. Dermoscopy applied to pediculosis corporis diagnosis. An Bras Dermatol. 2014;89:513–4.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Nikam VV, Mehta HH. A nonrandomized study of trichoscopy patterns using nonpolarized (contact) and polarized (noncontact) dermatoscopy in hair and shaft disorders. Int J Trichology. 2014;6:54–62.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Di Stefani A, Hofmann-Wellenhof R, Zalaudek I. Dermoscopy for diagnosis and treatment monitoring of pediculosis capitis. J Am Acad Dermatol. 2006;54:909–11.PubMedGoogle Scholar
  19. 19.
    Zalaudek I, Argenziano G. Dermoscopy of Nits and Pseudonits. N Engl J Med. 2012;367:1741.PubMedGoogle Scholar
  20. 20.
    Doche I, Vincenzi C, Tosti A. Casts and pseudocasts. J Am Acad Dermatol. 2016;75:e147–8.PubMedGoogle Scholar
  21. 21.
    Zhuang K, Ran X, Dai Y, et al. An Unusual Case of White Piedra Due to Trichosporon inkin Mimicking Trichobacteriosis. Mycopathologia. 2016;181:909–14.PubMedGoogle Scholar
  22. 22.
    Miteva M, Tosti A. Dermatoscopy of hair shaft disorders. J Am Acad Dermatol. 2013;68:473–81.PubMedGoogle Scholar
  23. 23.
    Lallas A, Zalaudek I, Argenziano G, et al. Dermoscopy in General Dermatology. Dermatol Clin. 2013;31:679–94.PubMedGoogle Scholar
  24. 24.
    Bakos RM, Bakos L. Dermoscopy for diagnosis of pediculosis capitis. J Am Acad Dermatol. 2007;57:727–8.PubMedGoogle Scholar
  25. 25.
    DeFazio JL, Spencer P. Dermoscopy of Phthiriasis. N Engl J Med. 2010;362:e33.PubMedGoogle Scholar
  26. 26.
    Lacarrubba F, Micali G. The Not-so-naked Eye: Phthiriasis Palpebrarum. Am J Med. 2013;126:960–1.PubMedGoogle Scholar
  27. 27.
    Chuh A, Lee A, Wong W, et al. Diagnosis of Pediculosis pubis: a novel application of digital epiluminescence dermatoscopy. J Eur Acad Dermatol Venereol. 2007;21:837–8.PubMedGoogle Scholar
  28. 28.
    Micali G, Lacarrubba F. Phthiriasis Palpebrarum in a Child. N Engl J Med. 2015;373:e35.PubMedGoogle Scholar
  29. 29.
    Bauer J, Forschner A, Garbe C, Röcken M. Dermoscopy of Tungiasis. Arch Dermatol. 2004;140:761–3.Google Scholar
  30. 30.
    Cabrera R, Daza F. Tungiasis: eggs seen with dermoscopy: Correspondence. Br J Dermatol. 2007;158:635–6.PubMedGoogle Scholar
  31. 31.
    Cataldo K, Alvarez S, Abarzua A. Dermoscopy in tungiasis. Indian J Dermatol Venereol Leprol. 2014;80:371.PubMedGoogle Scholar
  32. 32.
    Criado PR, Landman G, dos Reis VMS, Belda JW. Tungiasis under dermoscopy: in vivo and ex vivo examination of the cutaneous infestation due to Tunga penetrans. An Bras Dermatol. 2013;88:649–51.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Bakos RM, Bakos L. ‘Whitish chains’: a remarkable in vivo dermoscopic finding of tungiasis. Br J Dermatol. 2008;159:991–2.PubMedGoogle Scholar
  34. 34.
    Dunn R, Asher R, Bowling J. Dermoscopy: Ex vivo visualization of fleas head and bag of eggs confirms the diagnosis of Tungiasis: Dermoscopy benefits early diagnosis. Australas J Dermatol. 2012;53:120–2.PubMedGoogle Scholar
  35. 35.
    Di Stefani A, Rudolph CM, Hofmann-Wellenhof R, Müllegger RR. Comments and opinions. Arch Dermatol. 2005;141:1045–6.Google Scholar
  36. 36.
    Torres-Guerrero E, Quintanilla-Cedillo MR, Ruiz-Esmenjaud J, Arenas R. Leishmaniasis: a review. F1000Research. 2017;6:750.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Ayhan E, Ucmak D, Baykara SN, et al. Clinical and dermoscopic evaluation of cutaneous leishmaniasis. Int J Dermatol. 2015;54:193–201.PubMedGoogle Scholar
  38. 38.
    Llambrich A, Zaballos P, Terrasa F, et al. Dermoscopy of cutaneous leishmaniasis. Br J Dermatol. 2009;160:756–61.PubMedGoogle Scholar
  39. 39.
    Taheri AR, Pishgooei N, Maleki M, et al. Dermoscopic features of cutaneous leishmaniasis. Int J Dermatol. 2013;52:1361–6.PubMedGoogle Scholar
  40. 40.
    Yücel A, Günaşti S, Denli Y, Uzun S. Cutaneous leishmaniasis: new dermoscopic findings. Int J Dermatol. 2013;52:831–7.PubMedGoogle Scholar
  41. 41.
    AlJasser MI, Lui H, Zeng H, Zhou Y. Dermoscopy and near-infrared fluorescence imaging of cutaneous larva migrans: letter to the editor. Photodermatol Photoimmunol Photomed. 2013;29:337–8.PubMedGoogle Scholar
  42. 42.
    Elsner E, Thewes M, Worret WI. Cutaneous larva migrans detected by epiluminescent microscopy. Acta Derm Venereol. 1997;77:487–8.PubMedGoogle Scholar
  43. 43.
    Veraldi S, Schianchi R, Carrera C. Epiluminescence microscopy in cutaneous larva migrans. Acta Derm Venereol. 2000;80:233.PubMedGoogle Scholar
  44. 44.
    Matsuda M, Oiso N, Yano Y, Kawada A. Dermoscopy for Tick Bite: Reconfirmation of the Usefulness for the Initial Diagnosis. Case Rep Dermatol. 2011;3:94–7.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Oiso N, Kawara S, Yano Y, Kawada A. Diagnostic effectiveness of dermoscopy for tick bite. J Eur Acad Dermatol Venereol. 2010;24:231.PubMedGoogle Scholar
  46. 46.
    Forcier M, Musacchio N. An overview of human papillomavirus infection for the dermatologist: disease, diagnosis, management, and prevention: Overview of HPV for the dermatologist. Dermatol Ther. 2010;23:458–76.PubMedGoogle Scholar
  47. 47.
    Al Aboud AM, Nigam PK. Wart (Plantar, Verruca Vulgaris, Verrucae). In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2018. Accessed 4 Nov 2018.
  48. 48.
    Bae JM, Kang H, Kim HO, Park YM. Differential diagnosis of plantar wart from corn, callus and healed wart with the aid of dermoscopy. Br J Dermatol. 2009;160:220–2.PubMedGoogle Scholar
  49. 49.
    Dalmau J, Abellaneda C, Puig S, et al. Acral Melanoma Simulating Warts: Dermoscopic Clues to Prevent Missing a Melanoma. Dermatol Surg. 2006;32:1072–8.PubMedGoogle Scholar
  50. 50.
    Tanioka M, Nakagawa Y, Maruta N, Nakanishi G. Pigmented wart due to human papilloma virus type 60 showing parallel ridge pattern in dermoscopy. Eur J Dermatol. 2009;19:643–4.PubMedGoogle Scholar
  51. 51.
    Yoong C, Di Stefani A, Hofmann-Wellenhof R, et al. Unusual clinical and dermoscopic presentation of a wart. Australas J Dermatol. 2009;50:228–9.PubMedGoogle Scholar
  52. 52.
    Micali G, Lacarrubba F. Possible applications of videodermatoscopy beyond pigmented lesions. Int J Dermatol. 2003;42:430–3.PubMedGoogle Scholar
  53. 53.
    Micali G, Lacarrubba F. Augmented diagnostic capability using videodermatoscopy on selected infectious and non-infectious penile growths: using VD on selected infectious and non-infectious penile growths. Int J Dermatol. 2011;50:1501–5.PubMedGoogle Scholar
  54. 54.
    Lacarrubba F, Verzì AE, Dinotta F, et al. Dermatoscopy in inflammatory and infectious skin disorders. G Ital Dermatol E Venereol Organo Uff Soc Ital Dermatol E Sifilogr. 2015;150:521–31.Google Scholar
  55. 55.
    Vázquez-López F, Kreusch J, Marghoob AA. Dermoscopic semiology: further insights into vascular features by screening a large spectrum of nontumoral skin lesions. Br J Dermatol. 2004;150:226–31.PubMedGoogle Scholar
  56. 56.
    Micali G, Lacarrubba F, Massimino D, Schwartz RA. Dermatoscopy: Alternative uses in daily clinical practice. J Am Acad Dermatol. 2011;64:1135–46.PubMedGoogle Scholar
  57. 57.
    Dong H, Shu D, Campbell TM, et al. Dermatoscopy of genital warts. J Am Acad Dermatol. 2011;64:859–64.PubMedGoogle Scholar
  58. 58.
    Watanabe T, Yoshida Y, Yamamoto O. Differential diagnosis of pearly penile papules and penile condyloma acuminatum by dermoscopy. Eur J Dermatol. 2010;20:414–5.PubMedGoogle Scholar
  59. 59.
    Kim S-H, Seo S-H, Ko H-C, et al. The use of dermatoscopy to differentiate vestibular papillae, a normal variant of the female external genitalia, from condyloma acuminata. J Am Acad Dermatol. 2009;60:353–5.PubMedGoogle Scholar
  60. 60.
    Zaballos P, Ara M, Puig S, Malvehy J. Dermoscopy of molluscum contagiosum: a useful tool for clinical diagnosis in adulthood. J Eur Acad Dermatol Venereol. 2006;20:482–3.PubMedGoogle Scholar
  61. 61.
    Morales A, Puig S, Malvehy J, Zaballos P. Dermoscopy of Molluscum Contagiosum. Arch Dermatol. 2005;141.Google Scholar
  62. 62.
    Lacarrubba F, Verzì AE, Ardigò M, Micali G. Handheld reflectance confocal microscopy for the diagnosis of molluscum contagiosum: Histopathology and dermoscopy correlation. Australas J Dermatol. 2017;58:e123–5.PubMedGoogle Scholar
  63. 63.
    Ianhez M, Cestari S da CP, Enokihara MY, Seize MB de PM. Dermoscopic patterns of molluscum contagiosum: a study of 211 lesions confirmed by histopathology. An Bras Dermatol. 2011;86:74–9.Google Scholar
  64. 64.
    Alfaro-Castellón P, Mejía-Rodríguez SA, Valencia-Herrera A, et al. Dermoscopy Distinction of Eruptive Vellus Hair Cysts with Molluscum Contagiosum and Acne Lesions. Pediatr Dermatol. 2012;29:772–3.PubMedGoogle Scholar
  65. 65.
    Amer M, Helmy A, Amer A. Trichoscopy as a useful method to differentiate tinea capitis from alopecia areata in children at Zagazig University Hospitals. Int J Dermatol. 2017;56:116–20.PubMedGoogle Scholar
  66. 66.
    Bourezane Y, Bourezane Y. Analysis of trichoscopic signs observed in 24 patients presenting tinea capitis: Hypotheses based on physiopathology and proposed new classification. Ann Dermatol Vénéréologie. 2017;144:490–6.Google Scholar
  67. 67.
    Brasileiro A, Campos S, Cabete J, et al. Trichoscopy as an additional tool for the differential diagnosis of tinea capitis: a prospective clinical study. Br J Dermatol. 2016;175:208–9.PubMedGoogle Scholar
  68. 68.
    Ekiz Ö, Şen BB, Rifaioğlu EN, Balta I. Trichoscopy in paediatric patients with tinea capitis: a useful method to differentiate from alopecia areata. J Eur Acad Dermatol Venereol. 2014;28:1255–8.PubMedGoogle Scholar
  69. 69.
    Elghblawi E. Idiosyncratic findings in trichoscopy of tinea capitis: comma, zigzag hairs, corkscrew, and Morse code-like hair. Int J Trichology. 2016;8:180.PubMedPubMedCentralGoogle Scholar
  70. 70.
    Hernández-Bel P, Malvehy J, Crocker A, et al. Un nuevo marcador dermatoscópico de tinea capitis: «pelos en coma». Actas Dermosifiliogr. 2012;103:836–7.PubMedGoogle Scholar
  71. 71.
    Hughes R, Chiaverini C, Bahadoran P, Lacour J-P. Corkscrew hair: a new dermoscopic sign for diagnosis of tinea capitis in black children. Arch Dermatol. 2011;147:355.PubMedGoogle Scholar
  72. 72.
    Mapelli ETM, Gualandri L, Cerri A, Menni S. Comma hairs in tinea capitis: a useful dermatoscopic sign for diagnosis of tinea capitis. Pediatr Dermatol. 2012;29:223–4.PubMedGoogle Scholar
  73. 73.
    Neri I, Starace M, Patrizi A, Balestri R. Corkscrew hair: a trichoscopy marker of tinea capitis in an adult white patient. JAMA Dermatol. 2013;149:990.PubMedGoogle Scholar
  74. 74.
    Pinheiro AMC, Lobato LA, Varella TCN. Dermoscopy findings in tinea capitis: case report and literature review. An Bras Dermatol. 2012;87:313–4.PubMedGoogle Scholar
  75. 75.
    Schechtman RC, Silva NDV, Quaresma MV, et al. Dermatoscopic findings as a complementary tool in the differential diagnosis of the etiological agent of tinea capitis. An Bras Dermatol. 2015;90:13–5.PubMedPubMedCentralGoogle Scholar
  76. 76.
    Slowinska M, Rudnicka L, Schwartz RA, et al. Comma hairs: a dermatoscopic marker for tinea capitis. J Am Acad Dermatol. 2008;59:S77–9.PubMedGoogle Scholar
  77. 77.
    Wang H-H, Lin Y-T. Bar code–like hair: dermoscopic marker of tinea capitis and tinea of the eyebrow. J Am Acad Dermatol. 2015;72:S41–2.PubMedGoogle Scholar
  78. 78.
    Babel DE, Pelachyk JM, Hurley JP. Tinea nigra masquerading as acral lentiginous melanoma. J Dermatol Surg Oncol. 1986;12:502–4.PubMedGoogle Scholar
  79. 79.
    Gupta G, Burden AD, Shankland GS, et al. Tinea nigra secondary to Exophiala werneckii responding to itraconazole. Br J Dermatol. 1997;137:483–4.PubMedGoogle Scholar
  80. 80.
    Smith SB, Beals SL, Elston DM, Meffert JJ. Dermoscopy in the diagnosis of tinea nigra plantaris. Cutis. 2001;68:377–80.PubMedGoogle Scholar
  81. 81.
    Noguchi H, Hiruma M, Inoue Y, et al. Tinea nigra showing a parallel ridge pattern on dermoscopy. J Dermatol. 2015;42:518–20.PubMedGoogle Scholar
  82. 82.
    Nazzaro G, Ponziani A, Cavicchini S. Tinea nigra: a diagnostic pitfall. J Am Acad Dermatol. 2016;75:e219–20.PubMedGoogle Scholar
  83. 83.
    Lacarrubba F, Dall’Oglio F, Dinotta F, Micali G. Exogenous pigmentation of the sole mimicking in situ acral melanoma on dermoscopy. J Dermatol Case Rep. 2012;6:100–1.Google Scholar
  84. 84.
    Criado PR, Delgado L, Pereira GA. Dermoscopy revealing a case of Tinea Nigra. An Bras Dermatol. 2013;88:128–9.PubMedPubMedCentralGoogle Scholar
  85. 85.
    Rossetto AL, Corrêa PR, Cruz RCB, et al. A case of Tinea nigra associated to a bite from a European rabbit (Oryctolagus cuniculus, Leporidae): the role of dermoscopy in diagnosis. An Bras Dermatol. 2014;89:165–6.PubMedPubMedCentralGoogle Scholar
  86. 86.
    Ye Y, Zhang X, Zhao Y, et al. The clinical and trichoscopic features of syphilitic alopecia. J Dermatol Case Rep. 2014;8:78–80.PubMedPubMedCentralGoogle Scholar
  87. 87.
    Piraccini BM, Broccoli A, Starace M, et al. Hair and scalp manifestations in secondary syphilis: epidemiology, clinical features and trichoscopy. Dermatology. 2015;231:171–6.PubMedGoogle Scholar
  88. 88.
    Tognetti L, Cinotti E, Perrot J-L, et al. Syphilitic alopecia: uncommon trichoscopic findings. Dermatol Pract Concept. 2017;7:55–9.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Sean Ekinde
    • 1
  • Elisa Cinotti
    • 1
  1. 1.Department of Medical, Surgical and Neurological Science, Dermatology SectionUniversity of Siena, S. Maria alle Scotte HospitalSienaItaly

Personalised recommendations