Dermatoscopy for the cutaneous mastocytosis diagnosis in children

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Abstract
Dermatoscopic signs of various clinical types of cutaneous mastocytosis in children are described. The study included 50 children (25 males and 25 females) aged 1 month to 14 years with cutaneous mastocytosis, who were followed up at the Moscow Research and Practical Center for Dermatovenerology and Cosmetology from 2016 to 2022. During the study, the change in dermatoscopic signs of mastocytosis was assessed, considering the age of patients, the clinical type, and the disease duration. A «rainbow» sign and pigmentation alteration were observed in all clinical types of cutaneous mastocytosis. The «rainbow» sign is a stable dermatoscopic sign observed both at the onset of the disease and with long-term rashes. Pigmentary changes (pigment network, brown staining) were observed in all patients in mature foci of mastocytosis. In some cases, we observed the pale yellow central area of the rash elements. We considered them a dermatoscopic sign of the exudative morphological element formation (blister) in patients with skin mastocytoma and diffuse cutaneous mastocytosis. The reticular vascular pattern had significant variability depending on the type of mastocytosis. Persistent reticular vascular pattern may indicate the need for antimediator therapy. When assessing the Darier’s sign, a decrease in the intensity of the yellowish tint and the pigment network in the lesions of all clinical types was observed, except for the monomorphic type of maculopapular cutaneous mastocytosis. The study results showed that each clinical type of cutaneous mastocytosis has its own typical dermatoscopic patterns. In pediatric dermatology practice, invasive diagnostic procedures are often challenging. The dermatoscopy at the first visit of a patient with mastocytosis helps to make the correct clinical diagnosis and conduct a differential diagnosis with pigmentary neoplasms, juvenile xanthomas, and other skin diseases in children.

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