We appreciate the insightful comments made by Di Stefani and colleagues describing additional dermoscopic features of tungiasis. We reviewed our collection of dermoscopic images of 6 of 10 sand fleas located at both feet of 1 patient. All had the same size and stage of maturation. Dermoscopically, all 6 presented with the central brown ring described in our article. Two showed one blue-to-black area, as shown by Dr Di Stefani et al; 1 presented with at least 3 of these structures in a radial pattern; and another 3 sand fleas had none of these structures. Thus, this structure seems to be variable, even in sand fleas of the same stage of maturation. It might be speculated that these structures correspond to eggs, but it might also be hematin in the gastrointestinal tract of the parasite.
Bauer J, Forschner A, Garbe C, Röcken M. Variability of Dermoscopic Features of Tungiasis. Arch Dermatol. 2005;141(5):643–644. doi:10.1001/archderm.141.5.643
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