Preliminary evaluation of penile papule dermatoses with reflectance confocal microscopy in children
Lixin Chen1, Ying Wang1, Wanxing Zhang1
1Department of Dermatology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China.
Insights
Reflectance confocal microscopy (RCM) aids in diagnosing penile papule dermatoses like lichen striatus (LS), lichen nitidus (LN), juvenile xanthogranuloma (JXG), and molluscum contagiosum (MC) in children. RCM reveals unique features for each condition, improving diagnostic accuracy.
Area of Science:
- Dermatology
- Medical Imaging
- Pediatrics
Background:
- Penile papule dermatoses including lichen striatus (LS), lichen nitidus (LN), juvenile xanthogranuloma (JXG), and molluscum contagiosum (MC) present similar appearances, leading to frequent misdiagnosis in children.
- Accurate diagnosis of these ambiguous penile lesions in pediatric patients is crucial.
Purpose of the Study:
- To evaluate the in vivo diagnostic utility of reflectance confocal microscopy (RCM) for differentiating four common penile papule dermatoses in children.
- To identify unique RCM characteristics for LS, LN, JXG, and MC.
Main Methods:
- A study involving 12 patients with LS, nine with LN, seven with JXG, and nine with MC.
- In vivo evaluation of penile dermatoses using reflectance confocal microscopy (RCM) to analyze lesion characteristics.
Main Results:
- Each of the four dermatoses exhibited distinct RCM features.
- LS showed destroyed papillary rings with mononuclear cell clusters. LN presented with completely destroyed papillary rings forming solitary cavity-like structures. JXG displayed dilated papillary rings filled with large bright ring cells and particulate matter. MC lesions were crater-shaped with aggregated uniform roundish structures.
Conclusions:
- Reflectance confocal microscopy (RCM) provides real-time visualization of key diagnostic features for LS, LN, JXG, and MC on the penis in children.
- RCM enhances the ability to distinguish between these commonly misdiagnosed pediatric penile dermatoses.
Background:
Owing to their similar appearance, lichen striatus (LS), lichen nitidus (LN), juvenile xanthogranuloma (JXG), and molluscum contagiosum (MC) on the penis often lead to misdiagnosis and missed diagnosis, especially in children. In vivo evaluation of penile dermatoses with reflectance confocal microscopy (RCM) is helpful in the diagnosis of these ambiguous lesions in children.
Methods:
We recruited 12 patients with LS, nine with LN, seven with JXG, and nine with MC and evaluated the characteristics and distinguishing features of the four kinds of papule dermatoses on the penis using RCM.
Results:
The four dermatoses all had unique RCM features. LS generally showed focally destroyed dermal papillary rings, with numerous mononuclear cell clusters aggregated inside the papillary rings, and highly refractive clumps were observed. For LN, the dermal papillary rings were completely destroyed and arranged in a solitary, enlarged, cavity-like structure, in which round cells, particulate matter structures, and plump cellular structures were aggregated; the adjacent skin was completely normal. In JXG, the dermal papillary rings were significantly dilated, and the superficial dermis was filled with different-sized large bright ring cells; smaller, refractive, roundish structures; and particulate matter. For MC, the normal structures completely disappeared; the lesions were arranged in a crater-shaped structure; and a mass-like substance formed by the aggregation of multiple, uniform, roundish structures was observed within the crater.
Conclusion:
RCM allows for real-time visualization of major key diagnostic and distinguishing features of four papule dermatoses, LS, LN, JXG, and MC, on the penis in children.
