DERMATOLOGY DIAGNOSTIC UPDATE
TheWood’sLight’sDiagnostic
Use
inDermatolog
y
Brittanya Limone, LaVonne Meadows
ABSTRACT: The field of dermatology utilizes a wide variety of
tools to aid in the determination of a diagnosis. Diagnostic tools
are helpful when the cause of a patient’s presentation may not
be obvious based on history and physical examination. The
purpose of this column is to highlight some of the more
commonly encountered diagnostic tools in dermatology, the
background and indications for their use, their construct and
application, the ways to interpret their results, and their
important clinical implications. This article presents the Wood’s
light, a useful and cost-effective tool to quickly assess many
dermatologic conditions.
Key words: Fluorescence, Wood’s Lamp, Wood’s Light,
Ultraviolet, Radiation
BACKGROUND
The Wood’s light was first developed in 1903 by a
physicist, Robert Wood. He created a filter that only
transmitted ultraviolet (UV) radiation. In 1919, he
published three UV photographs of faces and hands,
noting that the teeth and patches of skin would fluoresce;
however, Wood was unsure of the best utilization of his
filter. In 1925, two Frenchphysicists, Margot and Deveze,
discovered the first applicable use of a Wood’s light in
dermatology. After studying a patient with tinea capitis,
they discovered that infected hairs fluoresced when under
UV light (Sharma & Sharma, 2016). Although initially
VOLUME 9 | NUMBER 4 | JULY/AUGUST 2017
Copyright © 2017 Dermatology Nurses' Association. Unauthorized reproduction of this article is prohibited.
used to detect fungal infection of the hair, over a century
later, the Wood’s light
Brittanya Limone, BS, MA, Loma Linda University School of
Medicine, Loma Linda, CA.
LaVonne Meadows, MD, Dermatology Section, Loma Linda
Department of Dermatology and VA Medical Center, Loma Linda,
CA.
The authors declare no conflict of interest.
Correspondence concerning this article should be addressed to
LaVonne Meadows, MD, Section of Dermatology, VA Loma Linda
Healthcare System, 11201 Benton Street, MC#111D, Loma Linda,
CA 92357.
E-mail: lavonnemeadows@gmail.com
Copyright B 2017 by the Dermatology Nurses’ Association. DOI:
10.1097/JDN.0000000000000323
hasbeenprovenusefulasadiagnostictoolforanumber of
dermatologic conditions (Asawanonda & Taylor, 1999).
Diagnostic test: Wood’s light
Description:alightsourcetransmittingonlyUVradiation
INDICATIONS
Wood’s light is used for the primary evaluation of
pigmentary disorders, cutaneous infections, and
porphyrias. The lamp can also aid in the evaluation of
chemical peeling treatment, tetracycline adverse reactions,
and photodynamic diagnosis of skin cancer (Asawanonda
& Taylor, 1999). Table 1 describes a variety of
dermatologic diagnoses aided by the use of a Wood’s light.
CONSTRUCT
The Wood’s lamp is a light source that contains a
highpressure mercury arc filtered by a barium silicate with
9% nickel oxide compound, also known as the Wood’s
filter. The filter produces an emission of a selective UV
wavelength spectrum between 320 and 400 nm (Sharma &
Sharma, 2016). The most inexpensive lights are small
handheld models with batteries and small fluorescent
tubes. Some recommend that professionals use a light with
a highintensity 100-W mercury vapor bulb and power
211
 DERMATOLOGY DIAGNOSTIC UPDATE

supply (Ruocco et al., 2011). However, simple use of an
inexpensive light-emitting diode black-light flashlight was
noted to be as effective in detecting fluorescence or
accentuation of skin lesions when compared with a
standard Wood’s light (Kaliyadan & Kuruvilla, 2015).
MECHANISM
The Wood’s light is a source of UV radiation, within the
320- to 400-nm spectrum, that excites a variety of
fluorescent patterns when applied to tissues. Fluorescence
occurs when shorter wavelengths of light are absorbed by
tissues thatthenemitalongerwavelength, usually asvisible
light. The emission of longer wavelengths in tissues occurs
from the transition of electrons into excited states. The
process commonly occurs in tissue compounds found in
elastin,
collagen,tryptophan,andnicotinamideadeninedinucleotide

TABLE 1. Dermatologic Diagnoses With the Use of Wood’s Light

Copyright © 2017 Dermatology Nurses' Association. Unauthorized reproduction of this article is prohibited.
 DERMATOLOGY DIAGNOSTIC UPDATE

Disease Description Appearance/Fluorescence

Hypopigmented lesions
Vitiligo Irregular areas of complete depigmentation Delineated vitiliginous patches due to loss of
functional melanocytes (Marks (Asawanonda & Taylor, 1999) & Miller, 2013)
Tuberous sclerosis Neurocutaneous disorder characterized by Enhanced appearance of numerous benign
hamartomas, seizures, characteristic ash-leaf patches mental retardation, adenoma
sebaceum, (Ponka & Baddar, 2012) and ash-leaf spots (Marks & Miller, 2013)
Hypomelanosis of Ito Whirled or streaked hypopigmentation that Demarcated whirled or streaked may be
associated with central nervous patterns (Ponka & Baddar, 2012) system, ocular, and
musculoskeletal anomalies (Asawanonda & Taylor, 1999)
Hyperpigmented lesions
Melasma Patchy hyperpigmentation of the face, usually Epidermal type: enhanced in women and associated with sunlight demarcation
of lesion exposure, pregnancy, and the use of oral Dermal type: lesions less detectable
contraceptives (Marks & Miller, 2013) (Asawanonda & Taylor, 1999)
Bacterial infections
Pseudomonas Causes of ecythema gangrenosum and hot Green fluorescence of saline sample tube folliculitis,
common infection of burns from wound or infected burns
(Asawanonda & Taylor, 1999) (Asawanonda & Taylor, 1999)
Erythrasma Attributed to infection by Corynebacterium Coral red (Asawanonda & Taylor, 1999) minutissimum;
appears as erythematous, brown, scaly patches affecting primarily the major body folds and
interdigital regions of the feet (Pinto et al., 2016)
Acne Propionibacterium acnes infection of Orange-red in comedones (Ponka &
pilosebaceous follicles leading to formation Baddar, 2012) of comedones
and inflammation (Marks &
Miller, 2013)
Fungal infections
Tinea (pityriasis) versicolor Caused by an infection with Malassezia furfur Yellowish white or copper-orange of the stratum corneum
leading to subsequent (Ponka & Baddar, 2012) pink, tan, or white fine, scaling patches (Marks &
Miller, 2013)
Tinea capitis Superficial fungal infection on the head or
scalp with associated alopecia, scaling, and occipital
and/or posterior cervical lymphadenopathy (Marks
& Miller, 2013)
Microsporum audouinii Blue-green (Ponka & Baddar, 2012)
M. canis Blue-green (Ponka & Baddar, 2012)
M. ferrugineum Blue-green (Ponka & Baddar, 2012)
M. distortum Blue-green (Ponka & Baddar, 2012)
M. gypseum Dull yellow (Ponka & Baddar, 2012)
Trichophyton schoenleinii Dull blue (Ponka & Baddar, 2012)
Pityrosporum folliculitis Follicular infection of Malassezia furfur Bluish white in follicular pattern
(Asawanonda & Taylor, 1999) (Ponka & Baddar, 2012)
Porphyrias Inherited or acquired conditions of defective heme synthesis that results in
precursor accumulation; subtypes vary by which
samples fluoresce: urine, teeth, red blood cells, or

VOLUME 9 | NUMBER 4 | JULY/AUGUST 2017 213

Copyright © 2017 Dermatology Nurses' Association. Unauthorized reproduction of this article is prohibited.
 DERMATOLOGY DIAGNOSTIC UPDATE

212 Journal of the Dermatology Nurses’ Association

TABLE 1. Dermatologic Diagnoses With the Use of Wood’s Light, Continued

Disease Description Appearance/Fluorescence
Porphyria cutanea tarda Red-pink (Ponka & Baddar, 2012)
Erythropoietic porphyria Red-pink (Ponka & Baddar, 2012) Erythropoietic protoporphyria Red-pink (Ponka & Baddar, 2012)
Variegate porphyria Red-pink (Ponka & Baddar, 2012)
Chemical peels
Salicylic acid Compounds utilized to remove the top layer(s) Green (Asawanonda & Taylor, of the skin for a newer or smoother
appearance 1999)
Fluorescein sodium (Asawanonda & Taylor, 1999) Yellow-orange (Asawanonda &
Taylor, 1999)
Medications
Tetracycline Antibiotic that can be applied topically and Topical: coral-red initially Y yellow
also may cause an adverse reaction of after a few minutes (Asawanonda yellowing nails
(Asawanonda & Taylor, 1999) & Taylor, 1999)
Tumors
Squamous cell carcinoma Malignant neoplasm of keratinocytes; appears Photodynamic diagnosis: red clinically as scaling, indurated
plaque or nodule (Ruocco, Baroni, Donnarumma, & that may bleed or ulcerate (Marks & Miller,
2013) Ruocco, 2011)

(Asawanonda & Taylor, 1999). Normal skin creates a
poorly characterized, blue fluorescence under a Wood’s
light, primarily due to absorption by dermal collagen
pyridinoline cross-links that emit longer wavelengths and
more visible light than epidermal and dermal melanin
(Asawanonda & Taylor, 1999; Sharma & Sharma, 2016).
Of note, the risks of UV radiation exposure with a
Wood’s light are minimal when occurring within a
controlled clinical setting. Filters constructed in the
Wood’s light prevent excessive exposure to radiation. The
UV-A radiance at the surface of the lamp is around 1Y5
mW/cm2; however, during a dermatologic examination,
the skin and eyes are normally exposed to less than 1
mW/cm2. Less than1mW/cm2 is considered within
threshold limits; therefore, Wood’s light UV radiation is
generally considered nonhazardous (AGNIG, 2002;
University of WisconsinMadison, 2005).
APPLICATION
The application of a Wood’s light is fairly simple, but a
few of the following steps will help to reduce
misinterpretations. Ideally, the lamp must warm up for
about 1minute.Theexaminationroommustbedark,preferably
without windows or with black occlusive shades. The
examiner’s eyes should be well adjusted to the dark before
examination to optimally discern any contrasts. The
examiner should shine the Wood’s light directly above
lesion or sample of interest, keeping the light 4Y5 inches
away from the area of interest. Washing the area before
examination with the light should be avoided because it
may cause pigment dilution (Gupta & Singhi, 2004;
Sharma & Sharma, 2016).
INTERPRETATION OF RESULTS
Because the lamp’s diagnostic abilities stem from the
principle that every molecule has a distinctive absorption,
emission, and scattering property, changes in diseased
skin will create specific fluorescent patterns and/or
changes in color (Sharma & Sharma, 2016). Disease
processes will lead to changes in emission by either
directly altering the endogenous fluorophores or by
indirectly changing the tissue morphology that affects
light absorption andscattering. Thus, the Wood’s light
enables detection of wavelength-shifted light in tissues
by finding variations from normal fluorescence (Poh et
al., 2011). Table 1 offers a detailed explanation of the
diseases and their appearances under a Wood’s light.

Copyright © 2017 Dermatology Nurses' Association. Unauthorized reproduction of this article is prohibited.
 DERMATOLOGY DIAGNOSTIC UPDATE
The examiner must be careful of potential pitfalls
leadingtomisinterpretation,includingtopicalmedications,li
nt, and soap residue. These should be wiped away with a
dry gauze from the site before Wood’s light examination
as they can cause fluorescence and create false-positives,
which are usually removable. Of note, the common
sources of error typically include petrolatum-containing
ointments producing a blue-purple fluorescence, salicylic
acid-containing medications forming a green
fluorescence, and a light blue fluorescence reflecting
from an examiner’s white coat (Gupta & Singhi, 2004;
Ponka & Baddar, 2012).
CLINICAL STUDIES
A study conducted by Pinto et al. (2016) from 2011 to
2012 assessed the clinical and epidemiological features
of coryneform skin infections, including pitted
keratolysis, erythrasma, and trichobacteriosis. Seventy-
five patientsV60 (80%) with pitted keratolysis, 8 (10.7%)
with erythrasma, and 7 (9.3%) with trichobacteriosis
casesVwere included in the study. Patients were included
and excluded based on clinical features and the results of
a Wood’s lamp examination. The authors noted that the
Wood’s lamp examination proved to be an
‘‘indispensable’’ tool in the diagnosis of erythrasma
because the unique coral red fluorescence distinguished
erythrasma with macerations and scaling from eczema
and candidiasis. The use of a Wood’s lamp was equally
valuable in diagnosing trichobacteriosis in patients with
yellow concretions on their axillary hair through the
detection of yellow fluorescence on the hair shaft.
Maleki and Fata (2005) conducted a study between
2003 and 2004 to evaluate the differences between direct
smear and Wood’s light results in diagnosing pityriasis
versicolor and erythrasma. Two hundred fifteen
individuals were included with 88 patients suspected for
pityriasis versicolor and 127 suspected for erythrasma.
All of the patients were tested by Wood’s light in a dark
room; a fresh smear of KOH 10% was issued for patients
with pityriasis versicolor, and a direct stained smear by
methylene blue was issued for those with erythrasma. Of
the 88 patients suspected for pityriasis versicolor, 55
(62.5%) had positive golden-yellow fluorescence under
Wood’s light, and 59 (67%) had a positive direct smear.
In the group with erythrasma, 38 (29.9%) of the patients
had positive orange-red
fluorescence,and40(31.57%)haddirectstained smears
VOLUME 9 | NUMBER 4 | JULY/AUGUST 2017
Copyright © 2017 Dermatology Nurses' Association. Unauthorized reproduction of this article is prohibited.
showing Corynebacterium minutissimum. On the basis of
statistical chi-square analysis, there was no statistical
difference in both disease-suspected groups regarding the
use of Wood’s light or direct smear; thus, the Wood’s
light test was an equivalent diagnostic tool with the added
benefits of low cost and ease of use.
IMPORTANT IMPLICATIONS
In hypopigmentation disorders, the Wood’s light guards
against overlooking hard-to-detect lesions on fair-skinned
patients by sharpening the appearance of the lesion’s
margins. In epidermal melasma lesions, the light helps to
improve the contrast between hyperpigmented lesions in
darker skin tones. Unfortunately, in dermal
hyperpigmentation, lesions are less apparent under
Wood’s light than room light because some of the
fluorescence of dermal collagen occurs both above and
below dermal melanin, thus diminishing the emission of
light to the examiner’s eyes (Asawanonda & Taylor,
1999).
In terms of bacterial infection, Wood’s light allows
early detection and treatment of Pseudomonas infections
(Asawanonda & Taylor, 1999). Pseudomonas creates a
pigment called pyoverdine that produces green
fluorescence under a Wood’s light. This can be shown on
hair follicles in cutaneous Pseudomonas infections such
as hot tub folliculitis. Unfortunately, fluorescence may
not be observed if the patient recently cleaned the area
because of dilution. However, more importantly, saline
samples obtained from wounds in ecythma gangrenosum
or Pseudomonas infected burns may show positive
fluorescence hours before blood culture results, thus
enabling immediate treatment for a potentially
devastating infection (Asawanonda & Taylor, 1999).
In tetracycline use, yellowing nails is a potential side
effect,butaWood’slight enablesthedistinctionbetweena
tetracycline adverse reaction and pathologic causes of
yellowing nails (Asawanonda & Taylor, 1999). Psoriasis,
yellow nail syndrome, cardiac decompensation, diabetes
mellitus, familial amyloidosis with polyneuropathy,
hyperbilirubinemia, peripheral vascular disease, and
resolving
subungualhemorrhagesarepathologieswiththepotential to
cause yellow nail discoloration. However, these
pathologies typically produce a negative fluorescence on
Wood’s lampexamination, whereas oral tetracycline causes
a yellow fluorescence of the fingernail’s lunulae, even if
215
 DERMATOLOGY DIAGNOSTIC UPDATE
the nail appears to have returned to normal color under
room light (Hendricks, 1980).
Regarding chemical peeling treatments, the use of
fluorescent compounds under a Wood’s lamp helps to
avoid overcoating and ensures evenly spread medication.
The
FIGURE 1. An example of a Wood’s light used in photodynamic
diagnostics, showing bright-red fluorescence of the face.
goal of chemical peel therapy is to apply a single, even
214
coat of solution. However, this therapy carries a high level
of operator bias. Application of strong agents, such as
phenol solution and trichloroacetic acid 9 25%, produces a
‘‘dusky white frost’’ on the skin to accurately represent
treated areas (Matarasso, Glogau, & Markey, 1994).
However, mild superficial peeling agents, such as
Jessner’s solution, glycolic acid, and trichloroacetic acid G
Copyright © 2017 Dermatology Nurses' Association. Unauthorized reproduction of this article is prohibited.
20%, may not produce a change in the skin, thus leading to
accidentally missed areas or a deeper peel than intended
from precautionary overcoating. Under a Wood’s light, the
mixing of salicylic acid and fluorescein sodium with
chemical peeling agents produces a green and
yelloworange fluorescence, respectively. This allows for
visualization of the applied peel without altering the
agent’s properties. Thus, the ability of the Wood’s light to
detect fluorescence provides a standardization tool for
chemical peels to prevent skipping and overcoating
regions (Matarasso et al., 1994).
The use of the light aids in the diagnosis of porphyrias
by detecting porphyrins in either urine, teeth, stool, or
blood based on the porphyria subtype (Asawanonda &
Taylor, 1999). The same concept has been used to check
for cancers (Poh et al., 2011). Photodynamic diagnostics
takes advantage of the fact that 5-aminolevulinic-
acidderived porphyrins tend to accumulate in neoplastic
tissue. Application of topical 5-aminolevulinic acid
ointment over tumor sites leads to subsequent breakdown
to protoporphyrinogen IX resulting in a bright-red
fluorescence of the porphyrinsunder aWood’s light (Figure
1). This technique has been useful in determining basal
cell carcinomas, solar keratosis, Bowen’s disease,
squamous cell carcinoma, and extramammary Paget’s
disease (Asawanonda & Taylor, 1999; Poh et al., 2011).
SUMMARY STATEMENT
In conclusion, Wood’s light as a diagnostic tool has stood
the test of time and provides a cost-effective, valuable
means to rapidly assess dermatologic conditions.
REFERENCES
Advisory Group of Non-Ionising Radiation (AGNIG). (2002). Health effects
from ultraviolet radiation: Report of an advisory group on nonionising
radiation. National Radiological Protection Board, 13(1), 20Y22.
Asawanonda, P., & Taylor, C. R. (1999). Wood’s light in dermatology.
International Journal of Dermatology, 38(11), 801Y807.
Gupta, L. K., & Singhi, M. K. (2004). Wood’s lamp. Indian Journal of
Dermatology, Venereology, & Leprology, 70(2), 131Y135.
Hendricks, A. A. (1980). Yellow lunulae with fluorescence after tetracycline
therapy. Archives of Dermatology, 116(4), 438Y440.
Journal of the Dermatology Nurses’ Association
Kaliyadan, F., & Kuruvilla, J. (2015). Using a hand-held black-light source
instead of a Wood’s lamp. Journal of the American Academy of
Dermatology, 72(6), e153Ye154.
Maleki, M., & Fata, A. (2005). Evaluation of wood’s light and direct smear
fordiagnosisofpityriasisversicoloranderythrasma.Saudi Medical Journal,
26(9), 1484Y1485.
Marks, J. Jr., & Miller, J. (2013). Principles of dermatology (5th ed.). New
York, NY: Elsevier.
 DERMATOLOGY DIAGNOSTIC UPDATE

Matarasso, S. L., Glogau, R. G., & Markey, A. C. (1994). Wood’s lamp for
superficial chemical peels. Journal of American Academy of
Dermatology, 30(6), 988Y992.
Pinto, M., Hundi, G. K., Bhat, R. M., Bala, N. K., Dandekeri, S., Martis, J.,
& Kambil, S. M. (2016). Clinical and epidemiological features of
coryneform skin infections at a tertiary hospital. Indian Dermatology
Online Journal, 7(3), 168Y173.
Poh, C. F., MacAulay, C. E., Laronde, D. M., Williams, P. M., Zhang, L., &
Rosin, M. P. (2011). Squamous cell carcinoma and precursor lesions:
Diagnosis and screening in a technical era. Periodontology, 57(1),
73Y88.
Ponka, D., & Baddar, F. (2012). Wood lamp examination. Canadian Family
Physician, 58(9), 976.
Ruocco, E., Baroni, A., Donnarumma, G., & Ruocco, V. (2011). Diagnostic
procedures in dermatology. Clinics in Dermatology, 29(5), 548Y556.
Sharma, S., & Sharma, A. (2016). Robert Williams Wood: Pioneer of
invisible light. Photodermatology, Photoimmunology, & Photomedicine,
32(2), 60Y65.
University of Wisconsin-Madison. (2005). Radiation safety for radiation
workers. Chapter 16: UV radiation safety (p. 271). Madison, WI:
University of Wisconsin, Printing Services Office. Retrieved from
https:// www.ehs.wisc.edu/rad/Chapter16-2005.pdf

VOLUME 9 | NUMBER 4 | JULY/AUGUST 2017 217

Copyright © 2017 Dermatology Nurses' Association. Unauthorized reproduction of this article is prohibited.