Prevention of possible cross-infection among patients by dermoscopy: a brief review of the literature and our suggestion

Recently, Dominique et al. reported that contamination of the dermoscopic lens by human papillomavirus (HPV) may be common [1]. Results of their study revealed that wartspecific HPV DNA is detected with a high frequency (43%) on a dermoscopic lens before examination and that the detection rate is increased to 82% after plantar wart examination. Furthermore, cleaning dermoscope lenses with an antiseptic cleansing wipe containing bactericidal and virucidal agents was not effective in removing HPV DNA, as 74% of samples were positive. Although actual infectivity of the viruses was not investigated, their data indicate that dermoscopy could be a possible source of nosocomial infection. Dermoscopy has proven its diagnostic capabilities in pigmented and non-pigmented skin tumors [2]. It is also useful in the diagnosis of cutaneous infectious and inflammatory diseases [3,4]. As a dermatologist’s stethoscope, the use of dermoscopy is increasing since it is a remarkable screening tool in daily routine practice [2]. In this regard, the study which demonstrated that dermoscopy is a possible source of infectious disease transmission raises medical, ethical, and legal concerns with dermatologists. It increases the need for effective disinfection methods for the equipment. Proper sterilization or the use of preventive tools is crucial to prevent cross-contamination among patients. Several previous studies have suggested methods to decrease possible nosocomial infection by dermoscopy. • Kelly SC and Purcell SM reported that alcohol-based gel inhibits bacterial colonization [5]. It can obviate the risk of nosocomial infection during dermoscopic examination. However, the risk of viral infection was not investigated in the study. • Zampino et al suggested that polyvinyl chloride (PVC) food wrap can be used to prevent possible transmission of infections from mucosal lesions [6]. The PVC film is placed on the dermoscopic lens with mineral oil on both surfaces, which acts as a barrier for viral contamination. However, this method has its limitations, such as low availability of PVC film in dermatologic clinics, cumbersomeness of the technique, and unpredicted transmission of infections, which could occur if the film is damaged. • Polarized noncontact dermoscopy (PND) may be ideal in evaluating possible infectious lesions because it does not require direct contact with the lesions [7]. Although direct contact can be theoretically avoided using PND, unintentional contact could happen while focusing and observing the lesion because the space between PND and skin is narrow. • Disposable dermoscopic lens covers can be used. Stauffer et al. used a disposable polyethylene lens cover that was selfPrevention of possible cross-infection among patients by dermoscopy: a brief review of the literature and our suggestion