Reflectance confocal microscopy as a noninvasive complementary tool in the diagnosis of psoriatic balanitis

Dear Editor, Genital lesions are estimated to occur in 30–40% of patients with psoriasis, with a slight predominance in men. Less frequently they are the first and rarely the sole presentation of this common inflammatory disease in only 2–5% of affected patients.1 Therefore, its differential diagnosis can be wide, including mainly inflammatory diseases. As genital psoriasis is also a source of anxiety and sexual embarrassment, with other quality of life limitations, mostly in young patients, a fast and preferably noninvasive diagnosis is needed.2 Dermoscopy and reflectance confocal microscopy (RCM) have been developed in recent years, aiming for a higher accuracy in in vivo diagnosis. They can be of particular interest as complementary tools in the examination of sensitive areas like genital skin.3-6 The aim of our study was to describe RCM features of biopsy‐proven psoriatic balanitis in patients with no other skin or nail involvement from psoriasis, with dermoscopic and histopathological correlation. Seven male patients were consecutively recruited (mean 36 years of age, range 26–53). The genital lesions were first assessed using dermoscopy and RCM (Table 1). A punch biopsy from each suspicious glans lesion was also performed for histopathological examination. RCM imaging was obtained using a near infrared, reflectance mode, confocal laser scanning microscope (VivaScope1500®; Caliber I.D., Rochester, NY, U.S.A.).