The Dermoscopic Auspitz Sign.

A 20-year-old female patient presented to us with erythematous, scaly plaques over the extensor surfaces of the body. She had significant scaling over the scalp and associated nail changes, including pitting and onycholysis. A clinical diagnosis of chronic plaque psoriasis was made.

Using dermoscopy we were able to visualize regularly distributed dotted vessels on a light erythematous background [Figure 1]. On repeating the dermoscopy after scraping of the scales over part of the lesion, we were able to visualize the dotted vessels much more clearly, without inducing actual bleeding or discomfort to the patient [Figure 2].

Figure 1

Dermoscopy of psoriatic plaque showing white scales with regularly distributed dotted vessels on a light erythematous background (polarized light ×10, Foto ii pro)

Figure 2

Same lesion in Figure 1 with scales gently removed showing the vessels more prominently without inducing actual bleeding (polarized light ×10, Foto ii pro)

Dermoscopic features of plaque psoriasis include diffuse white scales with regularly distributed dotted vessels on a light erythematous background.[1] Auspitz's phenomenon/papillary tip bleeding denotes the presence of pinpoint bleeding of papillary vessels under easily detachable scales of psoriatic plaques.[2] When the presence of marked hyperkeratosis impedes the view of underlying features, scale removal may be useful to display the above-mentioned vascular pattern as well as possible tiny red blood drops. This has been referred to as the “dermoscopic Auspitz's sign.”[3]

We would like to suggest that the pattern of regular dotted vessels becoming prominent after removal of the scales itself strengthens the diagnosis of psoriasis, without actually having to induce bleeding. The dermoscopic Auspitz's sign is, thus, useful in demonstrating the concept behind the Auspitz's sign without causing significant pain or discomfort to the patient.

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Conflicts of interest

There are no conflicts of interest.