Brief Report

Comparison of Dermoscope and Woods Lamp as A Tool to Study Melanin

Depth in Melasma
The number of studies available in Goa. A
total of 50
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from http://journals.lww.com/idoj by
Introduction: Melasma is a common acquired disorder of patients were
pigmentation that presents as hyperpigmented macules and enrolled in the
patches predominately in the sun exposed areas of the study over a
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on
face. It is more commonly seen in women. duration of 3
Objective: To compare the woods lamp and dermoscopic months after taking
features of melasma. Materials and Methods: A total of 50 informed written
patients were enrolled in this cross-sectional analytical study in
consent after ethical
a tertiary care hospital setting for over a duration of
3 months. Melasma was clinically classified as centrofacial, committee
malar and mandibular and the patients were then approval. A
examined using the woods lamp (Dermaindia) and dermoscope detailed demographic
(Dermlite DL4). Patients were classified into epidermal, mixed, profile and
and dermal melasma based on the level of melanin thorough
pigment. Statisticalanalysis was done using IBM SPSS software clinical history with
(version 22) to find the Cohens kappa coefficient. details such as
(The degree of agreement between different methods of
the duration,risk
assessment/different observers.) Results: The level of
agreement between the two methods was done with the factors, and history
help of Kappa coefficient. The Cohens kappa coefficient of treatment
was 0.534 with aP= 0.00 (p <.05), which indicated a received were taken.
moderate strength of agreement. Conclusion: Among the
This was
two diagnostic tools, there was a moderate degree of
agreement between dermoscopy and woods lamp in the followedby a
analysis of melasma. Limitations: Both woods lamp and complete
dermoscopy are tools that are subjective in dermatological
nature. There was a lack of comparison with examination and
histopathology or newer diagnostic techniques like all findings and
reflectance confocal microscopy (RCM). information was
Keywords: Depth of pigment, dermoscopy, melasma, woods lamp documented.
in dermatology literature Clinical photographs
Introduction were taken using
portraying the correlation
Melasma, previously referred Nikkon DSLR 5300.
between wood’s lamp and
to the term chloasma, The participants
dermoscopic findings with regard
is an acquired disorder of were classified
to melasmaare scant.
hypermelanosis, most commonly according to
Therefore, the present study
seen in females and the clinical pattern
was undertaken to correlate
predominantly affectingthe face. of melasmainto
and compare the findings of
The clinical presentation is centrofacial, malar
woods lamp and dermoscope
most often in the form and mandibular
for melasma.
of hyperpigmented patches over subtypes. They
the face in three common were then
patters: Centrofacial, malar and This is an open access journal, and articles are distributed subjected to
mandibular.[1] under the terms of the Creative Commons examination by
Attribution-NonCommercial-ShareAlike 4.0 License, which
allows others to remix, tweak, and build upon the work the Woods lamp
Evaluating the depth of non-commercially, as long as appropriate credit is given and the and Dermoscope.
pigment in a case of new creations are licensed under the identical terms.
melasmais a useful guide The participants
For reprints contact:
to the treatment plan WKHLRPMedknow_reprints@wolterskluwer.com
were classified
and also for counselling into epidermal,
the patients regarding level Materials and Methods dermal and mixed
of expectations from the pattern of
A cross-sectional analytical
treatment. melasmabased on
study was performed in
the amount of
a tertiary care hospital setting
 Navya and Pai: Dermoscopy vs woods lamp in melasma

How to cite this article: Navya A, Pai V. Comparison

of dermoscope and woods lamp as a tool to study
melanin depth in melasma. Indian Dermatol Online J
2022;13:366-9.
Received: 20-Apr-2021. Revised: 26-Nov-2021.
Accepted: 28-Nov-2021. Published: 05-May-2022.
Annam Navya, Varadraj Pai
Department of Dermatology,
Venereology and Leprosy, Goa
Medical College, Bambolim,
Goa, India

Address for correspondence:

Dr. Annam Navya,
Department of Dermatology, Venereology and Leprosy,
Goa medical College, Room
Number 134, GARD Hostel,
Goa Medical College, Bambolim - 403 202, Goa, India.
E-mail: drnavyaannam@gmail.
com
 Navya and Pai: Dermoscopy vs woods lamp in melasma

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Website: www.idoj.in

DOI: 10.4103/idoj.idoj_245_21

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enhancement noted by the woods lamp. Distribution of cases according to
It was classified as epidermal depth of melasmausing woods lamp and
when enhancement was noticed, dermal when dermoscope is tabulated in table
there was no enhancement and mixed 1.
when there was a slight enhancement
The clinical photographs of cases with
noted.
corresponding woods lamp and dermoscopic
A DermliteDL4 dermoscope was images are depicted in Figure 1a-c.
utilized in the study. The color of
Through the Woods lamp, 24 (48%) of
melanin as well as the intensity and
the cases were identified as of
the pattern of pigment network was used
the epidermal subtype, 20 (40%) were
to identify the location of pigment.
of the mixed type and 6 (12%)
Through the dermoscope the visualization
of the cases were dermal. Through the
of black and dark brown to light
dermoscope, 15 (30%) cases were of
brown color with a regular well
the epidermal, 23 (46%) were of
defined pigment network was classified as
mixed type and dermal were 12
epidermal while the presence of bluish
(24%).
or bluish grey color with an
irregular ill-defined pigment network was The level of agreement between the
classified as dermal while combination two methods was done with the help
was classified as mixed. of Kappa coefficient. The Cohens
The statistical analysis was performed
using the IBM Statistical Package for Table 1: Comparison of classification of melasma depth
the Social Sciences software (SPSS version 22) by Woods Lamp and Dermoscopy
to compute the Cohens kappa coefficient Classification Classification of melasma by Kappa of melasma
(which assesses the degree of agreement by dermoscopy coefficient woods lamp Epidermal Mixed
between two different methods/observers) Dermal
Epidermal 15 9 0 0.534
assuming the values to significant
Mixed 0 14 6
when P < 0.05.
Dermal 0 0 6
Results
There were 50 participants in the Total 15 23 12
study. Mean age of the patients was
kappa coefficient was 0.534. The
43 years with range between 25 to
strength of agreement is considered
64 years. Females outnumbered males in
to be moderate with P = 0.00 (p
the study with 39 (78%) females and
< 0.05).
11 (22%) male participants.
Various dermoscopic findings that were
The most common pattern of melasmawas
observed are tabulated in the
the centrofacial pattern found in 25
Table 2.
(50%) cases followedby malar with 21
(42%) cases while only 4 (8%) cases Reticuloglobular pattern was the pattern
were of the mandibular type. observed in all cases. While the
epidermal subtype had predominately black
and dark brown color of the
 Navya and Pai: Dermoscopy vs woods lamp in melasma

and also
Table 2: Various Dermoscopic findings inability in
in melasma to our
dynamically
study monitor skin changes

Dermoscopic feature Epidermal melasma Mixed melasma Dermal melasma

Reticuloglobular pattern ++ (73.33%) ++ (74%) ++ (75%)
Homogeneous ++ (67%) + (21.79%) + (50%)
Brown, dark brown ++ (100%) + (100%) + (66.6%)
Black + (26.6%) - -
Grey - ++ a (85%) ++ (100%)
Granular pattern - + (43.4%) (predominately + (41.6%)(predominately
brown granules) grey granules)
Arcuate, honey comb, - + (predominately + (predominately grey)
moth eaten brown)
patterns
Perifollicular - + (56.5%) + (83.33%)
b
pigmentation
pigment,dermal had grey and greyish blue
color while mixed had a combination.
All cases had a follicular and
appendageal sparing.

Discussion
c
Melasmais a very common acquired
disorder of hyperpigmentation characterized
by the presence of symmetrical light
to dark brown macules most commonly
on the face and occasionally over
neck and forearms.
Woods lamp is one of the oldest
diagnostic tools in melasmawhich is
based on the principleof fluorescence.
Dermoscopy is a relatively recent
device used for the diagnosis and
classification of types of melasma.
Although the standard diagnostic test
to assess the depth of melanin
pigment is biopsy for histopathological study,
it is not feasible in all
patients due to its invasiveness Figure 1: Clinical, Wood's lamp and corresponding dermoscopic images
in the three patterns of melasma. Dermoscope: Dermlite DL4 with 10×
magnification under polarized mode. (a) Epidermal melasma. Woods
lamp: Uniform enhancement. Dermoscopy: Brown reticuloglobular
network. (black arrow). (b) Mixed melasma. Woods lamp: Few areas of
enhancement. Dermoscopy: Patchy brownish reticuloglobular network
(black arrow) with few grey areas (yellow arrow). Greyish and brown
granules (red arrow), arcuate and honey comb patterns (grey arrow). (c)
Dermal melasma. Woods lamp: No areas of enhancement. Dermoscopy-
brownish grey reticuloglobular pattern (black arrow), greyish granules
(red arrows), arcuate and honey comb patterns (yellow areas) and
perifollicular pigmentation (green arrow)
due to the impossibility of
evaluating the same area over
time and inflammatory effects
occurring in wound healing.
Newer methods like the RCM
(reflectance confocal microscopy) can
also be used for evaluating
the melanin depth in melasma.[2]

Indian Dermatology Online Journal | Volume 13 | Issue 3 | May-June 2022 367

 Navya and Pai: Dermoscopy vs woods lamp in melasma

With the help of Wood’s light higher percentage of mixed melasmacases

findings,Sanchez et al.[3] classified and a slightly lesser proportion of
melasmainto four subtypes: dermal cases.
Epidermal, dermal, mixed and
A recent in vivo RCM (reflectance
Wood’s light inapparent.
Downloaded from http://journals.lww.com/idoj by confocal microscopy) study depicted a
The Wood’s lamp examination done in heterogenous dispersalof melanophages
our patients revealed epidermal pattern as between different sites of melasma. This
the most common followedby
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= mixed
on and heterogenous dispersalof melanophages was
dermal patterns. While the percentage of apparent within different foci of individual
epidermal cases were similar to lesions of melasma. These observations
studies in the past,[4,5] our study question the existence of “true
showed a higher proportion of mixed epidermal” or “true dermal” types of
melasmaand a lesser percentage of melasmaand suggest that all melasmaare
dermal cases. therefore mixed.[9] Our study showed a
higher percentage of mixed melasmacases
Wood’s lamp evaluation is however
both by Wood's lamp and dermoscope,
limited to be applicable only for
as compared to similar studies done
the lighter skin types and not
in the past which therefore
suitable for type V or VI
indicatesa high level of inter-individua
fitzpatrik skin types.[6]
l variationin assessment either
Newer studies propose that the woods lamp through woods lamp or dermoscope.
examination is less specific and
There was moderate level of
dermal melanin is unrecognized by this
agreement between the two methods of
method.[7] A study was performed
assessment of depth [Cohens kappa
by Ponzio et al.[8] to ascertainthe
coefficient- 0.534] Manjunath et al.[4] and
instrument validity of a woods lamp
Dharni et al. [7]
reported a kappa coefficient
to identify the pattern of melasma,
of 0.833 in their respective
aimed to estimate the cases correctly
studies which indicated substantial level
classified as compared with the
of agreement.
histopathological examination in 61
patients. The study showed low levels of While Tamler et al.[1] reported a kappa
sensitivity, specificity and accuracyof coefficient of <0.2 indicating a
the examination under Wood’s lamp in weak level of agreement.
the three pathological types of
melasma. Limitations
In addition use of topical sunscreens, Newer diagnostic tools indicate that the
topical drugs, collagen and vascular changes may mixed pattern of melasmaappears to be
affect the outcomes of a present in all cases when analyzedwith
woods lamp examination.[7] respect to the depth of pigmentation.
Though our study also showed mixed
Dermoscopy allows for a more pattern as the most common variant but
objective classification for melasmaas not in all cases. This may be
it eliminates the interference by due to the factors like the
confounding factors such as analyzedimage, subjective technique and
vascular/collagen changes, topical agents etc.[7] interpretation, lack of comparison with
histopathology or new diagnostic
Dermoscopy additionally also allows the
techniques like RCM.
visualization of the vascular component
in melasma. Conclusion
In the present study, mixed variety (46%) Among the two diagnostic tools, there
was the most common pattern followedby was a moderate degree of
epidermal (30%) and dermal (24%) on agreement between dermoscopy and
dermoscopy. While the proportion of Wood's lamp in the analysis of
epidermal melasmawas similar to other melasma. Although the study
studies[1,4] our study had a is not intended to indicate the

368 Indian Dermatology Online Journal | Volume 13 | Issue 3 | May-June 2022

 Navya and Pai: Dermoscopy vs woods lamp in melasma

better tool of assessment of 2. Agozzino M, Licata G, Giorgio CM.

melasmadepth amongst the two, we Reflectance confocal microscopy
assessment of the depigmenting
found that dermoscopy aided in
agents complex for melasma treatment. J
identifying mixed pattern of Clin Aesthet Dermatol 2020;13:41-4.
melasmato a
Downloaded from http://journals.lww.com/idoj by
better extent which 3. Sanchez NP, Pathak MA, Sato S,
is corroborating with newer Fitzpatrick TB, Sanchez JL, Mihm
diagnostic tools. MC, et al. Melasma: A clinical, light
microscopic, ultrastructural, and
Declaration of patient consent
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The authors certify that they have
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obtained all appropriate patient consent Agrawal R. Melasma: Through the eye
forms. In the form the patient(s) of a dermoscope. Int J
has/have given his/her/their consent for Res Dermatol 2016;2:113-7.
his/her/their images and other clinical 5. Handel AC, Miot LD, Miot HA.
information to be reported in the Melasma: A clinical and epidemiological
journal. The patients understand that their review. An Bras Dermatol 2014;89:771-82.
6. Gilchrest BA, Fitzpatrick TB,
names and initials will not be
Anderson RR, Parrish JA. Localization
published and due efforts will be of melanin pigmentation in the
made to conceal their identity, but skin with Wood’s lamp. Br J
anonymity cannot be guaranteed. Dermatol 1977;96:245-8.
7. Dharni R, Madke B, Singh A.
Financial support and sponsorship Correlation of clinicodermoscopic and
woodslamp findings in patients having
Nil.
melasma. Pigment Int 2018;5:91-5.
Conflicts of interest 8. Ponzio HA, Cruz MF. Accuracy of
the exam with wood's lamp in
There are no conflicts of interest. the classification of chloasmas.
An Bras Dermatol 1993;68: 325-8.
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