Bloomed Pink Flowers! What Could It Be?

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Question: Identify the condition and the dermoscopic appearance that has been shown [Figure 1].Figure 1: Dermoscopy image on polarized light (10× magnification, DermLite DL4, Lischke Medizintechnik In den Hegen, Bochum, Germany)Answer: Dermoscopy images on polarized light (10× magnification) show tapered finger-like projections [Figure 2, black circle] and reddish-brown pigmented spots and globules at the distal end of projections [Figure 2, blue arrow]. Both linear and loop blood vessels are visible in the dermoscopic image [Figure 2, lack arrow and blue circle, respectively]. This cohesively gives an appearance of bloomed “Dahlia flowers,” with the papillary projections resembling the petals of the flower.[1]Figure 2: Dermoscopy image on polarized light (10× magnification) shows tapered finger-like projections (black circle) and reddish brown pigmented spots and globules at the distal end of projections (blue arrow). Linear blood vessels (black arrow) and loop blood vessels (blue circle) are also being shownThis is a dermoscopic image of a filiform wart exhibiting pseudo-Koebner phenomena [Figure 3].Figure 3: Clinical image showing multiple filiform warts exhibiting pseudo-Koebner phenomena over the posterior aspect of the upper trunkOther described patterns in filiform warts include evidence of vascularity in the form of dots, globules, linear vessels or loops, and pigmentary zones.[1,2] The finger-like projections denote hyperkeratosis and papillary hyperplasia, whereas the reddish brown pigmented spots at the distal end are suggestive of thrombosed dotted/linear blood vessels.[3] The finger-like papillary projections are considered to be a sensitive dermoscopic finding as it is seen in most of the filiform warts, unless being treated or removed with electrocautery or radiofrequency ablation. In addition, in the initial stages of growth, the dermoscopic image may not show a dahlia flower-like appearance due to the absence of multiple papillary projections resembling petals. Syringocystadenoma papilliferum, dermatosis papulosa nigra, verrucous epidermal nevus, and cutaneous horn and acquired digital fibrokeratoma are among few other entities with papillary projections which can be considered dermoscopic differentials. In syringocystadenoma papilliferum, exophytic milky-red projections are seen along with a polymorphous vascular pattern, whereas in dermatosis papulosa nigra, fissures and broad ridges with a cerebriform appearance are observed.[4,5] The verrucous epidermal nevus shows brown exophytic papillary structures, larger thick brown circles with a brownish background, and thick brown branched lines.[6] In this research, the diagnosis is obvious as the clinical image along with dermoscopy is characteristic of filiform warts. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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