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Introduction: Spongiosis is defined as intercellular edema and vesicles in the epidermis. Histopathology is the gold standard for the diagnosis of spongiotic disorders. Clinical diagnosis of eczema is sometimes unclear and confused with other dermatoses; histopathology often shows spongiotic tissue reaction patterns; such conditions are called spongiotic disorders. It is challenging for a dermatologist to make the correct diagnosis noninvasively with a dermoscope and thus we have taken up the study to correlate the dermoscopic and histopathological findings in spongiotic disorders to set dermoscopic criteria for the diagnosis. Objective: To study the dermoscopic features of spongiotic disorders and correlate clinical, dermoscopic, and histopathological findings. Materials and Methods: Two hundred fifty two patients, with history and clinical presentation suggesting eczema were enrolled. They were classified as Acute (<6 weeks), Subacute (6 weeks to 3 months), and Chronic (>3 months) eczemas based on duration. Dermoscopy and skin biopsy were performed on representative lesions. Data were compiled and statistically analyzed using frequency distribution and Chi-square test. Results: We correlated the diagnosis based on acute, subacute, and chronic with three modalities, clinical examination, dermoscopy, and histopathology. On clinical examination, acute (27.4%), subacute (42.9%), and chronic (29.7%) dermatitis. On dermoscopy, acute (28.5%), subacute (40.4%), and chronic (31.1%) dermatitis. On histopathology, acute (29.5%), subacute (44.2%), and chronic (26.3%) spongiosis. A positive correlation of 99%, 96.2%, and 95% was observed on dermoscopy and histopathology, in acute, subacute, and chronic eczemas, respectively. Dermoscopy of acute eczemas showed linear vessels (100%) and red background (100%). White-Clods (98.9%) and excoriation marks (70.1%). Dermoscopy of subacute eczemas showed white scales (99.1%), irregular pigment network (98.3%), vascular changes with irregular dots (97.4%), a brown-white background (93.1%), and black/brown/grey dots (91.4%). Dermoscopy of chronic eczema showed brown-white background (100%), irregular pigment network (100%), and black/brown/grey blotches (100%). Conclusion: Definitive dermoscopic patterns are observed consistently with spongiotic diseases and these can be used additionally to set dermoscopic criteria and confirm the diagnosis. Also, dermoscopic findings are well correlated with the already established histopathological features. [ABSTRACT FROM AUTHOR]

Background: Atrophic acne scarring is an unpleasant and often permanent complication and a therapeutic challenge for dermatologists. Platelet-poor plasma (PPP) gel injections are derived from the patient's own blood and used as a "biofiller" for skin rejuvenation. Objectives: The objective was to study the efficacy and safety profile of PPP gel in atrophic acne scars. Materials and Methods: Thirty patients with atrophic acne scars were included in the study. Topical anesthesia was applied on the area of interest 45 min prior to the procedure. 20 mL of blood was collected in eight sodium citrate bulbs and centrifuged to get PPP that is coagulated with heat to form gel. This gel (biofiller) was injected in the scarred areas monthly for 6 months. Patients were evaluated using Goodman and Baron Scar (GBS) scale (quantitative and qualitative), Physician Global Assessment, and Visual Analogue Scale (VAS) at each visit. The final visit was after 3 months of the last procedure. Results: The mean value of GBS at the first visit was 28, which reduced to 8.2 at the final visit. The analysis of variance test was applied to the quantitative scale from the baseline visit to the final visit. The F value was 462.55 with a P value < 0.0001. The paired t-test was applied for the GBS quantitative scale, which showed a value of 22.86 with a P value of <0.001. Transient local side effects were noted. Conclusion: Biofiller is efficacious in improving atrophic acne scars. It is a simple, minimally invasive, cost-effective procedure with no risk of immunogenic reaction. [ABSTRACT FROM AUTHOR]

Context: Confluent reticulated papillomatosis (CRP), terra-firme-forme-dermatitis (TFFD), and dermatitis neglecta (DN) are the benign, acquired conditions that present with dirty-looking hyperpigmented and hyperkeratosis lesions on neck, back, and truncal areas. They pose difficulty in diagnosis because of their clinical similarities and thereby in treatment approaches. Bedside test and histopathology is helpful in the diagnosis. Dermoscopy is utilized as an evidence-based diagnostic method. Aims: To evaluate and to compare the dermoscopic patterns among CRP, TFFD, and DN and to correlate them in terms of histopathological features. Materials and Methods: It was a cross-sectional observational study with a total of 62 patients, among whom 30 were CRP, 20 had TFFD, and 12 were diagnosed as DN. Clinical and dermoscopic evaluation was done in all patients, and histopathology was carried out in selective cases to confirm the diagnosis. Results: Global view of dermoscopy in CRP revealed a cerebriform pattern. The arrangement of pigment globules was characteristic in CRP, TFFD, and DN, giving a "cobblestone," "mosaic," and "cornflake-like" appearance, respectively. The color of the pigment globules was strikingly significant. Yellow globules were predominant in CRP and TFFD, having p values of 0.001 and 0.004, respectively. Scales were conspicuously present in CRP, with a statistically significant p value of 0.003. Focal white areas and hair changes were observed in CRP alone, whereas black dots were found only in TFFD. Conclusion: Dermoscopy acts as an in vivo and a noninvasive, rapid technique in the diagnosis of clinically look-alike conditions. It demonstrates characteristic features in CRP, TFFD, and DN. Thus, it is an evidence-based diagnostic method that assists the treating physician in daily clinical practice. [ABSTRACT FROM AUTHOR]

Treatment of PLF includes systemic steroids and intralesional steroids.[5] This case is unique in terms of the papular eruption of PLF, appearing at the hair transplantation site and responding well to topical tacrolimus. Dear Editor, Pseudolymphomatous folliculitis (PLF) is a rare manifestation of cutaneous pseudolymphoma and cutaneous lymphoid hyperplasia. T cells are positive for CD4 (c), CD8 (d), CD3 (e), and CD68 (f) gl PLF is a poorly-defined entity of cutaneous pseudolymphoma/cutaneous lymphoid hyperplasia, which was first described by McNutt in 1986.[2] It is characterized by dense infiltration of lymphocytes, accompanied by hyperplastic hair follicles. [Extracted from the article]

The article provides information on Bowen's disease (BD), a type of squamous cell carcinoma in situ, with a focus on dermoscopic features in an immunocompromised patient. The patient presented with a rapidly progressive, atypical BD lesion on the thigh, exhibiting peculiar dermoscopic findings such as dotted, glomerular, and polymorphous vessels, as well as white rosettes of variable size.

Background: Discoid lupus erythematosus (DLE) is chronic dermatosis manifests as scaly indurated plaques with erythema and peripheral hyperpigmentation. Few cases progress to systemic lupus erythematosus. Differentials include lichenoid photo dermatitis, Jessner's lymphocytic infilterate, and polymorphus light eruptions. It is difficult to assess the activity clinically. Histopathology is characteristic and evaluation of disease activity is possible. Dermoscopy is a useful diagnostic method in many dermatoses. Dermoscopy is reflection of histological changes. Hence, dermoscopic features may act as a tool for activity assessment. Here authors have pursued dermoscopic and histopathological correlation in DLE lesions to assess the activity of disease. Aims: To study dermoscopic features in DLE and correlate the patterns with histopathological changes in skin of color. Method: This study was conducted in a tertiary hospital. Clinically suspected and histopathologically proven lesions of DLE were enrolled in this study. The target lesion was marked and sent for biopsy after performing dermoscopy. Activity of the lesion was assessed on the basis of histopathological features. SPSS statistics for windows v20.0 (SPSS Inc, Chicago, USA) was used to analyze data. Chi-square and Fisher's χ2 test was used to statistically signify association. Cohen's kappa coefficient was used to determine the agreement. Results: Study included 110 patients with Fitzpatrick skin type IV-V having 120 lesions. Follicular keratotic plug [73 (60.8%)] and peri-follicular whitish halo [65(54.1%)] were commonly found in dermoscopy. Blue-gray and brown dots, telangiectasia, follicular red dots, white rosettes and white areas include other features. Interface dermatitis, peri-appendageal infilterate, melanin incontinence, melanophages and fibrosis were noted in histopathology. Perfect agreement was observed in follicular plugs. Conclusion: Dermoscopy patterns were well correlated with histopathological changes. Thus dermoscopy played an important role in assessing the activity of lesion. [ABSTRACT FROM AUTHOR]

Follicular mucinosis (FM)/alopecia mucinosa is not commonly seen in children. There are a limited number of case reports, and its prognosis and long-term outcome are unpredictable. We describe a case of FM in a 3-year-old child, which was confirmed on histopathology. The lesion resolved with topical pimecrolimus cream and targeted phototherapy with an excimer lamp and has not recurred. [ABSTRACT FROM AUTHOR]

Introduction: Many conditions included under figurate erythemas have similar clinical appearance which makes diagnosis difficult. Among these, eosinophilic annular erythema (EAE) is a rare, uncommon, underreported entity in the pediatric population. Case Report: Herein, we report an 11-year-old boy who presented with asymptomatic recurrent, erythematous-edematous annular plaques with central hyperpigmentation. Discussion: Review of the literature shows scarce reporting of such cases globally and none from India. Clinicopathological findings of our case, suggest that eosinophilic annular erythema is a distinct entity rather than a type of Wells' syndrome. [ABSTRACT FROM AUTHOR]

Subcutaneous phycomycosis is a rare saprophytic fungal infection. We herein report a case of subcutaneous phycomycosis with stony hard swelling on the chest wall as an unusual site of infection. Diagnosis was made based on the clinical, histopathological, and culture studies. Oral treatment with itraconazole resulted in rapid resolution of lesion. [ABSTRACT FROM AUTHOR]

Our patient has had AA since 3 years, but he recently developed age-related hormone-induced seborrhea on the background of fully functional sebaceous glands over the scalp. Sir, Alopecia areata (AA) is a common cause of non-scarring hair loss. On examination, numerous closely set open comedones with regrowing and vellus hair were seen all over the scalp [Figure 1]. [Extracted from the article]

Introduction: Many conditions included under figurate erythemas have similar clinical appearance which makes diagnosis difficult. Among these, eosinophilic annular erythema (EAE) is a rare, uncommon, underreported entity in the pediatric population. Case Report: Herein, we report an 11-year-old boy who presented with asymptomatic recurrent, erythematous-edematous annular plaques with central hyperpigmentation. Discussion: Review of the literature shows scarce reporting of such cases globally and none from India. Clinicopathological findings of our case, suggest that eosinophilic annular erythema is a distinct entity rather than a type of Wells' syndrome. [ABSTRACT FROM AUTHOR]

Palmoplantar psoriasis (PPP) is a variant of psoriasis which affects only 5% body surface area, but has a devastating impact on affected individual's quality of life. There are few studies assessing efficacy of individual drugs, and few comparative studies of efficacy of two drugs in the literature, however randomized control trial comparing all three drugs against each other has not been done. A total of 75 patients of PPP were enrolled for study and randomly divided into three groups A, B, C of 25 each and assigned for treatment with cyclosporine (CSA) (2.5‐5 mg/kg/d), methotrexate (MTX)(7.5‐15 mg/week), and acitretin (ACT) (25‐50 mg/d), respectively. Modified psoriasis area and severity index (PASI), psoriasis severity scale, visual analogue scale, physician global assessment, and PPQOL were used for monitoring response to therapy and improvement in quality of life up to end of study, and thereafter monthly follow‐up was done to find duration of remission for next 90 days. Side effects if any were recorded. There was a statistically significant difference in modified PASI for CSA, MTX, and ACT. The mean modified PASI at baseline was 12.8 ± 4.8 for CSA, 12.57 ± 3.8 for MTX, and 11.92 ± 3.28 for ACT (P =.75). Mean modified PASI reduced to 2.91 ± 1.8 for CSA, 6.57 ± 2.2 for MTX, and 4.7 ± 2.2 for ACT at week 5 (P = <.01). Mean modified PASI further reduced to 0.095 ± 0.35 for CSA, 2.12 ± 1.4 for MTX, and 0.78 ± 0.97 for ACT at end of study (P = <.01). However, average duration of remission was 9 weeks for ACT group, followed by 6.47 and 3 weeks for CSA and MTX group, respectively. Adverse events were comparatively more in ACT group as compared to MTX and CSA groups. PPP affects quality of life tremendously and warrants systemic treatment for the same. CSA provides fastest resolution of lesions and have highest efficacy. MTX and ACT have similar efficacy, but ACT provides longer duration of remission. [ABSTRACT FROM AUTHOR]

Background: The distribution of dermatophyte infections and their causative agents varies with geographical region. The present study was conducted to assess clinical profile of patients with dermatophytosis infection. Materials & Method: The present study was conducted on 86 patients of both genders. In all patients, a through clinical examination was performed. The skin specimen was taken for histopathological examination. Results: Out of 86 patients, males were 34 and females were 52. Type was T. corporis in 24, T. cruris in 14, T. manuum in 2, T. unguium in 13, T. Faceii in 12, T. capitis in 11 and T. pedis in 10. The difference was significant (P< 0.05). Conclusion: Dermatophytosis is common in skin disorder seen all age groups especially adults. Most common was T. corporis followed by T. cruris and T. manuum. [ABSTRACT FROM AUTHOR]

Background: Bullous pemphigoid is an immunobullous disease which affects the elderly. The present study was conducted to assess association of Bullous pemphigoid and neurological disorders. Materials & Method: The present study was conducted on 125 cases of pemphigoid. Parameters such as name, age, gender, clinical features, etc were noted. The medical history, neurological diseases and medications used by the patients were recorded. Results: Out of 125 cases, 65 were in males and 60 were in females. Common neurological disorders were dementia seen in 15, stroke in 12, Hemorrhagic stroke in 6, Parkinson's disease in 14 and epilepsy in 5. The difference was significant (P< 0.05). There was positive correlation of dementia, stroke and Parkinson's disease with Bullous pemphigoid (P< 0.05). Conclusion: Authors found that positive correlation of dementia, stroke and Parkinson's disease with Bullous pemphigoid. [ABSTRACT FROM AUTHOR]

Introduction: Lichen planus is a chronic autoimmune inflammatory disorder. At present, there is a lack of any specific scoring system to judge the severity of cutaneous lichen planus. Hence, a study was undertaken to establish and validate a system to define the severity of cutaneous lichen planus, i.e. Lichen Planus Severity Index.Materials and Methods: Setting: Skin outpatient department, Krishna Institute of Medical Sciences, Karad.Model: The formulation model was Psoriasis Area Severity Index (PASI) and the validation model was Onychomycosis Severity Index (OSI).Participants: The consensus group included two dermatologists and two dermatology residents with special interest in lichen planus and a statistician. Results of the consensus group were compared with a preliminary reproducibility group of two dermatologists and four dermatology residents. Later, reliability assessment was carried out by two groups: 1. Twenty-one dermatologists scored 20 photographs of four patients of lichen planus after being trained to use Lichen Planus Severity Index. 2. Six doctors (three experts and three randomly selected physicians) evaluated ten real-world patients of lichen planus in skin outpatient department. The physicians were blind to the scores assigned by experts.Steps To Calculate Score: There are five morphological types of lesions seen in lichen planus, namely, erythematous papule, violaceous papule, violaceous plaque, hyperpigmented hypertrophic papule and plaque and postinflammatory hyperpigmentation. Total involved body surface area is determined and a body surface area factor is assigned. Area involvement factor for each of these morphological lesions is calculated and multiplied with the respective multiplication factor. Sum of all the products gives the lesion severity score. Product of lesion severity score with the body surface area factor gives the final Lichen Planus Severity Score.Results: There was no significant difference between the scores of consensus group and preliminary reproducibility group. Both assessment groups showed high reliability. (Group 1: Cronbach alpha = 0.92, ICC = 0.85; Group 2: Cronbach's alpha = 0.99, ICC = 0.92). The correlation between Lichen Planus Severity Index and the standard Physician Global Assessment score was found to be positive (correlation coefficient = 0.73).Limitations: : The system is tedious and requires a steep learning curve. Possible uses of Lichen Planus Severity Index are yet to be explored and validated.Conclusion: Lichen Planus Severity Index is a new reproducible tool to grade the severity of lichen planus. [ABSTRACT FROM AUTHOR]

Introduction: Leprosy is a disease primarily affecting skin and nerve. Nail involvement, although indirect, is observed in several patients. This is a study to determine the pattern of nail changes in leprosy. Methods: It was an observational study involving 125 patients. Apart from cutaneous and neurological examination, nails were examined. Diagnosis was confirmed by previous records in already diagnosed cases, while by slit skin smear and histopathologically in new cases. Patients were grouped as per Ridley‑Jopling classification and further subdivided as per age, sex, and duration and reaction status. Nail changes in these groups were summarized and compared. Results: Overall prevalence of nail changes was 80% with 66.6% in TT patients, 79.4% in BT patients 50% in BB patients, 83.7% in BL patients and 84.3% in LL patients. Longitudinal melanonychia and longitudinal ridges were frequent finger nail changes with longitudinal melanonychia being more common among tuberculoid pole and longitudinal ridges among lepromatous pole. Brachyonychia, subungual hyperkeratosis and brown black pigmentation were frequent finger nail changes, with onychorrhexis being commonest among TT patients, subungual hyperkeratosis among BT patients, while brachyonychia among BL and LL patients. Anonychia and rudimentary nails were not found in tuberculoid pole. Beau’s lines, terry nails, pterygium, pincer nail, and onychorrhexis were significantly more frequent in ENL patients. Onychomadesis, which is not reported yet in leprosy, was found in one patient after severe ENL. Conclusion: Various changes in leprosy are due to multiple causes like neuropathic, traumatic, vascular, osseous, infections and drugs reflecting extensive systemic morbidity caused by Mycobacterium leprae. [ABSTRACT FROM AUTHOR]

Background: Lichen planus is a chronic mucocutaneous inflammatory disease which frequently involves the oral mucosa. The present study was conducted to assess prevalence of auto antibodies and clinical spectrum of lichen planus. Materials & Method: The present study was conducted on 82 patients of lichen planus of both genders. A thorough clinical examination was performed. 5 ml of blood was drawn in a sterile syringe with all aseptic precautions. Antibodies including anti-nuclear antibody, anti-desmoglein 1 antibody, anti-desmoglein 3 antibody, anti-keratinocyte antibody, anti-mitochondrial antibody and anti-thyroglobulin antibody were assayed in serum samples by indirect immunofluorescence according to commercially available testing kits. Results: Out of 82 patients, males were 24 and females were 58. Age group 11-20 years had 5 males and 15 females, 21-30 years had 8 males and 26 females, 31-40 years had 6 males and 10 females, 41-50 years had 3 males and 4 females and > 50 years had 2 males and 3 females. The difference was significant (P < 0.05). ANA was positive in 14, DSG- I in 15, DSG- III in 24, AKA in 27, AMA in 45 and TGA in 32. The difference was significant (P < 0.05). Conclusion: Authors found that most common auto- antibodies found was AMA, AKA and DSG- III. [ABSTRACT FROM AUTHOR]

Context: Trichostasis spinulosa (TS) is a common but underdiagnosed follicular disorder involving retention of successive telogen hair in the hair follicle. Laser hair removal is a newer treatment modality for TS with promising results. Aims: This study aims to evaluate the efficacy of 800 nm diode laser to treat TS in Asian patients. Subjects and Methods: We treated 50 Indian subjects (Fitzpatrick skin phototype IV-V) with untreated trichostasis spinulosa on the nose with 800 nm diode laser at fluence ranging from 22 to 30 J/cm² and pulse width of 30 ms. The patients were given two sittings at 8 week intervals. The evaluation was done by blinded assessment of photographs by independent dermatologists. Results: Totally 45 (90%) patients had complete clearance of the lesions at the end of treatment. Five (10%) subjects needed one-third sitting for complete clearance. 45 patients had complete resolution and no recurrence even at 2 years follow-up visit. 5 patients had partial recurrence after 8-9 months and needed an extra laser session. Conclusions: Laser hair reduction in patients with TS targets and removes the hair follicles which are responsible for the plugged appearance. Due to permanent ablation of the hair bulb and bulge, the recurrence which is often seen with other modalities of treatment for TS is not observed here. [ABSTRACT FROM AUTHOR]

Gorlin syndrome is a rare familial disorder characterized by numerous basal cell carcinomas along with facial skeletal findings. Here, we report a father and son case, presented with features of Gorlin syndrome. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 35-year-old female presented with asymptomatic reddish rash on extremities, abdomen and buttocks, recurring for the past ten years. It notes that prolonged standing, walking and wearing of stockings have aggravated the rashes on the lower extremities of the patient. It adds that a hypergammaglobulinemic purpura of Waldenstrom (HGPW) was considered and further diagnostic tests were carried out, including skin biopsy and immunofluorescence.

Background Necrolytic acral erythema (NAE) is a distinct skin entity and is strongly associated with chronic hepatitis C virus (HCV) infection. It is distinguished by its acral location, typical clinical and histopathologic features, and positive serum antibodies against HCV. Most cases have been treated with variable success using oral zinc, amino acids, and interferon with or without ribavirin therapy. Methods We report two patients with the clinical and histopathologic features of NAE; however, both tested seronegative for HCV. Both patients were treated with oral zinc acetate with good response, with one showing a partial relapse after stopping oral zinc. The clinical features, histopathologic findings, association of HCV, and treatment of NAE in different case reports were reviewed. Conclusion NAE has a strong association with HCV, particularly in prevalent countries such as Egypt. Nevertheless, it may occur independently without HCV association, and oral zinc may prove to be a less toxic therapeutic option for such cases. [ABSTRACT FROM AUTHOR]

The article presents information on the structure and mechanism of action of acitretin. Acitretin has become the retinoid of choice in treatment of psoriasis, replacing etretinate. The metabolism of acitretin occurs mainly in the liver. The major metabolite of acitretin is its 13-cisisoacitretin. A small amount of acitretin is converted into etretinate, which is more lipid-soluble and persists for much longer time in the fatty tissues. Acitretin is rapidly and extensively distributed throughout the body without unexpected accumulation in any tissue.

The article presents a case study of young girl with Piezogenic pedal papules. Topics include observation of skin-colored papules in clinical examination, determination of dermal elastic fibers fragmentation with subcutaneous fat herniation by skin biopsy, supplement of Micro-Cellular Rubber (MCR) insoles to the patient as symptomatic management, suggestions for local electroacupuncture usage by case reports and objective of therapeutic treatment is herniation prevention with fat entrapment.

Presents a quiz, which invites readers to identify the disease suffered by a patient.