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Year : 2019  |  Volume : 20  |  Issue : 4  |  Page : 349-350

Rosette: An additional in vivo dermoscopic finding in molluscum contagiosum


1 Department of Dermatology, Rita Skin Foundation, Kolkata, West Bengal, India
2 Department of Dermatology, Cloudnine Hospitals, Bengaluru, Karnataka, India

Date of Web Publication30-Sep-2019

Correspondence Address:
Dr Samipa Samir Mukherjee
Department of Dermatology, Cloudnine Hospitals, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_89_17

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How to cite this article:
Malakar S, Mukherjee SS. Rosette: An additional in vivo dermoscopic finding in molluscum contagiosum. Indian J Paediatr Dermatol 2019;20:349-50

How to cite this URL:
Malakar S, Mukherjee SS. Rosette: An additional in vivo dermoscopic finding in molluscum contagiosum. Indian J Paediatr Dermatol [serial online] 2019 [cited 2019 Nov 14];20:349-50. Available from: http://www.ijpd.in/text.asp?2019/20/4/349/268402



Sir,

Dermoscopic patterns in molluscum have been well described in the available literature; however, as more and more observations are made across the world nuances are being added to the existing list of patterns. Classically, the dermoscopy pattern described in cases of molluscum contagiosum reported in four publications included the presence of a central yellowish-white structure and vessels around the lesion (vessels in a crown pattern).[1] Ianhez et al. in 2011, further described the variations of patterns based on combinations of the absence and presence of orifices with the absence or presence of vessels and their vascular patterns.[2] We herein report a novel finding of dermoscopic rosette in addition to the crown vessel and central yellowish structure in a 7-year-old child which to the best of our knowledge is the of its kind in Indian literature.

A 7-year-old male child presented with asymptomatic lesions over the face and neck area of 2-month duration. Clinical evaluation revealed small dome-shaped pearly white papules few of them showing central umbilication, and a clinical diagnosis of molluscum contagiosum was made [Figure 1]. On dermoscopic evaluation, the clinical findings were further supported by the presence of crown vessels and central yellowish structures pointing toward the diagnosis of molluscum contagiosum. In addition, dermoscopy also showed the presence of rosettes inin vivo dermoscopy of more than one lesion [Figure 2].
Figure 1: Molluscum contagiosum lesions on the neck

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Figure 2: Dermoscopy demonstrating crown vessels, yellowish-white central area, and rosette (circled in green)

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Rosettes were described in 2009, as a dermoscopic structure characterized by 4 white points arranged as a 4-leaf clover, mainly localized over the follicular openings exclusively seen on polarized dermoscopy.[3] First believed to be specific for actinic keratosis and squamous cell carcinoma, they are not lesion-specific and are described in many conditions.[4] Although the exact etiology of this structure remains unknown, it has been grouped under the heading of shiny white structures with two other entities, namely, the shiny white lines and shiny white areas with more definitive etiology of fibrosis.[5] Further, it has been suggested that interaction of the polarized light with narrowed or keratin-filled adnexal openings could be the morphological correlate toward its formation.[4] Others suggested that rosettes correspond to an alternating focal hyperkeratosis and normal corneal layer and keratin-filled openings.[6] In a study by Haspeslagh et al. in an attempt to further establish the etiology of these structures, the authors stated that rosettes are an optical effect of crossed polarization by concentric fibrosis or horny material, and hence, are not lesion-specific and are seen commonly over actinic skin.[7] The smaller structures (0.1–0.2 mm) were caused by polarization of concentric horn material in follicular and even in some eccrine ducts at the infundibular level of the biopsy. The larger rosettes (0.3–0.5 mm) were caused by concentric fibrosis around the follicles. The same study reported the presence of rosettes as an ex vivo dermoscopic finding without further characterization in 1/17 molluscum biopsies received.

Since in our case, the molluscum was located on the face and neck area which were a part of the actinic skin, we think it could have been contributory to the presence of rosette on dermoscopy. However, since the rosettes have been postulated to represent fibrosis, we consider it imperative for further observations regarding the presence of this structure in early/late stage of disease or during the regressing stage of disease (which could be characterized by minimal fibrosis).

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
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.  Back to cited text no. 1
    
2.
Ianhez M, Cestari SC, Enokihara MY, Seize MB. Padrões dermatoscópicos do molusco contagioso: Estudo de 211 lesões confirmadas por exame histopatológico. An Bras Dermatol 2011;86:74-9.  Back to cited text no. 2
    
3.
Cuellar F, Vilalta A, Puig S, Palou J, Salerni G, Malvehy J, et al. New dermoscopic pattern in actinic keratosis and related conditions. Arch Dermatol 2009;145:732.  Back to cited text no. 3
    
4.
Liebman TN, Rabinovitz HS, Balagula Y, Jaimes-Lopez N, Marghoob AA. White shiny structures: Dermoscopic features revealed under polarized light. J Eur Acad Dermatol Venereol 2012;26:1493-7.  Back to cited text no. 4
    
5.
Liebman TN, Rabinovitz HS, Dusza SW, Marghoob AA. Rosettes may be observed in a range of conditions. Arch Dermatol 2011;147:1468.  Back to cited text no. 5
    
6.
González-Álvarez T, Armengot-Carbó M, Barreiro A, Alarcón I, Carrera C, García A, et al. Dermoscopic rosettes as a clue for pigmented incipient melanoma. Dermatology 2014;228:31-3.  Back to cited text no. 6
    
7.
Haspeslagh M, Noë M, De Wispelaere I, Degryse N, Vossaert K, Lanssens S, et al. Rosettes and other white shiny structures in polarized dermoscopy: Histological correlate and optical explanation. J Eur Acad Dermatol Venereol 2016;30:311-3.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

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