Named signs and metaphoric terminologies in dermoscopy: A compilation

Anupam Das; Bhushan Madke; Deepak Jakhar; Shekhar Neema; Ishmeet Kaur; Piyush Kumar; Swetalina Pradhan

doi:10.25259/IJDVL_1047_20

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doi:

10.25259/IJDVL_1047_20

pmid:

35146985

Named signs and metaphoric terminologies in dermoscopy: A compilation

Anupam Das, Bhushan Madke¹, Deepak Jakhar^2,, Shekhar Neema³, Ishmeet Kaur², Piyush Kumar⁴, Swetalina Pradhan⁵

Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India

1Department of Dermatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India

2Department of Dermatology, North DMC Medical College and Hindu Rao Hospital, New Delhi, India

3Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India

4Department of Dermatology, Katihar Medical College, Katihar, Bihar, India

5Department of Dermatology, All India Institute of Medical Sciences, Patna, Bihar, India

Corresponding author: Dr. Deepak Jakhar, Department of Dermatology, North DMC Medical College and Hindu Rao Hospital, New Delhi. dr.deepakjakhar@yahoo.in

Received: 2020-07-01, Accepted: 2021-06-01, Epub ahead of print: 2022-01-20, Published: 2022-11

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Das A, Madke B, Jakhar D, Neema S, Kaur I, Kumar P, et al. Named signs and metaphoric terminologies in dermoscopy: A compilation. Indian J Dermatol Venereol Leprol 2022;88:855-66.

Introduction

Dermoscopy is one of the most fascinating aspects of modern dermatology. It is a non-invasive bedside technique which facilitates the diagnosis of many common and uncommon dermatological conditions. Being an evolving technique, the dermoscopic features of various dermatoses have been traditionally described using multiple metaphoric terminologies and named signs. These metaphors and signs were intended to help memorize the newly introduced dermoscopic features. This article intends to enumerate and briefly describe the named signs and appearances in dermoscopy which will benefit the residents. To simplify, we have classified dermatoses as nevi, malignancies, infections and infestations (entomodermoscopy), pigmentary disorders, vascular disorders, papulosquamous disorders, hair (trichoscopy) and nail (onychoscopy) disorders.

Dermoscopic Signs in Nevi and Malignancies

Dermoscopy has remarkable diagnostic accuracy for benign and malignant skin tumours. Lesional dermoscopic examination may be helpful in avoiding unnecessary intervention. Melanocytic and non-melanocytic tumours show a specific pattern recognized by dermoscopy [Figures 1-4]. Some patterns such as “maple leaf appearance” and “blue-gray ovoid nests” are specific while others remain indicative. Dermoscopic signs should be clinically correlated to reach a final diagnosis. Metaphoric terminologies may help in the easy recall of signs associated with a particular disease, however, it may also mislead the physician as similar dermoscopic appearances have been reported in multiple diseases. Table 1 describes the signs and patterns observed in various benign and malignant skin tumours.

Blue-white veil (red star) in melanoma showing confluent blue pigmentation with an overlying white “ground-glass” haze (Dermlite DL4;×10;polarising)

Maple leaf (red arrow) and blue-gray ovoid nest (yellow circle) in basal cell carcinoma showing discrete, bulbous extensions connected to base and forming a leaf-like pattern (Dermlite DL4;×10;polarising)

Pore sign (yellow arrow) in epidermal cyst showing the barely visible punctum (Dermlite DL4;×10;polarising)

Sulci (yellow arrow) and gyri (blue arrow) in seborrheic keratosis showing cerebriform pattern (red circle) (Dermlite DL4;×10;non-polarising)

Table 1: Signs and patterns in melanocytic and non-melanocytic disorders

S. No.	Dermoscopic sign	Disease	Description
Melanocytic lesions
1	Beauty and the beast sign¹	Melanoma	Dermoscopy of benign melanocytic lesions is placed into nine categories and it generally fits into one of them and is considered “beauty.” Melanoma symbolized by the “beast” is a melanocytic lesion that derives from one of the malignant patterns or deviates from benign pattern
2	Blue-white veil	Melanoma	Described as confluent blue pigmentation with an overlying white “ground-glass” haze [Figure 1]
3	Honeycomb-like pigment network	Junctional nevus	A regular homogeneous honeycomb-like pigment network thinning out at the periphery
4	Isobar sign²	Lentigo maligna melanoma	The hair follicle openings show central black dot apart from granular pigment around the follicle known as annular granular pattern
5	Little red riding hood sign¹	Amelanotic or hypomelanotic melanoma	This sign comes from a fairy tale in which the wolf disguises himself as the grandmother but can be still be recognized by his enormous teeth. It is used to describe an individual lesion that at first glance looks benign, but on closer inspection with dermoscopy shows features of a melanoma
6	Micro-Hutchinson sign³	Subungual melanoma	Visible pigment on cuticle in case of melanonychia
7	Pseudo-micro-Hutchinson sign⁴	Congenital nevi	Dark nail plate pigmentation is visible through the transparent nail fold specially in children
8	Starburst pattern⁵	Spitz nevus	A hyperpigmented macule with regular peripheral pigmented streaks with central homogeneous pigmentation
Non-melanocytic lesion
1	Arborizing telangiectasia	BCC, other benign lesions	Multiple branching blood vessels in a tree-like pattern. More easily visualised in the non-pigmented BCC
2	Blink sign⁶	Actinic keratosis	Some dermoscopic structures are more prominent with non-polarised dermoscopy while others with polarised dermoscopy.^1,2The hybrid dermoscope allows the user to toggle between polarised and non-polarised light result in “blink sign.”
3	Chrysalis structures	Basal cell carcinoma, dermatofibroma, scars	White shiny linear streaks seen under polarised microscopy
4	Comedo-like opening	Seborrheic keratoses	Dark brown, gray- or black-coloured round to oval clefts containing keratin plug
5	Double edge sign⁷	Bowen’s disease	Two parallel pigmented edges at the periphery of the lesion
6	Finger print-like structures	Lentigo or early seborrheic keratosis	Thin light brown lines that do not interconnect to form a meshwork pattern
7	Jelly sign⁸	Solar lentigo/flat seborrheic keratosis	Smudging of pigment in some areas on contact dermoscopy is called as jelly sign
8	Large blue-gray ovoid nests	Basal cell carcinoma	Well-circumscribed, pigmented ovoid or elongated areas that are not connected to the pigmented tumour body
9	Leaf-like areas or Maple leaf-like areas⁹	Basal cell carcinoma	Discrete, bulbous extensions connected to base and forming a leaf-like pattern [Figure 2]
10	Milia-like cysts (stars in the sky appearance)¹⁰	Seborrheic keratosis, congenital nevi	Round circumscribed, white to yellow structure better visualized on non-polarised dermoscopy
11	Mobility sign¹¹	Epidermal cyst	In contact dermoscopy, when plate is shifted back and forth on the lesion with a slight pressure, nodular part of the lesion remains immobile while the overlying skin moves in same direction with the dermoscope plate
12	Moth eaten border¹²	Solar lentigo/flat seborrheic keratosis	Concave invaginations at the border of the lesion
13	Pore sign¹¹	Epidermal cyst	Highlights the barely visible punctum [Figure 3]
14	Ridges and fissures (cerebriform structures)	Seborrheic keratoses	Brain-like or cerebriform appearance with the grooves resembling “sulci” and the intervening ridges resembling surface “gyri” [Figure 4]
15	Rosette sign	Actinic keratosis, basal cell carcinoma, melanoma, discoid lupus erythematosus, molluscum	Four white points arranged as four-leaf clover. Non-specific, initially described in AK but seen in many conditions
16	Spoke wheel-like structures	Basal cell carcinoma	Radial projections surrounding a central darker point
17	Strawberry pattern¹³	Actinic keratosis	Background erythema interrupted by multiple small keratin filled follicular ostia

Dermoscopic Signs in Infections and Infestations

Recently, dermoscopy is being utilized to diagnose infections and infestations (entomodermoscopy) [Figures 5 and 6]. The classical “Delta wing-jet with contrail sign” is the hallmark of scabies, while newer signs and terminologies have been described to identify several bacterial, viral, fungal and other parasitic infections [Table 2].

Contrast halo sign in a case of hypopigmented pityriasis versicolor showing a ring of increased pigmentation (yellow arrow) around the primary hypopigmented (red star) lesion (Dino-lite AM4115ZT;×50;polarising)

Morse code-like hair in tinea capitis showing multiple horizontal bands (alternating red and yellow arrows) of fungal invasion in vellus hairs by masses of arthroconidia formed at intervals (Dermlite DL4;×10;polarising)

Table 2: Signs and patterns in infections

S. No.	Dermoscopic sign	Disease	Description
1	Bird’s feet-like structures and thorn crown¹⁴	Myiasis	Here, the posterior segment of the larva appears as creamy-white body with central bird’s feet-like structures which correspond the breathing spiracles. The white structures are surrounded by black dots in the periphery, appearing as thorn crown
2	Contrast halo sign¹⁵	Pityriasis versicolor	A halo of contrast to the central primary lesion of pityriasis versicolor. In hypopigmented variant, this contrast halo is a ring of increased pigmentation while in the hyperpigmented variant, the primary area of increased pigmentary network is surrounded by a halo of hypopigmentation [Figure 5]
3	Delta-wing jet with contrail sign¹⁶	Scabies	It presents as a white S-shaped line (contrail) corresponding to the irregular burrow excavated by the mite, whose anterior part of the body is appreciated as a brown triangle resembling a delta wing jet
4	Demodex tail^17,18	Demodicidosis Demodex dermatitis Spinulosis of face Pityriasis folliculorum Rosacea-like demodicidosis Granulomatous rosacea	Gelatinous, whitish-creamy 1–3mm long thread-like structure protruding out of the follicular opening. This feature signifies the presence of the mite and can be appreciated in more abundance in spinulosis of the face or pityriasis folliculorum, than other types of demodicidosis
5	Frog spawn appearance^19,20	Common wart	Multiple densely packed papillae with a central red dot or loop surrounded by a whitish halo giving it an appearance of frog spawn
6	Hang glider sign/triangular head^16,19,21	Scabies	It appears as a brown triangle that corresponds to the anterior section of the mite which includes the head and the two anterior pairs of legs of the mite
7	Mite-Gallery Unit (MGU)²²	Scabies	MGU is divided into three parts: The head hosting the mite; the body which represents what is clinically defined as the burrow containing the eggs and feces of the parasite; and the tail at the end of the tunnel which provides an incomplete structure as it is without a roof but is made of keratin collarettes
8	Morse code hair²³	Tinea incognito Tinea capitis	Multiple horizontal bands of fungal invasion invellus hairs by masses of arthroconidia formed at intervals. The masses of arthroconidia are separated by thinner fragments of hyphae [Figure 6]
9	Mosaic pattern^19]	Genital wart	Presence of groups of dotted or glomerular vessels at centre with a surrounding whitish network
10	Noodle sign²⁴	Norwegian scabies	It represents an accumulation of hundreds of burrows
11	Red corona/corona-like vessels^25,26	Molluscum contagiosum	A central pore or umbilication with polylobular white to yellow amorphous structures surrounded by linear, fine telangiectatic vessels
12	Reniform and hairpin loop structures²⁷	Myiasis	These represent the larva which appear as multiple, mobile, creamy white structures with reniform centers. Each reniform centre consists of three pairs of hairpin loop-like structures
13	Rosettes/4-leaf-clover-like appearance^28,29	Early molluscum	Four white points arranged as 4-leaf clover, mainly located around the follicular openings. This appearance is seen on polarized dermoscopy, and it is also seen in other conditions such as actinic keratosis, discoid lupus erythematosus and squamous cell carcinoma
14	White jade coin pendant sign^30,31	Talaromyces marneffeiinfection	It is seen as a circular or quasi-circular whitish amorphous structure with a central keratin plug or a haemorrhage
15	White starburst-like pattern^32-34	Leishmaniasis	White halo surrounding a central eroded area which may correspond to parakeratosis and hyperkeratosis surrounding the erosion
16	Yellow tears^33,35	Leishmaniasis cutaneous sporotrichosis	Yellowish structures with an oval and/or tear drop shape. This feature attributes to the follicular plugs due to the lateral compression of follicular openings

Dermoscopic Signs in Pigmentation Disorders

Dermoscopy is immensely helpful for diagnosing pigmentary disorders (both hypopigmentary and hyperpigmentary conditions) as most conditions are difficult to differentiate clinically, and biopsy is not feasible due to patient reluctance for fear of post-inflammatory hyperpigmentation [Figures 7 and 8]. Some of the important signs in hyperpigmentary and hypopigmentary disorders are summarised in Table 3.

Cristae (red star) and sulci (yellow arrow) pattern in acanthosis nigricans showing presence of grooves, furrows, ridges and crests along with hyperpigmented globules (green arrow) (Dino-lite AM4115ZT;×50;polarising)

Polka dot appearance (red circle) in unstable vitiligo showing multiple depigmented macules (blue arrow)[Dinolite AM4115ZT;50×;polarising]

Table 3: Signs and patterns in pigmentation disorders

S. No.	Dermoscopic sign	Disease	Description
Hyperpigmentation
1	Cristae and sulci pattern³⁶	Acanthosis nigricans	Presence of grooves, furrows, ridges and crests along with hyperpigmented dots [Figure 7]
2	Hill and valley pattern³⁶	Acanthosis nigricans	This is seen in severe cases of AN and appears as ridges (hills) and grooves (valleys)
3	Hub and spoke pattern³⁷	Macular amyloidosis	Brown clods and radiating brown lines from the clod
4	Reticuloglobular pattern³⁸	Melasma	Peripheral reticular pigmentation with central globules
5	Wagyu beef-like appearance³⁹	Erythema dyschromicum perstans	Pigmentation in crista cutis and presence of small brown dots
6	Worm-like structures⁴⁰	Exogenous ochronosis	Short, stout, curvilinear, “banana-shaped,” ochre-coloured fibres of varying thickness in the papillary and upper dermis
Hypopigmentation
1	Ameboid pattern⁴¹	Idiopathic guttate hypomelanosis,vitiligo	Relatively well-defined margins of the depigmented patch sending out pseudopod-like extensions
2	Cloudy sky-like pattern (cloudy pattern)⁴²	Idiopathic guttate hypomelanosis	Multiple small areas coalescing into irregular/polycyclic macules with several white shades and both well- and ill-defined edges, surrounded by patchy hyperpigmented network
3	Comet tail⁴³	Unstablevitiligo	Depigmented patch with koebnerization in a comet tail pattern
4	Manchurian gravy sign⁴⁴	Vitiligo post-skin grafting	After 2–3 months of micropunch grafting, grafts insituappear as homogeneous dark brown well-circumscribed pigmented structures with lighter brown-coloured areas emerging centrifugally from the darker structures
5	Nebulous pattern⁴¹	Vitiligo	Dense white depigmentation with ill-defined margins that merges indistinctly with the surrounding.
6	Petaloid pattern⁴⁵	Idiopathic guttate hypomelanosis	A well-defined depigmented macule with pigmented polycyclic margins
7	Polka dot appearance⁴¹	Unstablevitiligo	Depigmented macules in a polka dot appearance [Figure 8]
8	Reversed pigmentary network pattern⁴⁶	Evolving vitiligo	Net-like pigmentary network formed by homogeneous white lines separated by pigmented areas in between (opposite to that of normal reticulate pigmentary network)
9	Tapioca sago appearance⁴³	Unstablevitiligo	Satellite lesions appearing as small white blotches around the main patch of vitiligo
10	Trichrome pattern⁴⁷	Vitiligo	Zone of normal pigmentation surrounding a hypopigmented rim around depigmented patch
11	White chrysalis like structures⁴⁸	Extragenital lichen sclerosus	White-yellowish structureless areas, without any sharp margin to differentiate the hypopigmented patch from the surrounding skin

Dermoscopic Signs in Vascular Disorders

Dermatologists frequently encounter various vascular lesions (benign and malignant) and most of them are superficially distributed [Figure 9]. Dermoscopy of vascular lesions can highlight their vascular pattern and arrangement of blood vessels. Table 4 highlights the important dermoscopic signs and patterns observed in cutaneous vascular lesions.

White rail lines (black arrow) in pyogenic granuloma showing whitish streaks that intersect the lesion [Dermlite DL4;10×;polarising]

Table 4: Signs and patterns in vascular disorders

S. No.	Dermoscopic sign	Disease	Description
1	Collarette sign⁴⁹	Kaposi sarcoma	Four types of collarette signs have been described: white, brown, scaly and mixed. The pathological correlation of collarette sign was areas of epidermal invagination, where acanthosis and hyperkeratosis are prominent
2	Hypopyon sign^50,51	Lymphangioma circumscriptum	Presence of lacunae (often multicoloured). The lacunae has different amount of blood and lymphatic content owing to the presence of micro-shunts between lymphatic channels and small blood vessels. The extravasated cellular element of blood (erythrocytes) lies at the bottom and serum on the upper part giving rise to a “hypopyon sign” or 2-tone lacunae (as a result a half blood-filled lacunae resembling the hypopyon in the eye). it is a reliable feature to distinguish between LC and hemangioma
3	Rainbow pattern sign⁵²	Kaposi sarcoma	Presence of multicoloured areas similar to the spectrum of a rainbow. The pattern is predominantly seen in vascular lumen-rich histological subtype of KS and is not observed in the vascular lumen-poor subtype
4	White rail lines⁵³	Pyogenic granuloma	Whitish streaks or bands that intersect the lesion through and through [Figure 9]

Dermoscopic Signs of Papulosquamous Disorders

Skin disorders such as psoriasis, lichen planus, pityriasis rosea and subacute lupus erythematosus have a common morphologic appearance as scaly plaques [Figures 10-12]. Clinical differentiation may be difficult occasionally, thereby requiring histopathological confirmation. Dermoscopic magnification of surface structures and sub-surface features may aid in correct diagnosis by revealing disease-specific diagnostic features [Table 5].

Collerette sign (black arrow) in pityriasis rosea showing the characteristic peripheral white scale [Dinolite AM4115ZT;50×; polarising]

White track (between the black lines) of porokeratosis coronoid lamella appearing as well-defined, thin, white-yellowish, annular peripheral hyperkeratotic structure which resembles outlines of a volcanic crater (red arrow) seen from a high point. [Dinolite AM4115ZT;50×;polarising]

Dermoscopic Auspitz sign in psoriasis showing characteristic pattern consisting of diffuse white scales (blue arrow) at periphery and symmetrically and regularly distributed dotted vessels (yellow arrow) on a light or dull red background [Dinolite AM4115ZT;50×;polarising]

Table 5: Signs and patterns in papulosquamous disorders

S. No.	Dermoscopic sign	Disease	Description
1	Collarette sign^54,55	Pityriasis rosea	The characteristic peripheral whitish scaling seen in both herald patch and other lesions [Figure 10]
2	Cornoid lamella (white track sign)^56,57	Porokeratosis	A well-defined, thin, white-yellowish, annular peripheral hyperkeratotic structure (“white track”) which resembles outlines of a volcanic crater seen from a high point corresponds to cornoid lamella [Figure 11]
3	Dermoscopic Auspitz sign⁵⁸	Plaque psoriasis	In presence of marked hyperkeratosis after removal of scales, dermoscopy shows characteristic pattern consisting of diffuse white scales and symmetrically and regularly distributed dotted vessels and tiny red blood drops on a light or dull red background suggestive of dermoscopic Auspitz sign [Figure 12]
4	Rail-like appearance⁵⁹	Asteatotic eczema	Asteatotic eczema on dermoscopy is seen as white scales having a double free edge giving “rail-like” appearance
5	Red globular ring pattern⁶⁰	Plaque psoriasis	Typical pattern of vessels in psoriasis described as uniformly distributed “dotted,” “pinpoint” capillaries and coiled (or glomerular) vessels. The same pattern of blood vessels in psoriasis also described as red dots (for vessels with diameters up to 0.1 mm) or “red globules” terms
6	Spermatozoon-like structures⁶¹	Patch stage of mycosis fungoides	A peculiar vascular pattern (composed of a dotted and a short curved linear vessel) resembles spermatozoa
7	Sunburst appearance⁶²	Lichen nitidus	Lichen nitidus is characterised by shiny elevated surface with absence of dermatoglyphics over the lesions along with radial ridges and central circular depression. The radial ridges are seen to be radiating from the edges of central depression giving a “sunburst appearance.” It is classically seen on non-polarised dermoscopy
8	Trizonal concentric pattern⁵⁹	Acquired reactive perforating collagenosis	Central round brownish-greenish/yellowish-brown structureless area surrounded by a white keratotic collarette and an erythematous halo with or without dotted vessels
9	White starburst pattern⁶³	Prurigo Nodularis	Both hyperkeratotic and excoriated lesions of prurigo nodularis show arranged whitish lines or peripheral whitish halo with some centrifugal coarse projections on a brownish and/or reddish background
10	Wickham’s striae^64,65(polymorphic pearly whitish structures) Patterns: Reticular pattern, circular pattern, radial streaming, leaf venation starry sky pattern	Lichen planus	Leaf venation pattern of WS-delicate secondary striae branching from the centered WS venation, linked together at either end, resembling the crystal structure of snow Starry sky pattern: Clustered, follicular white dots

Dermoscopic Signs of Scalp and Hair Disorders

Trichoscopy is a valuable tool for not only diagnosing different hair and scalp disorders including alopecias but may be used additionally for assessing prognosis and monitoring treatment response [Figures 13 and 14]. It involves detailed observation of hair follicle openings, perifollicular and interfollicular scalp epidermis, dermal vasculature and hair shafts. A careful analysis of these findings is necessary for diagnosis. Over years, various trichoscopic signs have been documented and established. Some of these signs are non-specific, but are helpful in assessment of different alopecias, while other specific signs facilitate a quick diagnosis.^1,2We have compiled both non-specific and specific trichoscopic signs in Table 6.

Comma (blue arrow) and corkscrew hairs (red arrow) showing fractured, c-shaped hair shafts of homogeneous thickness and pigmentation; and short, spiral shaped hairs [Dermlite DL4;10×;polarising]

Peripilar cast in folliculitis decalvans showing concentric layers of scales around the emerging hair shaft (red circle) [Dermlite DL4;10×;polarising]

Table 6: Signs and patterns in scalp and hair disorders

S. No.	Dermoscopic sign	Disease	Description
Scalp related
1	“Cherry blossom” vascular pattern⁶⁶	Seborrheic dermatitis	Arborizing vessels surrounded by glomerular and comma-shaped vessels
2	Dandelion vascular conglomerate⁶⁶	Seborrheic dermatitis	Yellow dot surrounded by glomerular and comma-shaped vessels. This appears like seed head of dandelion (Taraxacumgenus) plants
3	Flambeau sign⁶⁷	Traction alopecia	Multiple linear white tracks (mimicking the shape of flame or lit torch) in the direction of traction on hairs. These white tracks are particularly noted posterior to fringe of hairs left (fringe sign) at the hair line
4	Honeycomb network^68,69	Sun exposure	Bald scalp shows increased pigmentation in a fine reticular pattern. It may be lost in various scarring alopecia
5	Peripilar sign^70,71	Androgenetic alopecia	Depressed brown halo around the hair follicle, represents perifollicular inflammation
6	Peripilar white halo^68,70	Central cicatricial scarring alopecia	Gray-white halo surrounding follicular openings
7	Red starburst sign^70,71	Discoid lupus erythematosus	Seen as circular, follicular erythema. Represents dilated follicular openings surrounded by dilated blood vessels
Hair shaft related
1	Bamboo hair^72,73	Trichorrhexis invaginata	Invagination of the distal portion of the hair shaft into its proximal portion forming a “ball in cup” appearance
2	Bent hairs⁷⁴	Tinea capitis	Hair shaft with a single bend at sharp angle
3	Broom fibres sign⁷⁵	Lichen simplex chronicus of scalp	Hair shaft gets broken longitudinally into two or more fragments and mimics broom fibres
4	Burnt matchstick hair⁷⁶	Trichotillomania	Hair with dark bulbar proximal tip with a linear stem of variable length
5	Coudability sign⁷⁷	Alopecia areata	Proximal narrowing (and subsequent kinking) of hair shafts
6	Coiled hairs⁷⁸	Trichotillomania	Broken (terminal) hairs that curl back
7	Comma hairs⁷⁴	Tinea capitis Sometimes, alopecia areata and trichotillomania	Fractured, c-shaped hair shafts of homogeneous thickness and pigmentation [Figure 13]
8	Corkscrew hairs⁷⁴	Tinea capitis	Short, spiral-shaped hairs [Figure 13]
9	Crawling snake appearance⁷⁹	Woolly hair syndrome	Short wavy cycles in the hair shaft resembling a crawling snake
10	Exclamation mark hairs⁷⁷	Alopecia areata	Broken hair shafts have a darker, thicker tip while the proximal portion is thinner and pale. Indicate active disease process
11	Flame hairs⁷⁷	Alopecia areata, trichotillomania, anagen effluvium	Semi-transparent, wavy or cone shaped, pigmented structure resembling flame. Represents pigmented hair cast
12	Golf tee hairs^72,73	Trichorrhexis invaginata	The cupped proximal end of hair shaft remains while the distal end fractures and fall off
13	Hair dust/hair powder⁷⁸	Trichotillomania	Small fragments of broken hair visible on the scalp
14	i-hairs^80,81	Tinea capitis alopecia areata, trichotillomania	Short hair with an accentuated distal end and a thin hypopigmented shaft just beneath the darker distal end, resembling the alphabet “i”
15	Mace hair⁸²	Trichotillomania	Distal end of the hair shaft is bulbous and the hair shaft is hyperpigmented throughout its length and the upper half is rough in texture due to pulling and playing action with hair
16	Matchstick hairs⁸³	Trichorrhexis invaginata	Short hair shafts with bulging tips
17	Morse code (bar code) like hairs⁷⁴	Tinea capitis	Hair shafts with irregular horizontal white bands. Correlates with zone of ectothrix. Hair shafts may get bent at this zone.
18	Peripilar cast^68-70	Lichen planus pilaris, also in discoid lupus erythematosus, folliculitis decalvans	Concentric layers of scales around the emerging hair shaft. Peripilar cast encircling 2–3 or more hairs is very suggestive of LPP [Figure 14] Thicker peripilar casts encircling six or more hairs is suggestive of folliculitis decalvans
19	Pigtail hairs (circle hairs)^77,78	Androgenetic alopecia, anagen effluvium, tinea capitis, Trichotillomania	Thin, curved, regrowing (vellus) hairs appear circular or coiled Correlates with hair regrowth
20	Pohl-pinkusconstrictions^68,69	Alopecia areata, anagen effluvium, cicatricial alopecia, telogen effluvium	Refers to zones of decreased hair shaft thickness
21	Question mark hair⁷⁸	Trichotillomania	The distal portion of the hair shaft is curved and appears like question mark. Unlike exclamation mark hairs, the proximal portion of hair shaft is not tapered
22	Regularly bended ribbon sign⁸⁴	Monilethrix	Bended regularly at multiple locations with tendency to curve in different directions, giving it an appearance of a regularly bended ribbon
23	Starburst pattern hyperplasia⁸⁵	Folliculitis decalvans	Perifollicular erythema arranged in a pattern of lines radiating from a centre (it results from fibrosis)
24	Tulip bulb hairs⁷⁸	Trichotillomania	Short hairs with tulip bulb-shaped ends
25	V sign or V-hairs⁷⁸	Trichotillomania	Two (or more) hairs emerging from same follicular opening get broken at similar level/height and give an impression of “V”
26	Zigzag hairs⁷⁴	Tinea capitis	Hair shafts bent at multiple sharp angles along the length. Hair shafts appear like letter “Z”

Dermoscopic Signs of Nail Disorders

Nail disorders are often complicated by dubious clinical diagnoses. Moreover, histopathological confirmation is difficult due to the tedious process of nail biopsy. The evolution of onychoscopy is one of the most significant contributions of dermoscope [Figures 15 and 16]. Some of the important onychoscopic signs are tabulated in Table 7.

Dendritic pattern (yellow circle) of endonyx appearing as the haphazard proliferation and branching of fungal elements in the nail plate. [Dinolite AM4115ZT;50×;polarising]

Ruin pattern (blue box) of onychomycosis appearing as indented areas on the subungual keratosis and distal pulverisation [Dinolite AM4115ZT;50×;polarising]

Table 7: Signs and patterns in nail disorders

S. No.	Dermoscopic sign	Disease	Description
1	Aurora borealis pattern⁸⁶	Onychomycosis	Parallel bands of different colours in the onycholytic nail plate
2	Chick-pea flour pattern⁸⁷	White superficial onychomycosis	Yellowish-white, opaque and friable debris on the nail plate, concentrated near the proximal nail fold
3	Dendritic pattern⁸⁸	Endonyx	The haphazard proliferation and branching of fungal elements in the nail plate [Figure 15]
4	Grid pattern⁸⁷	Superficial white onychomycosis	Interconnected linear striae progressing from proximal to distal end
5	Irregular pattern of LPB³	Malignant melanonychia	longitudinal lines that are irregular in colour, spacing, thickness and parallelism
6	Mirror sign⁸⁹	Onychomatricoma	Intraoperative dermoscopy sign: Symmetry of the lesion through a perpendicular axis in the proximal nail fold with the digitations (finger-like extensions of the tumour above the lunula) within the tumour being mirrored by the crypts within the nail plate
7	Pink glow sign⁹⁰	Subungual glomus tumour	Ultraviolet light dermoscopy glow of the glomus tumour due to its vascular nature
8	Pseudo-fibre sign⁹¹	Nail psoriasis	Red and black filamentous structures under the distal-free edge of nail plate
9	Regular pattern of longitudinal pigmentary bands³	Benign melanonychia	Parallel longitudinal lines are homogeneous in colour, spacing, thickness and orientation
11	Ruin pattern⁹¹	Onychomycosis	Indented areas on the subungual keratosis and distal pulverisation [Figure 16]
12	Sagrada Familia sign⁸⁹	Onychomatricoma	Intraoperative dermoscopy sign: Multiple, regularly spaced and arranged, hyperbolic cavities in the ventral aspect of the nail plate

Conclusion

Metaphoric language is a part of our cognitive development and is commonly used to comprehend new knowledge by comparing with already learned knowledge. The use of metaphoric language in dermoscopy has been both supported and opposed. Its use in dermatology (including dermoscopy) has been criticized for lacking a clear definition and specificity. A metaphor should be well defined and clearly pictured (descriptive terminology may be used), useful (help the student understand a new concept which is otherwise difficult and/or complex), straight forward and commonplace (easily recognized and remembered) and resemble the described dermoscopic feature.⁹² The aforementioned parameters must be kept in mind, while proposing a novel metaphoric term so as to minimize inter-observer variability and confusion in its interpretation. If a metaphor fails to satisfy these criteria, it may become difficult for the readers to interpret and remember them. Therefore, it is prudent to strike a balance between both metaphoric and descriptive angles, while coining the dermoscopic appearances.⁹³ Our attempt to compile the named signs and metaphoric language will be useful for the learners of dermoscopy and will make it interesting.

Declaration of patient consent

Patients’ consent is not required as the patients’ identities are not disclosed or compromised.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

Braun RP, Oliviero M, Kolm I, French LE, Ashfaq AM, Rabinovitz H, et al. Dermoscopy: What's new? Clin Dermatol. 2009;27:26-34.
[CrossRef] [PubMed] [Google Scholar]
Cognetta AB, Stolz W, Katz B, Tullos J, Gossain S. Dermatoscopy of lentigomaligna. Dermatol Clin. 2001;19:307-18.
[CrossRef] [Google Scholar]
Ronger S, Touzet S, Ligeron C, Balme B, Viallard AM, Barrut D, et al. Dermoscopic examination of nail pigmentation. Arch Dermatol. 2002;138:1327-33.
[CrossRef] [PubMed] [Google Scholar]
Sawada M, Ishizaki S, Kobayashi K, Dekio I, Tanaka M. Longterm digital monitoring in the diagnosis and management of congenital nevi of the nail apparatus showing pseudo-Hutchinson's sign. Dermatol Pract Concept. 2014;4:37-40.
[CrossRef] [PubMed] [Google Scholar]
Liu ZR, Jie L. Spitz nevus with specific dermoscopic features. Int J Dermatol Venereol. 2019;2:112-4.
[CrossRef] [Google Scholar]
Braun RP, Scope A, Marghoob AA. The blink sign in dermoscopy. Arch Dermatol. 2011;147:520.
[CrossRef] [PubMed] [Google Scholar]
Yang Y, Lin J, Fang S, Han S, Song Z. What's new in dermoscopy of Bowen's disease: Two new dermoscopic signs and its differential diagnosis. Int J Dermatol. 2017;56:1022-5.
[CrossRef] [PubMed] [Google Scholar]
Zalaudek I, Ferrara G, Argenziano G. Clonal seborrheic keratosis: A dermoscopic pitfall. Arch Dermatol. 2004;140:1169-70.
[CrossRef] [PubMed] [Google Scholar]
Wozniak-Rito A, Zalaudek I, Rudnicka L. Dermoscopy of basal cell carcinoma. Clin Exp Dermatol. 2018;43:241-7.
[CrossRef] [PubMed] [Google Scholar]
Minagawa A. Dermoscopy-pathology relationship in seborrheic keratosis. J Dermatol. 2017;44:518-24.
[CrossRef] [PubMed] [Google Scholar]
Elmas Ö. Dermoscopic diagnosis of epidermal cyst. Ann Med Res. 2019;26:1249-52.
[CrossRef] [Google Scholar]
Bollea-Garlatti LA, Galimberti GN, Galimberti RL. Lentigo maligno, Claves en el diagnóstico dermatoscópico. Actas Dermosifiliogr. 2016;107:489-97.
[CrossRef] [PubMed] [Google Scholar]
Peris K, Micantonio T, Piccolo D, Fargnoli MC. Dermoscopic features of actinic keratosis. J Dtsch Dermatol Ges. 2007;5:970-6.
[CrossRef] [PubMed] [Google Scholar]
Abraham LS, Azulay-Abulafia L, Aguiar DD, Torres F, Argenziano G. Dermoscopy features for the diagnosis of furuncular myiasis. An Bras Dermatol. 2011;86:160-2.
[CrossRef] [PubMed] [Google Scholar]
Kaur I, Jakhar D, Singal A. Dermoscopy in the evaluation of pityriasis versicolor: A cross sectional study. Indian Dermatol Online J. 2019;10:682-5.
[CrossRef] [PubMed] [Google Scholar]
Argenziano G, Fabbrocini G, Delfino M. Epiluminescence microscopy. A new approach to in vivo detection of Sarcoptesscabiei. Arch Dermatol. 1997;133:751-3.
[CrossRef] [PubMed] [Google Scholar]
Friedman P, Sabban EC, Cabo H. Usefulness of dermoscopy in the diagnosis and monitoring treatment of demodicidosis. Dermatol Pract Concept. 2017;7:35-8.
[CrossRef] [PubMed] [Google Scholar]
Segal R, Mimouni D, Feuerman H, Pagovitz O, David M. Dermoscopy as a diagnostic tool in demodicidosis. Int J Dermatol. 2010;49:1018-23.
[CrossRef] [PubMed] [Google Scholar]
Tschandl P, Argenziano G, Bakos R, Gourhant JY, HofmannWellenhof R, Kittler H, et al. Dermoscopy and entomology (entomodermoscopy) J Dtsch Dermatol Ges. 2009;7:589-96.
[CrossRef] [PubMed] [Google Scholar]
Piccolo V. Update on dermoscopy and infectious skin diseases. Dermatol Pract Concept. 2019;10:e2020003.
[CrossRef] [PubMed] [Google Scholar]
Suh KS, Han SH, Lee KH, Park JB, Jung SM, Kim ST, et al. Mites and burrows are frequently found in nodular scabies by dermoscopy and histopathology. J Am Acad Dermatol. 2014;71:1022-3.
[CrossRef] [PubMed] [Google Scholar]
Scanni G. The Mite-Gallery unit: A new concept for describing scabies through entodermoscopy. Trop Med Infect Dis. 2019;4:48.
[CrossRef] [PubMed] [Google Scholar]
Bhat YJ, Keen A, Hassan I, Latif I, Bashir S. Can dermoscopy serve as a diagnostic tool in dermatophytosis? A pilot study. Indian Dermatol Online J. 2019;10:530-5.
[CrossRef] [PubMed] [Google Scholar]
Chavez-Alvarez S, Villarreal-Martinez A, Argenziano G, AncerArellano J, Ocampo-Candiani J. Noodle pattern: A new dermoscopic pattern for crusted scabies (Norwegian scabies) J Eur Acad Dermatol Venereol. 2018;32:e46-7.
[CrossRef] [PubMed] [Google Scholar]
Zalaudek I, Giacomel J, Cabo H, Stefani AD, Ferrara G, Wellenhof RH, et al. Entodermoscopy: A new tool for diagnosing skin infections and infestations. Dermatology. 2008;216:14-23.
[CrossRef] [PubMed] [Google Scholar]
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.
[CrossRef] [PubMed] [Google Scholar]
Jakhar D, Misra A, Dabas S. Myiasis under dermatoscope: The hidden story. Indian Dermatol Online J. 2018;9:220-1.
[Google Scholar]
Ku SH, Cho EB, Park EJ, Kim KH, Kim KJ. Dermoscopic features of molluscum contagiosum based on white structures and their correlation with histopathological findings. Clin Exp Dermatol. 2015;40:208-10.
[CrossRef] [PubMed] [Google Scholar]
Malakar S, Mukherjee SS. Rosette: An additional in vivo dermoscopic finding in molluscum contagiosum. Indian J Paediatr Dermatol. 2019;20:349-50.
[CrossRef] [Google Scholar]
Li Q, Wang C, Zeng K, Peng X, Wang F. AIDS-associated disseminated talaromycosis (penicilliosis) marneffei. J Dtsch Dermatol Ges. 2018;16:1256-9.
[CrossRef] [Google Scholar]
Xian J, Huang X, Li Q, Peng X, Peng X. Dermatoscopy for the rapid diagnosis of Talaromyces marneffei infection: A case report. BMC Infect Dis. 2019;19:707.
[CrossRef] [PubMed] [Google Scholar]
Serarslan G, Ekiz Ö, Özer C, Sarikaya G. Dermoscopy in the diagnosis of cutaneous leishmaniasis. Dermatol Pract Concept. 2019;9:111-8.
[CrossRef] [PubMed] [Google Scholar]
Llambrich A, Zaballos P, Terrasa F, Torne I, Puig S, Malvehy J. Dermoscopy of cutaneous leishmaniasis. Br J Dermatol. 2009;160:756-61.
[CrossRef] [PubMed] [Google Scholar]
Taheri AR, Pishgooei N, Maleki M, Goyonlo VM, Kiafar B, Banihashemi M, et al. Dermoscopic features of cutaneous leishmaniasis. Int J Dermatol. 2013;52:1361-6.
[CrossRef] [PubMed] [Google Scholar]
Vinay K, Bhattacharjee R, Bishnoi A, Chatterjee D, Rudramurthy S, Dogra S. Dermatoscopic features of cutaneous sporotrichosis. J Eur Acad Dermatol Venereol. 2020;34:e718-20.
[CrossRef] [Google Scholar]
Nirmal B. Dermatoscopy image characteristics and differences among commonly used standard dermatoscopes. Indian Dermatol Online J. 2017;8:233-4.
[CrossRef] [PubMed] [Google Scholar]
Kumar P, Neema S, Pathak N. Macular amyloidosis in a middle-aged woman. Pigment Int. 2018;5:57-8.
[CrossRef] [Google Scholar]
Neema S, Chatterjee M. Dermoscopic characteristics of Melasma in Indians: A cross-sectional study. Int J Dermoscopy. 2017;1:6-10.
[CrossRef] [Google Scholar]
Tomii K, Fujimoto A, Yokoyama R, Kabata Y, Fujita S, Hayashi R, et al. Erythema dyschromicum perstans with a Wagyu beef-like appearance on dermoscopy. J Eur Acad Dermatol Venereol. 2020;34:e141-2.
[CrossRef] [Google Scholar]
Khunger N, Kandhari R. Dermoscopic criteria for differentiating exogenous ochronosis from melasma. Indian J Dermatol Venereol Leprol. 2013;79:819-21.
[CrossRef] [PubMed] [Google Scholar]
Al-Refu K. Dermoscopy is a new diagnostic tool in diagnosis of common hypopigmented macular disease: A descriptive study. Dermatol Reports. 2018;11:7916.
[CrossRef] [PubMed] [Google Scholar]
Errichetti E, Stinco G. Dermoscopy of idiopathic guttate hypomelanosis. J Dermatol. 2015;42:1118-9.
[CrossRef] [PubMed] [Google Scholar]
Kumar Jha A, Sonthalia S, Lallas A, Chaudhary RK. Dermoscopy in vitiligo: Diagnosis and beyond. Int J Dermatol. 2018;57:50-4.
[CrossRef] [PubMed] [Google Scholar]
Jha AK, Sonthalia S, Lallas A, Chaudhary RK. Post-graft trichrome and Manchurian gravy signs on dermoscopy can predict disease activity in vitiligo lesions post-skin grafting. Int J Dermatol. 2018;57:e144-5.
[CrossRef] [PubMed] [Google Scholar]
Ankad BS, Beergouder SL. Dermoscopic evaluation of idiopathic guttate hypomelanosis: A preliminary observation. Indian Dermatol Online J. 2015;6:164-7.
[CrossRef] [PubMed] [Google Scholar]
Thatte SS, Dongre AM, Khopkar US. Reversed pigmentary network pattern in evolving lesions of vitiligo. Indian Dermatol Online J. 2015;6:222-3.
[CrossRef] [PubMed] [Google Scholar]
Gandhi S, Shamanur M, Shashikiran AR, Kusagur M, Sugareddy Bhaskar V. A study of clinico-epidemiological and dermoscopic patterns of vitiligo in pediatric age group. Indian J Paediatr Dermatol. 2017;18:292-8.
[CrossRef] [Google Scholar]
Ankad BS, Beergouder SL. Dermoscopic patterns in lichen sclerosus: A report of three cases. Indian Dermatol Online J. 2015;6:237-40.
[CrossRef] [PubMed] [Google Scholar]
ErtürkYilmaz T, Akay BN, Heper AO. Dermoscopic findings of Kaposi sarcoma and dermatopathological correlations. Australas J Dermatol. 2020;61:e46-53.
[CrossRef] [PubMed] [Google Scholar]
Piccolo V, Russo T, Moscarella E, Brancaccio G, Alfano R, Argenziano G. Dermatoscopy of vascular lesions. Dermatol Clin. 2018;36:389-95.
[CrossRef] [PubMed] [Google Scholar]
Gencoglan G, Inanir I, Ermertcan AT. Hypopyon-like features: New dermoscopic criteria in the differential diagnosis of cutaneous lymphangioma circumscriptum and haemangiomas? J Eur Acad Dermatol Venereol. 2012;26:1023-5.
[CrossRef] [PubMed] [Google Scholar]
Cheng ST, Ke CL, Lee CH, Wu CS, Chen GS, Hu SC. Rainbow pattern in Kaposi's sarcoma under polarized dermoscopy: A dermoscopic pathological study. Br J Dermatol. 2009;160:801-9.
[CrossRef] [PubMed] [Google Scholar]
Zaballos P, Llambrich A, Cuéllar F, Puig S, Malvehy J. Dermoscopic findings in pyogenic granuloma. Br J Dermatol. 2006;154:1108-11.
[CrossRef] [PubMed] [Google Scholar]
Chuh AA. Collarette scaling in pityriasis rosea demonstrated by digital epiluminescence dermatoscopy. Australas J Dermatol. 2001;42:288-90.
[CrossRef] [PubMed] [Google Scholar]
Chuh AA. The use of digital epiluminescence dermatoscopy to identify peripheral scaling in pityriasis rosea. Comput Med Imaging Graph. 2002;26:129-34.
[CrossRef] [Google Scholar]
Zaballos P, Puig S, Malvehy J. Dermoscopy of disseminated superficial actinic porokeratosis. Arch Dermatol. 2004;140:1410.
[CrossRef] [PubMed] [Google Scholar]
Panasiti V, Rossi M, Curzio M, Bruni F, Calvieri S. Disseminated superficial actinic porokeratosis diagnosed by dermoscopy. Int J Dermatol. 2008;47:308-10.
[CrossRef] [PubMed] [Google Scholar]
Lallas A, Apalla Z, Tzellos T, Lefaki I. Dermoscopy in clinically atypical psoriasis. J Dermatol Case Rep. 2012;6:61-2.
[CrossRef] [PubMed] [Google Scholar]
Errichetti E. Dermoscopy of inflammatory dermatoses (inflammoscopy): An up-to-date overview. Dermatol Pract Concept. 2019;9:169-80.
[CrossRef] [PubMed] [Google Scholar]
Lacarrubba F, Pellacani G, Gurgone S, Verzì AE, Micali G. Advances in non-invasive techniques as aids to the diagnosis and monitoring of therapeutic response in plaque psoriasis: A review. Int J Dermatol. 2015;54:626-34.
[CrossRef] [PubMed] [Google Scholar]
Errichetti E, Piccirillo A, Stinco G. Dermoscopy as an auxiliary tool in the differentiation of the main types of erythroderma due to dermatological disorders. Int J Dermatol. 2016;55:e616-8.
[CrossRef] [PubMed] [Google Scholar]
Jakhar D, Grover C, Kaur I, Sharma S. Dermatoscopic features of lichen nitidus. Pediatr Dermatol. 2018;35:866-7.
[CrossRef] [PubMed] [Google Scholar]
Errichetti E, Piccirillo A, Stinco G. Dermoscopy of prurigo nodularis. J Dermatol. 2015;42:632-4.
[CrossRef] [PubMed] [Google Scholar]
Lallas A, Kyrgidis A, Tzellos TG, Karakyrio E, Karatolias A, Lefaki I, et al. Accuracy of dermoscopic criteria for the diagnosis of psoriasis, dermatitis, lichen planus and pityriasis rosea. Br J Dermatol. 2012;166:1198-205.
[CrossRef] [PubMed] [Google Scholar]
Vázquez-López F, Manjón-Haces JA, Maldonado-Seral C, RayaAguado C, Pérez-Oliva N, Marghoob AA. Dermoscopic features of plaque psoriasis and lichen planus: New observations. Dermatology. 2003;207:151-6.
[CrossRef] [PubMed] [Google Scholar]
Ruiz-Arriaga LF, Arenas R, Vega-Sánchez DC, Asz-Sigall D, MartínezVelazco MA. Seborrheic dermatitis: Three novel trichoscopic signs and its correlation to Malassezia sp. Colonization. Skin Appendage Disord. 2019;5:288-92.
[CrossRef] [Google Scholar]
Agrawal S, Daruwalla SB, Dhurat RS. The flambeau sign-a new dermoscopy finding in a case of marginal traction alopecia. Australas J Dermatol. 2020;61:49-50.
[CrossRef] [PubMed] [Google Scholar]
Lacarrubba F, Micali G, Tosti A. Scalp dermoscopy or trichoscopy. Curr Probl Dermatol. 2015;47:21-32.
[CrossRef] [PubMed] [Google Scholar]
Pirmez R, Tosti A. Trichoscopy tips. Dermatol Clin. 2018;36:413-20.
[CrossRef] [PubMed] [Google Scholar]
Miteva M, Tosti A. Hair and scalp dermatoscopy. J Am Acad Dermatol. 2012;67:1040-8.
[CrossRef] [PubMed] [Google Scholar]
Ocampo-Garza J, Tosti A. Trichoscopy of dark scalp. Skin Appendage Disord. 2018;5:1-8.
[CrossRef] [PubMed] [Google Scholar]
Miteva M, Tosti A. Dermatoscopy of hair shaft disorders. J Am Acad Dermatol. 2013;68:473-81.
[CrossRef] [PubMed] [Google Scholar]
Rudnicka L, Olszewska M, Waskiel A, Rakowska A. Trichoscopy in hair shaft disorders. Dermatol Clin. 2018;36:421-30.
[CrossRef] [PubMed] [Google Scholar]
Waskiel-Burnat A, Rakowska A, Sikora M, Ciechanowicz P, Olszewska M, Rudnicka L. Trichoscopy of tinea capitis: A systematic review. Dermatol Ther (Heidelb). 2020;10:43-52.
[CrossRef] [PubMed] [Google Scholar]
Agrawal S, Dhurat R, Ghate S, Sharma A, Surve R, Daruwalla S. Lichen simplex chronicus on the scalp: Broom fibres on dermoscopy; gear wheel sign and hamburger sign on histopathology. Indian Dermatol Online J. 2020;11:401-3.
[CrossRef] [PubMed] [Google Scholar]
Malakar S, Mukherjee SS. Burnt matchstick sign-a new trichoscopic finding in trichotillomania. Int J Trichol. 2017;9:44-6.
[CrossRef] [PubMed] [Google Scholar]
Waskiel A, Rakowska A, Sikora M, Olszewska M, Rudnicka L. Trichoscopy of alopecia areata: An update. J Dermatol. 2018;45:692-700.
[CrossRef] [PubMed] [Google Scholar]
Ankad BS, Naidu MV, Beergouder SL, Sujana L. Trichoscopy in trichotillomania: A useful diagnostic tool. Int J Trichol. 2014;6:160-3.
[CrossRef] [PubMed] [Google Scholar]
Rakowska A, Slowinska M, Kowalska-Oledzka E, Rudnicka L. Trichoscopy in genetic hair shaft abnormalities. J Dermatol Case Rep. 2008;2:14-20.
[CrossRef] [PubMed] [Google Scholar]
Rudnicka L, Szepietowski J, Slowinska M, Lukomska M, Maj M, Pinheiro A. Tinea capitis In: Rudnicka L, Olszewska M, Rakowska A, eds. Atlas of Trichoscopy. London: Springer; 2012. p. :367.
[CrossRef] [Google Scholar]
Malakar S, Mehta PR. “I hair”: A prognostic marker in alopecia areata and trichotillomania. Indian J Dermatol. 2017;62:658-60.
[CrossRef] [PubMed] [Google Scholar]
Malakar S, Mukherjee SS. Mace sign-a definitive sign of trichotillomania? Our Dermatol Online. 2017;8:1-2.
[CrossRef] [Google Scholar]
Goujon E, Beer F, Fraitag S, Hovnanian A, Vabres P. 'Matchstick' eyebrow hairs: A dermoscopic clue to the diagnosis of Netherton syndrome. J Eur Acad Dermatol Venereol. 2010;24:740-1.
[CrossRef] [PubMed] [Google Scholar]
Rakowska A, Slowinska M, Czuwara J, Olszewska M, Rudnicka L. Dermoscopy as a tool for rapid diagnosis of monilethrix. J Drugs Dermatol. 2007;6:222-4.
[Google Scholar]
Rakowska A, Slowinska M, Kowalska-Oledzka E, Warszawik O, Czuwara J, Olszewska M, et al. Trichoscopy of cicatricial alopecia. J Drugs Dermatol. 2012;11:753-8.
[Google Scholar]
Piraccini BM, Balestri R, Starace M, Rech G. Nail digital dermoscopy (onychoscopy) in the diagnosis of onychomycosis. J Eur Acad Dermatol Venereol. 2001;27:509-13.
[CrossRef] [PubMed] [Google Scholar]
Grover C, Jakhar D, Sharma S. The grid pattern of white superficial onychomycosis. Indian J Dermatol Venereol Leprol. 2020;86:568-70.
[CrossRef] [PubMed] [Google Scholar]
Jakhar D, Grover C, Kaur I. Dendritic pattern: Unique onychoscopic feature in endonyx. J Am Acad Dermatol. 2019;81:e89-90.
[CrossRef] [PubMed] [Google Scholar]
Ginoux E, PerierMuzet M, Poulalhon N, Debarbieux S, Dalle S, Thomas L. Intraoperative dermoscopic features of onychomatricoma: A review of 10 cases. Clin Exp Dermatol. 2017;42:395-9.
[CrossRef] [PubMed] [Google Scholar]
Thatte SS, Chikhalkar SB, Khopkar US. “Pink glow”: A new sign for the diagnosis of glomus tumour on ultraviolet light dermoscopy. Indian Dermatol Online J. 2015;6:S21-3.
[CrossRef] [PubMed] [Google Scholar]
Yorulmaz A, Artuz F. A study of dermoscopic features of nail psoriasis. Postepy Dermatol Alergol. 2017;34:28-35.
[CrossRef] [PubMed] [Google Scholar]
Giacomel J, Zalaudek I, Marghoob AA. Metaphoric and descriptive terminology in dermoscopy: Lessons from the cognitive sciences. Dermatol Pract Concept. 2015;5:69-74.
[CrossRef] [PubMed] [Google Scholar]
Blum A, Argenziano G. Metaphoric and descriptive terminology in dermoscopy: Combine “blink” with “think”. Dermatol Pract Concept. 2015;5:23.
[CrossRef] [PubMed] [Google Scholar]