Reflectance Confocal Microscopic Features of Dermatophytes, Scabies, and Demodex

Reflectance confocal microscopy provides in vivo imaging of the epidermis and superficial dermis at cellular level resolution and can be used to detect cutaneous fungal^1- 2 and parasitic infestations.³ Reflectance confocal microscopy of an erythematous annular scaly patch on the abdomen reveals branching fungal hyphae (Figure 1, arrows), diagnostic of tinea corporis. A linear burrow on the wrist of a pruritic patient demonstrates Sarcoptes scabiei eggs with developing mites (Figure 2, wide arrow) and feces (Figure 2, narrow arrows). Characteristic features of Demodex folliculorum, which can be seen moving in a video that is available online here, are also shown in Figure 3: 8 legs (4 of which are indicated by narrow arrows) and an elongated body (wide arrow). Figure 4 reveals the native state of Demodex, with tails (arrows) protruding from a hair follicle (F). In vivo visualization of cutaneous organisms with reflectance confocal microscopy at the bedside provides an alternative to scrapings, microscopy, cultures, and biopsies.