Dermoscopy a Versatile Tool to Bust the Quackery

INTRODUCTION Quackery is very rampant in developing countries due to a lack of awareness and not-so-stringent laws to prevent the same. The problem poses a serious threat and challenge in front of medical professionals. The onus rests with qualified PR actioners to raise the awareness against the same. Reinforced counselling, supplemented with visual evidence to counteract quackery, will facilitate this task. No tool surpasses the dermoscope in clinical dermatological practice for demonstrating these points to patients and raising their awareness. This case highlights the utility of dermoscopic findings in educating patients about the adverse effects of such practices. CASE REPORT A 32-year-old male without any comorbidity reported multiple wheals over the body along with angioedema for 3 days. He had a history of upper respiratory tract infection a week before this episode. He was diagnosed as a case of acute urticaria with angioedema and prescribed antihistamines. During examination of the face, we noticed bilaterally symmetrical faintly erythematous plaques over the temporal area [Figure 1]. The patient denied any complaint about these plaques and was not interested in treating the same. Upon further inquiry, the patient disclosed the use of a chemical concoction recommended by an unqualified individual for preventing hair loss and promoting regrowth in bald areas. He noted the absence of a formal prescription and indicated that the chemical solution was dispensed in an unlabelled plastic bottle, reportedly used by many without adverse effects. The patient had initiated this treatment one week prior, reported no complaints, and intended to continue until hair regrowth was achieved. We performed the dermoscopy (DermLite 3rd Gen, made in the USA) of the affected area. Dermoscopy revealed multiple red and blue clods representing intradermal hemorrhages at different levels. We observed prominent tortuous dilated blood vessels in arboriform and reticulate patterns, disproportionate to the visible erythema [Figure 2]. Given the patient's insistence on continuing the treatment, we displayed the image on a laptop screen and explained the intradermal changes along with hemorrhage inside dermis. Furthermore, we explained the pathogenesis of androgenetic alopecia and evidence-based treatment options available for the same. Following extensive counseling and visualization of the affected area, the patient acknowledged that the observed damage was a side effect of the chemical potion and opted to discontinue its use. Furthermore, he resolved to educate others about the dangers of using chemicals prescribed by unqualified individuals. Dermoscopic examination of the area was indicative of irritant contact dermatitis, likely due to the application of a strong chemical agent. The continuation of treatment might have resulted in ulceration of that area. The patient was prescribed antihistamines for his acute urticaria with angioedema symptoms.Figure 1: Bilaterally symmetrical well-defined erythematous plaque near right (1a) and left (1b) receding hairlineFigure 2: Dermoscopic picture showing multiple blue (white arrow) and red clods (yellow arrow) and dilated tortuous vessels in arboriform (yellow circle) and reticulate patterns (white circle) over right (2a) and left lesion (2b) (DermLite 3rd Gen, made in the USA)CONCLUSION The observation from this case has shown that dermoscopy is not just a tool for the diagnosis of skin disorders but can also be used to educate the people about harmful effect of quackery.[1] Dermoscopy can help in spreading awareness against such practices as the visual images of the affected area create a lasting and convincing impact on patients' psyche.[2] This case highlights that the newer equipment with audiovisual appeals can be effectively utilized to spread awareness against quackery practices, but the larger studies are required to establish this role. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest