Clinical utility of dermoscopy in diagnosing pigmented genital warts: A case report
Keywords:
dermoscopy, diagnosis, genital warts, pigmentedAbstract
Genital warts are the most common benign hyperplastic lesions caused by HPV infection. Diagnosis workup of genital warts is based on history, physical examination, acetowhite test, dermoscopy, histopathology and polymerase chain reaction (PCR). Dermoscopy is a non-invasive tool used to enhance the diagnostic accuracy of genital warts. This case report aims to understand the diagnostic role of dermoscopy in pigmented genital warts. A 24 years old female with widespread verrucous, confluent, pigmented papules in the inguinal regions bilaterally and labia majora since 4 months ago. Acetowhite test was negative. Dermoscopic examination revealed a mosaic pattern with brownish globular area, knob-like, dan finger-like pattern, and glomerular vessels. Histopatological examination showed hyperkeratosis, acanthosis, papillomatosis, and koilocytes, with increased number of melanocytes in the basal layer. The dermoscopic features of genital warts are varies according to clinical manifestations and shows correlation with histopathologic features. Specific dermoscopic features of genital warts are mosaic patterns, finger-like patterns, knob-like patterns, with/without dots or globules pigmented area, with dotted, glomerular and hairpin vessels. The mosaic pattern correlated with hyperkeratosis, acanthosis and capillary dilatation in the papillary dermis. The finger-like pattern correlated with papillomatosis, hyperkeratosis, acanthosis, dilatation and elongation of vessels. The identification of specific dermoscopic features in correlation with clinical manifestation and histopathological can be used to establish diagnosis of pigmented genital warts.References
Zhang Y, Jiang S, Lin H, Guo X, Zou X. Application of dermoscopy image analysis technique in diagnosing urethral condylomata acuminate. An Bras Dermatol. 2018;93(1):67–71.
Sterling JC. Human Papillomavirus Infections. In: Kang S, Amagai M, Bruckner A, Enk A, Margolis D, McMichael A, et al., editors. Fitzpatrick’s Dermatology in General Medicine. 9th ed. New York: McGraw-Hill; 2019. p. 3095–106.
Clanner-Engelshofen BM, Marsela E, Engelsberger N, Guertler A, Schauber J, French LE, et al. Condylomata acuminata: A retrospective analysis on clinical characteristics and treatment options. Heliyon. 2020;6(3):1–7.
Latini A. Clinical Management of Anogenital Warts and Intraepithelial Neoplasia. In: Cristaudo A, Giuliani M, editors. Secually Transmitted Infections: Advances in Understanding and Management. Switzerland: Springer; 2020. p. 233–54.
O’Mahony C, Gomberg M, Skerlev M, Alraddadi A, de las Heras-Alonso ME, Majewski S, et al. Position statement for the diagnosis and management of anogenital warts. J Eur Acad Dermatol Venereol. 2019;33(6):1006–19.
Delmonte S, Benardon S, Cariti C, Ribero S, Ramoni S, Cusini M. Anogenital warts treatment options: A practical approach. G Ital Dermatol Venereol. 2020;155(3):261–8.
Winer RL, Koutsky LA. Genital Human Papillomavirus Infection. In: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, Corey L, et al., editors. Sexually Transmitted Diseases. 4th ed. New York: McGraw Hill; 2008. p. 489–508.
Kumar P, Bhari N, Gupta V, Ramachandran VG, Arava S, Dar L, et al. Atypical morphology of anogenital warts is not a marker of atypical histology or of infection to the high-risk human papillomavirus genotypes. Int J Dermatol. 2017;56(10):1017–21.
Kirnbauer R, Lenz P. Human Papillomaviruses. In: Bolognia JL, Schaffer J v, Cerroni L, Callen JP, Cowen EW, Hruza GJ, et al., editors. Dermatology. 4th ed. Philadelphia: Elsevier; 2018. p. 1383–99.
Worowski K, Bachmann L, Chan P, Johnston C, Muzny C, Park I, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Rexomm Rep. 2021;70(4):1–187.
Wu YH, Hsiao PF, Chen CK. Histopathologic and immunohistochemical distinction of condyloma and seborrheic keratosis in the genitofemoral area. Dermatologica Sin. 2013;31(2):54–8.
Shen X, Yu RX, Shen CB, Li CX, Jing Y, Zheng YJ, et al. Dermoscopy in China: Current status and future prospective. Chin Med J. 2019;132(17):2096–104.
Piccolo V. Update on dermoscopy and infectious skin diseases. Dermatol Pract Concept. 2020;10(1):1–10.
Lacarrubba F, Borghi A, Verzì AE, Corazza M, Stinco G, Micali G. Dermoscopy of genital diseases: a review. J Eur Acad Dermatol Venereol. 2020;34(10):2198–207.
Chatterjee M, Neema S. Dermatoscopy of infections and infestations. Indian Dermatol Online J. 2021;12(1):14–23.
Veasey JV, Framil VM de S, Nadal SR, Marta AC, Lellis RF. Genital warts: Comparing clinical findings to dermatoscopic aspects, in vivo reflectance confocal features and histopathologic exam. An Bras Dermatol. 2014;89(1):137–40.
Lallas A, Errichetti E. Introduction. In: Lallas A, Errichetti E, Ioannides D, editors. Dermoscopy in General Dermatology. Florida: Taylor and Francis; 2019. p. x–xix.
Errichetti E, Zalaudek I, Kittler H, Apalla Z, Argenziano G, Bakos R, et al. Standardization of dermoscopic terminology and basic dermoscopic parameters to evaluate in general dermatology (non-neoplastic dermatoses): an expert consensus on behalf of the International Dermoscopy Society. Br J Dermatol. 2020;182(2):454–67.
Lacarrubba F, Verzì AE, Micali G. Viral indections. In: Lallas A, Errichetti E, Ioannides D, editors. Dermoscopy in General Dermatology. Florida: CRC Press; 2019. p. 221–7.
Dong H, Shu D, Campbell TM, Frühauf J, Soyer P, Hofmann-Wellenhof R. Dermatoscopy of genital warts. J Am Acad Dermatol. 2011;64(5):859–64.
Zhang Y, Zou X, Guo X. Application value of dermoscopy in the diagnosis of condyloma acuminatum. Chin J Dermatol. 2017;50:493–6.
Araújo MG, Magalhães GM, Garcia LC, Vieira ÉC, Carvalho-Leite M de LR de, Guedes ACM. Update on human papillomavirus – Part II: complementary diagnosis, treatment and prophylaxis. An Bras Dermatol. 2021;96:125–38.