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Wood’s lamp

Lalit Kumar Gupta, M. K. Singhi

Department of Dermatology, Venereology & Leprology, Dr. S. N. Medical College, Jodhpur, India.

Address for correspondence: Dr. M. K. Singhi, H. No. 3, MDM Hospital Road, Jodhpur, India. E-mail : [email protected]

Wood’s lamp was invented in 1903 by a Baltimore made of barium silicate with 9% nickel oxide, the
physicist, Robert W. Wood. 1 It was first used in “Wood’s filter.” This filter is opaque to all light rays
dermatology practice for the detection of fungal except a band between 320 and 400 nm with a peak at
infection of hair by Margarot and Deveze in 1925.2 365 nm. Fluorescence of tissues occurs when Wood’s
Wood’s lamps are small, durable, inexpensive, safe and (UV) light is absorbed and radiation of a longer
very easy to use. Although mainly used in the diagnosis wavelength, usually visible light, is emitted. The output
of some infective and pigmentary dermatoses, they of Wood’s lamp is generally low (< 1 mw/cm2).2 The
have recently been used as a diagnostic tool for certain fluorescence of normal skin is very faint or absent and
skin cancers. is mainly due to constituents of elastin, aromatic amino
acids and precursors or products of melanin.3
PHYSICS
TECHNIQUE OF WOOD’S LAMP EXAMINATION
Wood’s lamp (Figure 1) emits long-wave UV radiation
(UVR), also called black light, generated by a high The use of a Wood’s lamp does not require great skill.
pressure mercury arc fitted with a compound filter However, some practical points should be kept in mind
to avoid misinterpretation of results.4-6

The lamp should ideally be allowed to warm up for
about 1 minute.

The examination room should be perfectly dark,
preferably a windowless room or a room with black
occlusive shades.

The examiner should get dark adapted in order to
see the contrast clearly.

The light source should be 4 to 5 inches from the
lesion.

Washing the area before subjecting it for Wood’s
lamp examination should be avoided since it may
yield false negative results due to dilution of the
pigment.
Figure 1: Wood’s lamp
Topical medicaments, lint and soap residues should

How to cite this article: Gupta LK, Singhi MK. Wood’s lamp. Indian J Dermatol Venereol Leprol 2004;70:131-5.
Received: February, 2004. Accepted: March, 2004. Source of Support: Nil.

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Gupta LK, et al: Wood’s lamp

be wiped off from the site to be examined since BACTERIAL INFECTIONS

these may fluoresce under Wood’s light. Common
sources of error are bluish or purplish fluorescence Pseudomonas infections
produced by ointments containing petrolatum, Pathogenic Pseudomonas species produce a pigment
green fluorescence by salicylic acid containing ‘pyoverdin’ or ‘fluorescein’ which shows green
medicaments, and light reflected from examiners fluorescence under Wood’s light. Fluorescence is
white coat producing light blue fluorescence. detected when the bacterial count exceeds 105/cm2, the
number required for infections.10 Wood’s lamp can
APPLICATIONS OF WOOD’S LAMP detect early Pseudomonas infection of burn wounds and
widespread cutaneous erosions in pemphigus, toxic
SUPERFICIAL FUNGAL INFECTIONS epidermal necrolysis and Stevens-Johnson syndrome.
The diagnosis of ecthyma gangrenosum can also be
Tinea capitis made earlier than confirmatory blood culture reports
The first use of Wood’s lamp was for the detection of by injecting saline into the wound and examining the
tinea capitis based on the fact that some dermatophyte solution thus withdrawn under Wood’s light.11
species produce characteristic fluorescence under UV
light. The chemical responsible for the fluorescence is Erythrasma
pteridine.7 Wood’s lamp is helpful in the diagnosis and Corynebacterium minutissimum shows coral red
treatment of an individual patient as well as for mass fluorescence under Wood’s light due to water soluble
screening and control of epidemics in schools.8 It can coproporphyrin III produced by the organisms. Hence,
also help to assess the length and response to washing the area will remove the fluorescence.
treatment; the end point being emergence of non- Subclinical colonization by these organisms can also
fluorescent hair. Dermatophytes that cause fluorescence be detected using Wood’s lamp, in the toe webs, scalp
are generally members of the Microsporum genus. or the trunk.8,9
However, the absence of fluorescence does not
necessarily rule out tinea capitis as most Trichophyton ACNE VULGARIS
species, with the exception of T. schoenleinii, are non-
fluorescent. 7 The fluorescence pattern of Coproporphyrin is the major porphyrin produced by P.
dermatophytes is shown in Table 1. acnes that imparts orange-red fluorescence to the
comedones inhabited by P. acnes. Facial follicular
Pityriasis versicolor fluorescence correlates well with the P. acnes
Malassezia furfur emits a yellowish-white or copper- population.12
orange fluorescence. Wood’s lamp can detect sub-
clinical infection and the extent of infection. It can also Coral red fluorescence is frequently seen in normal
help distinguish Pityrosporum folliculitis from other individuals over facial follicular openings and the
causes of folliculitis.9 papillae of the tongue. Similar fluorescence due to
proto- or coproporphyrins may be occasionally seen in
squamous cell carcinomas and even non-malignant leg
ulcers. Some malignant neoplasms of the
gastrointestinal or respiratory tracts may show similar
fluorescence.
Table 1: Fluorescence characteristics of tinea capitis
Organism Color of fluorescence
Microsporum audouinii Blue-green
Microsporum canis Blue-green PIGMENTARY DISORDERS
Microsporum ferrugineum Blue-green
Microsporum distortum Blue-green
Microsporum gypseum Dull-yellow Hypopigmentary and depigmentary dermatoses
Trichophyton schoenleinii Dull-blue a) Hypopigmentation in fair skinned persons can be

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Gupta LK, et al: Wood’s lamp

very difficult to discern. In hypopigmented or light may also serve as a prognostic guide in the
depigmented lesions there is less or no epidermal treatment of melasma, as the epidermal type of
melanin. Consequently, there is a window through melasma is more likely to respond favorably to
which the light induced autofluorescence of dermal depigmenting agents than other types.
collagen can be seen. Due to the abrupt cut-off in
the visible emission from lesional skin, the margins Wood’s lamp can also be a very useful guide in chemical
of hypopigmented or depigmented spots appear peeling. Addition of salicylic acid (in a 1:5 ratio) or
sharper under Wood’s light. The lesions appear fluorescein sodium (1:15 ratio) to peeling solutions and
bright blue-white due to autofluorescence.6 observing for green and yellow-orange fluorescence
respectively under Wood’s light helps to avoid
Wood’s lamp is therefore helpful in making a overcoating of the peeling solution and ensures the
diagnosis of vitiligo 13 and particularly even treatment of all areas.19
differentiating it from pityriasis alba, leprosy and
post-inflammator y hypopigmentation or for PORPHYRIA
identifying evolving lesion in a fair skinned person.
It is similarly useful in demonstrating evolving Detection of excess porphyrins in the teeth, urine,
lesions of chemical leukoderma 13, leukoderma stool samples, red blood cells and blister fluid in
associated with melanoma,14 the ash leaf macules different forms of porphyrias can easily be done with
of tuberous sclerosis, 15 and hypomelanosis, 16 the help of Wood’s lamp. Addition of dilute
especially in the fair skinned. Wood’s lamp can hydrochloric acid to the sample being examined
also help to differentiate nevus depigmentosus intensifies the fluorescence by converting
from nevus anemicus; the latter does not porphyrinogens to porphyrins. 20 The types of
show accentuation with Wood’s light. fluorescence observed in the principal porphyrias are
Follicular repigmentation following oral shown in Table 2.
photochemotherapy can also be demonstrated
earliest by the use of Wood’s light. PHOTODYNAMIC DIAGNOSIS

Hyperpigmentary dermatoses A relatively newer, non-invasive and simple technique

Wood’s lamp can be used to determine the depth of is being developed for the diagnosis of premalignant
melanin in the skin. The variations in epidermal and malignant conditions. It involves the application
pigmentation become more apparent under Wood’s of 20% ALA ointment to the tumor and leaving it
light. For dermal pigmentation, this contrast is less on for 4-6 hours under occlusion, allowing
pronounced. However, this applies only for the fair skin protoporphyrinogen IX to accumulate, after which the
types and not for type V or VI skin.17 area is illuminated with Wood’s light. This
photodynamic diagnosis has proved very useful in the
Based on Wood’s light findings, Sanchez et al 18 diagnosis of basal cell epithelioma, squamous cell
classified melasma into four subtypes: epidermal, epithelioma, Bowen’s disease, solar keratosis and
dermal, mixed and Wood’s light inapparent. Wood’s extramammary Paget’s disease.21

Table 2: Fluorescence findings in porphyrias

Diagnosis Sample Fluorescence
Erythropoietic porphyria RBC, urine, teeth, bones, blister fluid Red-pink
Erythropoietic protoporphyria RBC, feces, gall stones Red-pink
Hepatoerythropoietic porphyria RBC, feces, urine Red-pink
Porphyria cutanea tarda Urine, feces Red-pink
Variegate porphyria Urine (in crisis only), feces Red-pink
RBC: Red blood cells.

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Gupta LK, et al: Wood’s lamp

MISCELLANEOUS USES REFERENCES

The other lesser recognized but useful applications of 1. Wood RW. Secret communications concerning light rays. J
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Detection of systemically administered drugs such Montpellier 1925;6:375-8. Quoted from: Asawanonda P,
Charles TR. Wood’s light in dermatology. Int J Dermatol
as tetracycline or mepacrine in the skin and nail
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Wood’s light has a sterilizing effect on 14. Koh HK, Sober AJ, Nakagawa H. Malignant melanoma and
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used to sterilize culture media.28 Acad Dermatol 1983;9:696-708.

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