Dermoscopy
Dermoscopy (also called surface microscopy or epiluminescence microscopy) is a noninvasive diagnostic tool in modern dermatology. Using polarized light and lenses that magnify 10x to 100x, it lets the dermatologist see through the stratum corneum and directly examine the microstructure of the epidermis, the basement membrane zone, the superficial dermis, the capillary network, and the distribution of melanin and hemosiderin, none of which can be seen with the naked eye.
At Haute-Derma, dermoscopy does more than distinguish complex pigmentary disorders (melasma, Riehl melanosis, lichen planus pigmentosus, erythema dyschromicum perstans) or screen early for malignant lesions (melanoma, BCC, SCC). It also guides treatment planning and lets us measure the results of laser and mesotherapy treatment session by session.
The Physics of Dermoscopy and Polarized Light
Light naturally reflecting off the stratum corneum tends to obscure what lies beneath. Dermoscopy overcomes this in two ways:
- Non-Polarized Dermoscopy (NPD): Direct light is used together with a contact fluid (dermoscopy oil, alcohol or ultrasound gel) on the skin to reduce refraction. NPD is best for very superficial structures in the stratum corneum and epidermis, such as scale, follicular openings, blackheads and superficial pustules.
- Polarized Dermoscopy (PD): Two cross-polarized filters cancel surface glare completely without any contact fluid. Polarized light reaches the superficial dermis, giving a clear view of:
- Dermal pigment: Blue-gray granules and melanophages.
- Blood vessels: Linear, dotted, arborizing or looped capillaries.
- Fibrotic structures: Shiny white lines (chrysalis or crystalline structures) that reflect changes in collagen.
Key Dermoscopic Patterns in Pigmentary and Vascular Disorders
| Condition | Characteristic Dermoscopic Features | Level of Involvement |
|---|---|---|
| Epidermal melasma | Uniform, well-defined pigment network | Epidermis (basal layer) |
| Dermal melasma / nevus of Ota | Scattered dots and globules, no distinct pigment network | Superficial to deep dermis |
| Riehl melanosis | Fine blue-gray dots with dotted or linear dilated capillaries | Superficial dermis (melanophages + inflammation) |
| Lichen planus pigmentosus (LPP) | Gray-black perifollicular dots, pseudonetwork | Damaged basement membrane + dermis |
| Basal cell carcinoma (BCC) | Arborizing vessels, leaf-like and spoke-wheel structures | Epidermis + superficial dermis |
| Melanoma | Atypical pigment network, blue-white veil | Full-thickness epidermis and deep dermis |
Clinical Uses of Dermoscopy at Haute-Derma
- Accurate Classification of Pigmentary Disorders: Color and pattern on dermoscopy help us reliably separate melasma, Riehl melanosis, lichen planus pigmentosus (LPP) and erythema dyschromicum perstans (EDP), avoiding the wrong treatment and the rebound hyperpigmentation it can cause.
- Screening for Precancerous Lesions and Skin Cancer (Non-Melanoma and Melanoma): We apply the ABCDE rule and the 3-point checklist under dermoscopy to detect basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and actinic keratosis early, before any procedure or laser treatment.
- Choosing Laser Wavelength and Energy
- Brown pigment or an epidermal network: 532 nm picosecond laser or BBL is preferred.
- Blue-gray pigment or dermal granules: 1064 nm low-fluence picosecond toning is required, combined with mesotherapy to repair the basement membrane.
- Measuring Skin Recovery Over Time: Standardized dermoscopy photos at each treatment milestone (sessions 1, 3 and 6) track the drop in pigment granule density and the narrowing of dilated capillaries.
Our Medical Dermoscopy Procedure at Haute-Derma
- Cleansing and Skin Preparation: Sunscreen, makeup and dirt are fully removed from the area to be examined.
- Polarized Mode Examination: A dedicated digital dermoscope is used across the whole affected area to record dermal pigment, the vascular network and fibrous bands.
- Digital Dermoscopy Mapping and Records: High-resolution dermoscopy images are stored in the electronic medical record so pigment and vascular findings can be compared at each follow-up visit.
- Physician Review and a Personalized Plan: The dermatologist personally analyzes the images, explains the underlying tissue changes to the patient and prescribes the safest combined treatment.
