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DERMOSCOPIC CLASSIFICATION OF MELASMA: CONCORDANCE STUDY AND CORRELATION WITH THE MELANOPHAGES COUNT
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Federal University of Rio de Janeiro. University Hospital and School of Medicine. Sector of Dermatology and Post-Graduation Program in General Clinics. Rio de Janeiro, RJ, Brazil / Santa Casa da Misericordia do Rio de Janeiro. Professor Rubem David Azulay Dermatology Institute. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. University Hospital and School of Medicine. Sector of Dermatology and Post-Graduation Program Course in Dermatology. Rio de Janeiro, RJ, Brazil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Santa Casa da Misericordia do Rio de Janeiro. Professor Rubem David Azulay Dermatology Institute. Rio de Janeiro, RJ, Brazil.
Santa Casa da Misericordia do Rio de Janeiro. Professor Rubem David Azulay Dermatology Institute. Rio de Janeiro, RJ, Brazil / Ipanema Federal Hospital. Internal Medicine and Dermatology Departments. Rio de Janeiro, RJ, Brazil.
Santa Casa da Misericordia do Rio de Janeiro. Professor Rubem David Azulay Dermatology Institute. Rio de Janeiro, RJ, Brazil.
Santa Casa da Misericordia do Rio de Janeiro. Professor Rubem David Azulay Dermatology Institute. Rio de Janeiro, RJ, Brazil.
Santa Casa da Misericordia do Rio de Janeiro. Professor Rubem David Azulay Dermatology Institute. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. University Hospital and School of Medicine. Sector of Dermatology and Post-Graduation Program Course in Dermatology. Rio de Janeiro, RJ, Brazil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Santa Casa da Misericordia do Rio de Janeiro. Professor Rubem David Azulay Dermatology Institute. Rio de Janeiro, RJ, Brazil.
Santa Casa da Misericordia do Rio de Janeiro. Professor Rubem David Azulay Dermatology Institute. Rio de Janeiro, RJ, Brazil / Ipanema Federal Hospital. Internal Medicine and Dermatology Departments. Rio de Janeiro, RJ, Brazil.
Santa Casa da Misericordia do Rio de Janeiro. Professor Rubem David Azulay Dermatology Institute. Rio de Janeiro, RJ, Brazil.
Santa Casa da Misericordia do Rio de Janeiro. Professor Rubem David Azulay Dermatology Institute. Rio de Janeiro, RJ, Brazil.
Santa Casa da Misericordia do Rio de Janeiro. Professor Rubem David Azulay Dermatology Institute. Rio de Janeiro, RJ, Brazil.
Abstract
Background: Melasma is a common hypermelanosis characterized by symmetrical brownish macules, especially on the face. Histologic analysis demonstrates increased epidermal and dermal melanin. Dermoscopy is useful to estimate the depth of the melanin and may help in the diagnosis and classification of melasma, with therapeutic importance.
Objectives: To evaluate the diagnostic concordance of dermoscopic classification of epidermal or mixed subtypes of melasma and the correlation between dermoscopic and histopathological findings.
Methods: Twenty-eight women with facial melasma, phototypes III to V, ages between 30 and 61 years were selected. Based on the evaluation of clinical and dermoscopic images, two independent observers classified melasma into epidermal or mixed subtypes. The intra and interobserver concordances were calculated. Histopathological analysis of epidermal melanin extension and maximum number of melanophages per high-power field (400×; HPF) have been assessed. Association between the melanophages count and the dermoscopic classification was evaluated.
Results: Intraobserver agreement was 82.1%, and between observers, from 78.6% to 89.3%, according to the Kappa index. Histopathology revealed increased intraepidermal melanin and the presence of dermal melanophages in all the samples. Ten or more melanophages/HPF was significantly associated with mixed melasma.
Conclusions: Moderate to substantial concordance in the dermoscopic classification of melasma was found, and the correlation between this classification and the dermal melanophages count have been suggested. Intradermal component of every case of melasma should be considered for therapeutic and prognostic purposes.
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