Case Reports
The Rainbow Pattern and Rosettes in different types of Cutaneous Scars
A Kelati*, H Baybay, S Gallouj, FZ Mernissi
Corresponding Author: Awatef Kelati, MD, Department of Dermatology, University Hospital Hassan II, 202 Hay Mohamadi, Fez, Morocco, Tel: 212698006717; E-mail:
Received: January 23, 2017; Accepted: February 4, 2017; Published: February 26, 2017;
Citation: Kelati A, Baybay H, Gallouj S & Mernissi FZ. (2017) The Rainbow Pattern and Rosettes in different types of Cutaneous Scars. Dermatol Clin Res, 3(1): 127-129.
Copyrights: ©2017 Kelati A, Baybay H, Gallouj S & Mernissi FZ. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

There were only a few publications interested in carsdermoscopy, the study of Min Gun Yoo et al. confirmed that vascular structures are significantly noticed in Keloids [1], the observation of Martin JM. et all pointed out  dermoscopy as a tool to detect remaining non absorbable sutures in surgical scars [2]. The correspondence of Pérez-Pérez L et al. [3] was the only one that reported the presence of the rainbow pattern and rosettes in a case of keloid.

In this report, we confirm the findings of Pérez et al, and we present three cases of different types of scars with two features in common: rainbow pattern and rosettes in a keloid (Figure 1), rainbow alone in an atrophic scar  (Figure 2) and  rosettes in another case of recent scar (Figure 3).

The Rainbow Pattern (RP) is related to the difference of perception of the polarized light by different component of the dermis with anarchical arrangement of spindle cells around the vessels. Therefore, it is not surprising  to find it in scars with an important fibrous and vascular components in Keloids or in atrophic scars where the interaction of these components with polarized light are easily explored  by the dermoscope due to the atrophic character of the scar.

This rainbow pattern may have therapeutic implications, especially in hypertrophics cars, because it means that the scar contains an important vascular component which is a good target for the Pulseddye laser.

The term of rosette characterized by 4 white points arranged as a 4-leaf clover mainly localized inside the follicular openings in Polarized contact dermoscopy. The rosette sign may be complete as described before, or incomplete when we have only three or two clods linked to each other. Histologically, it correspond to changes of orthokeratosis and parakeratosis, It is occasionally seen in actinickeratosis and squamous cell carcinoma and  otherneoplasms. In scars, we explain  the rosettes sign by the abundant spindle cells and fibrosis around follicular openings, the presence of this sign in forms the clinician that the follicular unit is involved, so superficial treatments like presso therapy and topical corticosteroids are not an option, Instead, treatments that penetrate deeply into the dermis are mandatory.

Ultimately, the rainbow pattern and   the rosettes sign are not exceptionally seen in scars, and their presence may modify our therapeutic options.

1.       Yoo MG, Kim I-H (2014) Keloids and hypertrophic scars: characteristic vascular structures visualized by using dermoscopy. Ann Dermatol 26: 603-609.

2.       Martín JM, Calduch L, Jordá E (2008) Dermoscopy on the detection of remaining nonabsorbable sutures in surgical scars. J Cosmet Dermatol 7: 226.

3.       Pérez-Pérez L, García-Gavín J, Allegue F, Zulaica A (2014) The rainbow pattern and rosettes in cutaneous scars. Actas Dermo-Sifiliográficas 105: 96–97.