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There were only a few publications interested in carsdermoscopy,
the study of Min Gun Yoo et al. confirmed that vascular structures are
significantly noticed in Keloids [1], the observation of Martin JM. et all
pointed out dermoscopy as a tool to
detect remaining non absorbable sutures in surgical scars [2]. The
correspondence of Pérez-Pérez L et al. [3] was the only one that reported the
presence of the rainbow pattern and rosettes in a case of keloid.
In this report, we confirm the findings of Pérez
et al, and we present three cases of different types of scars with two features
in common: rainbow pattern and rosettes in a keloid (Figure 1), rainbow alone in an atrophic scar (Figure
2) and rosettes in another case of
recent scar (Figure 3).
The Rainbow Pattern (RP) is related to the
difference of perception of the polarized light by different component of the
dermis with anarchical arrangement of spindle cells around the vessels.
Therefore, it is not surprising to find
it in scars with an important fibrous and vascular components in Keloids or in
atrophic scars where the interaction of these components with polarized light
are easily explored by the dermoscope
due to the atrophic character of the scar.
This rainbow pattern may have therapeutic
implications, especially in hypertrophics cars, because it means that the scar
contains an important vascular component which is a good target for the
Pulseddye laser.
The term of rosette characterized by 4 white
points arranged as a 4-leaf clover mainly localized inside the follicular
openings in Polarized contact dermoscopy. The rosette sign may be complete as
described before, or incomplete when we have only three or two clods linked to
each other. Histologically, it correspond to changes of orthokeratosis and
parakeratosis, It is occasionally seen in actinickeratosis and squamous cell
carcinoma and otherneoplasms. In scars,
we explain the rosettes sign by the
abundant spindle cells and fibrosis around follicular openings, the presence of
this sign in forms the clinician that the follicular unit is involved, so
superficial treatments like presso therapy and topical corticosteroids are not
an option, Instead, treatments that penetrate deeply into the dermis are
mandatory.
Ultimately, the rainbow pattern and the rosettes sign are not exceptionally seen
in scars, and their presence may modify our therapeutic options.
1.
Yoo MG, Kim I-H (2014) Keloids and
hypertrophic scars: characteristic vascular structures visualized by using
dermoscopy. Ann Dermatol 26: 603-609.
2. Martín JM, Calduch L,
Jordá E (2008) Dermoscopy on the detection of remaining nonabsorbable sutures
in surgical scars. J Cosmet Dermatol 7: 226.
3.
Pérez-Pérez L, García-Gavín J, Allegue F,
Zulaica A (2014) The rainbow pattern and rosettes in cutaneous scars. Actas
Dermo-Sifiliográficas 105: 96–97.
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