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Background: Fordyce granules, sometimes referred to as Fordyce dots, are aberrant sebaceous glands that present as diminutive, non-painful, elevated lesions exhibiting a yellowish or whitish hue, measuring 1 to 3 mm in diameter, and manifesting inside the oral cavity. Likewise, these particles may also be seen in the vaginal region and inside the oral cavity. Aim: The primary objective of the current study is to evaluate the potential association between Fordyce granules and the skin type of individuals who seek dental care at the Dental Clinics of Qassim University. Materials and Methods: The current cross-sectional research was undertaken at the Dental Clinics of Qassim University, with a sample of 87 patients diagnosed with Fordyce's granules. The research consisted of a heterogeneous sample of participants, including individuals of all genders, ranging in age from 18 to 85 years. The study included a comprehensive evaluation of several anatomical regions to identify the existence of Fordyce's granules. This examination was conducted by a single examiner who had undergone calibration. Additionally, the participants' skin types were established using the Baumann Skin Typing System questionnaire. The data that was gathered was afterward analyzed utilizing statistical methods via the use of SPSS software. A pre-set significance level was established at P < 0.05. Results: The distribution of skin types among the study participants with Fordyce's granules were found to be oily skin (51.3%), dry skin (47.9%), sensitive skin (49.3%), and resistant skin (56.3%). The results of the research showed that there was no statistically significant correlation between the two variables, i.e. skin type and the presence of Fordyce's granules. This conclusion is supported by the increased P values of 0.941 for those with oily skin and 0.785 for individuals with dry skin. Conclusion: No relation between skin type and Fordyce's granules in the current study. [ABSTRACT FROM AUTHOR]

Zoon's balanitis or balanitis plasmacellularis circumscripta is a chronic inflammatory disorder of the genital mucosa that can affect both males and females (Zoon's vulvitis). It is not a sexually transmitted disease but can still cause anxiety to the patients because of its chronic nature. Hence, proper diagnosis and early management are necessary. It is a clinical mimicker of other commoner genital dermatoses and is mostly a diagnosis of exclusion when other diseases have been ruled out. It is characterised by a well-demarcated shiny erythematous patch or plaque over the genital mucosa. Histopathological examination becomes necessary when we are unable to differentiate it from premalignant lesions. It reveals lozenge-shaped keratinocytes with siderophages, haemorrhages and variable plasma cell infiltrate in the dermis. Dermoscopy shows spermatozoa-like, convoluted vessels with structureless red orange areas. Response to topical therapy alone is not always satisfactory. However, lasers and surgical management can provide long-term remission. [ABSTRACT FROM AUTHOR]

Schwannomas synonymously known as neurilemmomas or neurinomas are uncommon benign neoplasms of neural sheath origin. They account for 5% of all benign soft-tissue tumors. 6%-8% of tumors occur intracranially and 25%-45% occur extracranially in the head-and-neck region, of which cutaneous schwannomas located in the dermis or subcutaneous tissue in the head and neck are an unusual entity. Of the seven subtypes described by Erlandson, ancient schwannoma is a very rare distinctive histopathological variant resulting from long-term degenerative changes and accounts for 0.8% of all soft-tissue tumors. This seminal article is a systematic review of schwannomas in the ear in its entirety from 1977 to 2023 along with a case report of a profusely bleeding cutaneous ancient schwannoma occurring in the mastoid region in a swelling of a short duration of 6 months in a 75 year old female. To the best of our knowledge, this case has two firsts to its credit. It is the first reported case of an ancient schwannoma in the mastoid region and also the first reported case presenting with bleeding from the schwannoma. Due to its rarity, ancient schwannoma must be included in the differential diagnosis for any bleeding mass in the ear to avoid an erroneous diagnosis of malignancy. [ABSTRACT FROM AUTHOR]

Dermoscopy refers to evaluation of the skin surface using surface microscopy. It is mainly used for the diagnosis of skin disorders. We report two cases in which dermoscopy played a role in treatment. Our first case was a 40-year-old female with history of insect bite. We evaluated the patient using a dermoscope and removed the tick with mouth part embedded in dermis using forceps ensuring full removal after procedure. The second case was a 35-year-old female who presented with a non-healing ulcer over lower back, following excision of epidermoid cyst. Dermoscopy showed the presence of a thread which was removed and repeat dermoscopy following extraction ensured its full removal. [ABSTRACT FROM AUTHOR]

Background: Nasal reshaping using hyaluronic acid (HA) filler has become a widespread technique and injections are usually performed in deep layers. As an alternative, we propose an innovative approach where HA is injected into the dermis, the so called MesoRhinoFiller. Aims and Objectives: The aim of this study was to describe our injection technique using a smooth, cohesive, and slightly viscous HA filler injected in the dermis. Materials and Methods: A retrospective review of the author’s clinical experience from March 2017 to March 2020 was presented. A total of 280 consecutive patients were treated with HA injections to improve their nasal appearance. The mean volume was 0.5 cc HA filler/treatment. Results: An average increase of 4.9±3.4° was obtained for the nasofrontal angle, and of 7.0±4.5° for the columella labial angle. Asymmetries in the nasal profile and alar rim were also corrected. All the patients were satisfied with the results and no complications occurred. Conclusion: Injecting HA fillers in the dermal plane is a versatile approach that provides very satisfactory results. This technique allows one to better correct aesthetical, post-traumatic, and post-surgical defects compared with the usual injection rhinoplasty procedures where the filler is injected deep onto the bone/cartilage in the midline of the nose. [ABSTRACT FROM AUTHOR]

Becker’s naevus (BN) presents as a unilateral, hyperpigmented patch with hypertrichosis over the upper trunk/proximal upper extremity. Usually, block-like/geographical pattern is seen; however, linear forms have also been reported. A 21-year-old man presented to us with a history of hyperpigmented, well to ill-defined discrete-to-coalescent plaques with brownish macules scattered at the periphery, over posteromedial aspect along Blaschko’s lines, extending from the buttock to the ankle of the right lower limb. No associated hypertrichosis/focal defects were seen. On dermoscopy (10×, DermLite DL4W, Dana Point, California) pigment network, scaling with perifollicular accentuation, perifollicular hypopigmentation, and uniform brown dots/globules/lines were seen. A skin biopsy revealed acanthosis and focal papillomatosis with increased pigment in the basal layer; pigment incontinence and melanophages were seen in the dermis. To the best of our knowledge, only one such case has been reported with Blaschko-linear BN over the lower limb. We present here an uncommon case of Blaschko-linear BN over the lower limb with dermoscopy and a concise literature review of BN over the lower limb. [ABSTRACT FROM AUTHOR]

A case study involves an 8-year-old boy with unique cutaneous morphological features, novel variant of epidermal naevus termed "naevus spinofiliformis," characterized by multiple spinous projections and filiform hyperkeratotic lesions, highlighting the need for further study and validation of this rare entity in epidermal naevi.

Hair is a feature that is only found in mammals. In all species, it is an epidermal protrusion composed of an outer cuticle, middle cortex, and inner medulla. Hair's primary purpose in mammals is to aid with thermoregulation. Every domestic animal species has a distinct hair pattern that can be used in forensic investigations. The aim of the present study is to observe the different animal hairs under stereomicroscope for forensic analysis. Hair is a unique characteristic seen only in mammals. It is an epidermal protrusion composed of an outer cuticle, middle cortex, and inner medulla in all species. The primary function of hair in animals is to aid with thermoregulation. Every domestic animal species has a specific hair pattern that forensic investigators can employ. The shaft profile was straight in all the animal hairs. In the proximal end, the root was absent because the hair was cut from the respective animals. Cuticles were absent in all the hair strands. The surface texture was smooth in dog hair, rough and spiculated in cat hair, and coarse in horse and rat hair. Microscopic examination of hairs reveals morphological distinctions that allow animal hairs from different species to be distinguished. In forensic investigations, microscopic examinations of various animal hairs are useful. [ABSTRACT FROM AUTHOR]

Acute graft-versus-host disease of the gastrointestinal tract (GI-aGVHD) is a rare condition, often requiring multiple laparotomies, ultimately leading to a burst abdomen. We report the successful use of a dermal regeneration template (DRT), combined with negative pressure wound therapy (NPWT) and skin grafts, to reconstruct the abdominal skin in an 11-year-old boy. The patient was a case of aplastic anemia, who underwent bone marrow transfers, the first of which failed and the second one was successful. He eventually developed gastrointestinal GVHD. Repeated laparotomies were done for recurrent intestinal obstruction. He also underwent resection anastomosis and end ileostomy, after which he developed an anterior abdominal wall defect due to a burst abdomen. After 12 months of management with multiple dressings, NPWT, and DRT, a stable coverage was achieved, without skin retraction. We report our experience in anterior abdominal wall reconstruction in a case of GI-aGVHD using DRT [ABSTRACT FROM AUTHOR]

Angiosarcoma (AS) is a rare malignant tumor of vascular or lymphatic epithelium, typically presenting as a bruise-like patch over the face or scalp in the seventh–ninth decades. Here, we report a case of cutaneous AS (cAS) in a 51-year-old male patient who presented with a cauliflower-like growth in the groin with skin-colored shiny flat-topped satellite papules in the surrounding areas, some of which were umbilicated. Based on examination, the patient was considered retro positive and the following differentials were considered: Buschke–Lowenstein tumor with giant molluscum, Kaposi sarcoma, and squamous cell carcinoma. Histopathological examination suggested the diagnosis as AS, which was confirmed by immunohistochemistry that was positive for CD31 and CD34. The report highlights the unusual site and clinical presentation of cAS. [ABSTRACT FROM AUTHOR]

The article focuses on a case study of a rare lipidized fibrous histiocytoma (LFH) in a young Indian woman, detailing its clinical presentation as a hyperpigmented and hyperkeratotic nodule on the leg. It covers the diagnostic challenges, histopathological features, and a comparative analysis of LFH with other dermatofibromas, emphasizing the rarity of this variant and its distinct presentation in Fitzpatrick type IV skin.

Context: Chronic non-healing ulcer causes significant morbidity, high cost and reduced quality of life. Aims: To compare autologous platelet-rich fibrin matrix and transplantation of autologous non-cultured epidermal cell suspension in the treatment of chronic non-healing ulcers. Methods: The study was single-centre, prospective, randomised comparative study conducted in a tertiary care center in North India. Patients with chronic non-healing ulcer were included and randomly divided into two treatment groups- Group 1: Platelet-rich fibrin matrix (PRFM) procedure was done every 2 weeks with maximum three sittings and in Group 2: Transplantation of autologous noncultured epidermal cell suspension (NCES) procedure was done once. Follow-up was done every 2 weeks for 8 weeks then monthly for up to 5 months to evaluate the healing of the ulcer. The data were analysed by statistical package for social science (SPSS) trial version 22. To find out a significant difference in mean value between groups, the Chi-square test, student's t-test, and Mann–Whitney U test were used. Results: A total of 41 patients were included in the study. Complete healing of ulcers occurred in 89.5% of the patients in the PRFM group and 93.8% of the patients in the NCES group at the end of 5 months (P = 0.33). The mean duration of complete healing in PRFM was 1.7 months and in NCES was 2.13 months (P = 0.20). Conclusions: Both procedures were effective, and there was no significant difference between the two procedures. [ABSTRACT FROM AUTHOR]

Lack of quality control can affect the safety, efficacy, and acceptability of herbal products that may lead to health problems. Cannabis sativa L. (Cannabaceae) has been widely used as an ethnomedicinal practice for its medicinal values. This study aims to establish pharmacognostic specifications of C. sativa as per standard procedures. Macroscopic-microscopic characteristics, physicochemical parameters, thin-layer chromatography (TLC) fingerprinting, and phytochemical screening of C. sativa leaves collected from various locations throughout Thailand were investigated. Leaves are palmate consists of seven leaflets with green color, margin is serrate with acuminate apex. Anomocytic stomata were found in the upper epidermis while unicellular and glandular trichomes with cystolith were found in the lower epidermis and the epidermis layer covered with cuticle. The physicochemical analysis revealed that the loss on drying (4.068 ± 0.084 %w/w) was within acceptable limits, total ash (14.360 ± 0.084%w/w), acid insoluble ash (2.726 ± 0.080%w/w), ethanol-soluble extractive (11.101 ± 0.223%w/w), water-soluble extractive (23.038 ± 0.306%w/w), and water content (7.523 ± 0.524%w/w). TLC fingerprint showed nine spots with Rf value 0.14, 019, 0.23, 0.29, 0.32, 0.45, 0.58, 0.70, and 0.76. Phytochemical screening of Cannabis leaves indicated the presence of phenolic compounds, flavonoids, alkaloids, diterpenes, triterpenes, and steroids. This study provided referential data for the accurate plant identity, and establishment of cannabis leaves monograph in Thailand. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 65-year-old male with a rare pigmented variant of eccrine poroma on the palm. Topics discussed include the clinical presentation and histopathological features of pigmented eccrine poroma, its rare occurrence on atypical sites such as the palm, and the importance of surgical excision in its treatment.

Cutaneous pili migrans (CPM) is an uncommon condition in which a hair fragment penetrates the skin and produces a creeping lesion similarly of cutaneous larva migrans associated with local pain. There are few reports of CPM in the literature, and none visually describes the migration of the hair shaft in the epidermis associated with pain. Herein, we showed the first report describing a case of an in situ sequential migration of CPM in an adult patient. [ABSTRACT FROM AUTHOR]

A 15-year-old healthy boy presented with multiple eruptive brown-colored to hyperpigmented papules all over the body for 1 year. His serum lipids were normal, and HIV serology was negative. Biopsy revealed hyperplastic epidermis along with an ill-defined lesion in the dermis that was composed of spindle-shaped fibroblastic cells and multiple cholesterol clefts within foamy macrophages. A diagnosis of cholesterotic dermatofibroma was made. The case is unusual for the young age of presentation and the presence of multiple eruptive papules. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 19-year-old Chinese female with facial erythema and papules. Examinations revealed a slight thickening of the facial epidermis and epithelioid granulomas in the dermis, and a positive purified protein derivative (PPD) skin and the T-cell spot test. The patient was finally diagnosed with cutaneous tuberculosis (CTB), was given quadruple antitubercular therapy, after which a 2-year post-treatment follow-up showed no recurrences.

Nevus lipomatosus superficialis is a rare hamartomatous lesion of skin, also named as pedunculated lipofibroma. This entity is unknown to many primary care physicians, Hence, many times, it is not diagnosed and misinterpreted as any of its differential diagnoses like lipofibromas, skin tags, hemangioma, lymphangioma, and focal dermal hypoplasia. Histopathologically, it is characterized by the presence of clusters of mature fat cells in the dermis. Here we report a case of an 11-year-old male who presented with a lower back swelling since birth (4.8 x 3.6 cm) which gradually increased over time and became lobulated, pedunculated, and non-tender. It is an uncommon entity with distinct clinical and histopathological features. Awareness about this lesion, its clinical presentation, morphological features, and favourable outcome is necessary so that it can be differentiated from other skin neoplasms. [ABSTRACT FROM AUTHOR]

Polymorphous light eruption (PMLE) is the most common, idiopathic, acquired photodermatosis, characterized by abnormal, recurrent, and delayed reaction to sunlight. Polymorphous light eruption is common worldwide but the morphology, distribution, and pigmentary changes are unique in Indian skin which is discussed in this review. The prevalence of PMLE is around 10–20% in the general population. It commonly occurs in females between 20and 30 years of age. It is the most common photodermatosis in school-going children. Visible light sensitivity is an important phenomenon in PMLE. It typically presents as recurrent and chronic lesions over photoexposed sites. Initially, patchy erythema occurs with pruritus. Most of the Indians belong to type IV to type VI skin and pigmentary changes are commonly seen. The unique feature of PMLE in Indian skin is the pigmentary change which varies from hypopigmented to hyperpigmented lesions. These pigmentary changes may occur alone or in combination with erythematous or skin-colored lesions. The pigmentary lesions are seen in more than 50% of lesions. The histopathology of PMLE is characterized by the presence of hyperkeratosis, spongiosis with or without the presence of liquefactive degeneration in the epidermis. Dermal changes in the upper and mid dermis include the presence of dense perivascular lymphocytic infiltrate. The management of PMLE includes both preventive measures and medical management. Topical sunscreens, topical steroids, hydroxychloroquine and antioxidants play a very important role. [ABSTRACT FROM AUTHOR]

Eyebrows have been known to be an importance aspect of facial aesthetics and eyebrow restoration is now a part of anti-ageing procedures too. Microblading is a new technique in the field of permanent cosmetics for eyebrow restoration. Currently, it is one of the most sort after treatment in aesthetic procedures due to the curiosity and awareness raised by social media. Microblading is a form of superficial micropigmentation, wherein pigment is deposited till the papillary dermis, with the help of a manual device and a blade consisting of stacked needles. The resultant crisp, discrete hair like incisions simulate the eyebrow hair to give a natural look. The results are semi-permanent and last only 12-18 months. In the recent years, with the advancement in the instrumentation of microblading there have been several modifications in this procedure. Microblading has now found its applications not only in cosmetic treatments but also in dermatological conditions such as alopecia totalis, hypothyroidism, chemotherapy induced madarosis etc. It is a vital tool in any dermatology or cosmetic practise for its extensive applications. But with the rise in popularity of microblading, there is also a rise of untrained professionals performing it leading to a rise in its side-effects. This article aims at not only guiding on the instrumentation and procedure of microblading but also its pre and post procedure care, interaction with other aesthetic procedures and treating its complications. [ABSTRACT FROM AUTHOR]

Background: The estimation of fetal epidermal thickness has clinical significance for dermatological investigation and diagnosis of fetal prematurity. Objective: We aimed to collect baseline data of fetal epidermal thickness and secondarily to study the correlation of gestational age (GA) from epidermal thickness. Materials and Methods: Thirty fetuses were selected for the study aged from 11 to 40 weeks. They were divided into six groups at a 4-week interval. The mean epidermal thickness was measured at four sites such as the abdomen, interscapular region, scalp, and palm. The histometric analysis was done with the help of amscope 5MP Aptina MT9P001. Results: The mean age of gestation was 25.67 ± 8.45 weeks. The mean epidermal thickness of the abdominal, interscapular, scalp, and palmar region was 21.9 ± 12.9 μm (3.41–42.48), 111.21 ± 74.39 μm (7.9–214.51), 27.58 ± 13.26 μm (11.7–46.2), and 139.73 ± 96.40 μm (7.3–280.51), respectively. The growth pattern of the epidermis of the different region was significantly variable based on the ANOVA (P = 1.98E-13 P < 0.05 significant) and paired t-test of interregion comparison. Conclusions: The epidermal thickness has a significant positive correlation with GA and anatomical sites. We emphasize that epidermal thickness is a newborn maturity marker at birth. [ABSTRACT FROM AUTHOR]

Introduction: Atrophic dermatofibroma is a rare variant of dermatofibroma which is many times underdiagnosed. Case Report: We report a case report of a 29-year-old female who came to the dermatology department with black-colored lesions on the lower leg for the past 7 years. Histopathological examination revealed a non-encapsulated dermal tumor involving upper to deep reticular dermis and extending to superficial subcutis. There was epidermal hyperplasia, and at the center of the lesion a slight epidermal atrophy was present. Discussion: It is a commonly underdiagnosed variant of dermatofibroma. Histopathologically, this disorder presents as a decrease in at least 50% of the thickness of the dermis relative to the adjacent dermis. The case is rare and hence reported. [ABSTRACT FROM AUTHOR]

Introduction: Morphea profunda or subcutaneous morphea is a variant of morphea in which inflammation and sclerosis found in deep dermis, subcutaneous tissue, fascia or muscle. Case report: We are report an atypical case of subcutaneous morphea in five year-old girl, presenting with atrophy of subcutaneous fat over the left lower limb in a liner pattern, closely mimicking linear lipoatrophy. Discussion: Early intervention in such cases can halt progression of the disease. [ABSTRACT FROM AUTHOR]

Introduction: Morphea is a rare fibrosing disorder of the skin and underlying tissues. Deep morphea involves the deep dermis, subcutis, fascia, muscle, and bone. The above structures may be involved independently or in combination. Case report: We describe a case of deep morphea presenting as muscle weakness, independent of skin lesions, in a child with generalized morphea. Discussion: Muscle weakness, even in the absence of overlying or progressive skin sclerosis, can be deep morphea, especially when segmental and associated with atrophy. [ABSTRACT FROM AUTHOR]

We describe an objective method to measure the volume of a dermis-fat graft (DFG) implant for socket reconstruction. We reviewed the charts of 10 patients undergoing dermis fat grafting as a primary or secondary implant for anophthalmic socket reconstruction between January 2018 and December 2019. The amount of the DFG required to replace the volume of an appropriate spherical implant for the operated eye was predetermined. The volume of the DFG implant was measured by the water displacement method as per the Archimedes principle. Patient demographics, complications, and the outcome were analyzed regarding cosmesis and volume replacement. All patients were satisfied with the final cosmesis. Follow-up ranged from 6 to 18 months (mean 10.7 months). Thus, we concluded that the water displacement method is a simple and easy procedure to objectively determine the amount of the autologous DFG needed to replace the volume in an anophthalmic socket. [ABSTRACT FROM AUTHOR]

Background: Oxidative stress is implicated in the pathogenesis of vitiligo. The function of DJ-1 in oxidative damage of melanocytes is still elusive. Aims: The aim of this study was to investigate the role of DJ-1 in oxidative damage of melanocytes. Material and Methods: The expression of DJ-1 in melanocytes was studied by reverse transcription-quantitative polymerase chain reaction and Western blot. Short-interfering RNAs (siRNA) were employed to downregulate DJ-1. The cells were pooled into three groups: mock group (cells with transfection reagent), negative control (NC) group (negative siRNA control), and siRNA group. After H2O2treatment for 24 h, the morphological changes, cell viability, apoptosis, intracellular reactive oxygen species (ROS) levels, mitochondrial membrane potential (MMP), and mitochondrial respiration were measured in different groups. Results: DJ-1 was highly expressed in PIG1 melanocytes. DJ-1 knockdown rendered PIG1 melanocytes more susceptible to oxidative stress. Loss of DJ-1 led to apoptosis of PIG1 cells by impairing the function of mitochondria, including morphological abnormalities, ROS accumulation, depolarization of MMP, less adenosine-triphosphate (ATP) production, and less proton leak. Conclusions: DJ-1 plays a role in maintaining the antioxidative capacity in epidermal melanocytes. [ABSTRACT FROM AUTHOR]

Nikolsky's sign has been a very useful diagnostic tool in cases of skin disorders like pemphigus, toxic epidermal necrolysis, etc., The sign is demonstrated when lateral pressure is applied on the border of an intact blister, which results in the dislodgment of the normal epidermis and extension of the blister. [ABSTRACT FROM AUTHOR]

Perforating dermatoses are characterized by transepidermal elimination of altered dermal components or foreign particles. Owing to their common clinical presentation as umbilicated papules with a keratotic plug, histopathology and special staining play a very crucial role in the diagnosis. Perforating calcific elastosis, (periumbilical perforating pseudoxanthoma elasticum), an uncommon acquired localized cutaneous dermatoses, is characterized by transepidermal elimination of modified elastic fibres. It is usually seen in middle-aged obese multiparous women as well-defined periumbilical hyperpigmented atrophic plaques. We report a case of a 66-year-old female who presented with a mildly pruritic hyperpigmented periumbilical plaque of 2 years duration. Histopathology studies revealed multiple fragmented, thick, short, and curly eosinophilic fibers; along with granular basophilic material in the dermis, which stained positive for calcium and elastin, thus clinching the diagnosis of perforating calcific elastosis. There were no features of hereditary pseudoxanthoma elasticum. We report this case for its rarity. [ABSTRACT FROM AUTHOR]

An 18-year-old male presented with an erythematous plaque on the left side of face and neck since 4 years. The lesion was devoid of hair, had follicular prominences, and showed increased localized sweating. Histopathology revealed an increased number of eccrine glands in the myxoid stroma with multiple vascular elements in the dermis, favoring the diagnosis of eccrine angiomatous hamartoma. This case illustrates a relatively uncommon clinical presentation of eccrine angiomatous hamartoma as a hairless, hyperhidrotic plaque in the head and neck region. [ABSTRACT FROM AUTHOR]

A case study of conjunctival melanoma invading the nasolacrimal duct, stressing the rarity of such cases and the potential challenges in managing them. Despite en bloc orbital exenteration and an 8-year post-surgery period without recurrence, the lacrimal drainage apparatus remains a high-risk site for metastasis, underscoring the importance of cautious treatment approaches.

The ridged skin of the palms and soles has several unique features: (i) presence of dermatoglyphics created by alternating ridges and grooves forming a unique pattern, (ii) presence of the highest density of eccrine sweat glands and absence of pilosebaceous units, and (iii) differential expression of keratins compared to the glabrous skin. These features explain the preferential localization of palmoplantar keratoderma (PPK) and several of its characteristic clinical features. PPK develops as a compensatory hyperproliferation of the epidermis and excessive production of stratum corneum in response to altered cornification of the palmoplantar skin due to mutations in the genes encoding several of the proteins involved in it. PPK can manifest as diffuse, focal, striate, or punctate forms per se or as a feature of several dermatological or systemic diseases. There is a wide genetic and phenotypic heterogeneity in hereditary PPK, due to which reaching an accurate diagnosis only on the basis of clinical features may be sometimes challenging for the clinicians in the absence of molecular studies. Nevertheless, recognizing the clinical patterns of keratoderma, extent of involvement, degree of mutilation, and associated appendageal and systemic involvement may help in delineating different forms. Molecular studies, despite high cost, are imperative for accurate classification, recognizing clinical patterns in resource poor settings is important for appropriate diagnosis, genetic counseling, and management. This review intends to develop a practical approach for clinical diagnosis of different types of hereditary PPK with reasonable accuracy. [ABSTRACT FROM AUTHOR]

Background: Organotypic tissue-cultured skin equivalents are used for a broad range of applications either as possible substitute for animal tests or for transplantation in patient-centered care. Aims: In this study, we implemented melanocytes in a tissue-cultured full-thickness skin equivalent, consisting of epidermis and dermis. The versatility of this skin-like model with respect to pigmentation and morphological criteria was tested. Materials and Methods: Pigmented skin equivalents were morphologically characterized, and melanogenesis was evaluated after treatment with kojic acid – a tyrosinase inhibitor and forskolin – a well-known activator of the cyclic adenosine 3,5-monophosphate pathway. Pigmentation was measured either by determination of the extinction at 400 nm after melanin extraction with KOH correlated to a melanin standard curve or by reflectance colorimetric analysis, monitoring reflectance of 660 nm and 880 nm emitting diodes. Results: The morphological analysis revealed characteristic epidermal stratification with melanocytes located at the basal layer. Stimulation with forskolin increased the pigmentation, whereas treatment with kojic acid caused bleaching. Conclusion: The present study demonstrates that the herein-introduced organotypic tissue-cultured skin equivalent is comparable to the normal human skin and its versatility in tests regarding skin pigmentation. Therefore, this model might help understand diseases with dysfunctional pigmentation such as melasma, vitiligo, and postinflammatory hyperpigmentation. [ABSTRACT FROM AUTHOR]

Background: Nowadays noninvasive techniques are performed to evaluate the biophysical properties of skin in vivo. Aims: The aim of this study was to evaluate the biophysical and ultrasonographic properties of skin in chronic contact or atopic dermatitis to provide better insight into pathogenesis, diagnosis, and treatment response. Materials and Methods: The stratum corneum hydration, transepidermal water loss (TEWL), pH, erythema, melanin, sebum, friction, temperature, elasticity parameters (R0, R2, and R5), the thickness and echo-density of epidermis, dermis, and subepidermal low-echogenic band (SLEB) were measured on lesional, perilesional, and symmetrical skin of 22 chronic dermatitis patients. The average of perilesional and symmetrical skin values (control) was compared with lesional values. Results: Stratum corneum hydration (P<0.001), friction (P=0.02), sebum (P=0.01), and R0 (P<0.001) were significantly lower in lesion, TEWL (P=0.03), pH (P=0.001), erythema (P=0.004), and temperature (P=0.04) were significantly higher in lesion. The thickness of epidermis (P=0.002), dermis (P=0.034), and SLEB (P<0.001) were significantly higher in lesion; and the echo-density of dermis (P<0.001) and SLEB (P<0.001) was significantly lower in lesion. Conclusion: Chronic contact and atopic dermatitis are characterized by certain changes in biophysical and biomechanical properties of the skin. The evaluation of these parameters might be useful in the early diagnosis and assessment of treatment response. [ABSTRACT FROM AUTHOR]

Background: Alopecia areata (AA) describes a sudden localized patchy alopecia. The cause of AA is not completely clear and its incidence may be related to genetic, autoimmune, and environmental factors. Aim: To explore the possible mechanisms of AA and to provide a basis for the early diagnosis and treatment of AA. Methods: Gene microarray data from 122 scalp skin biopsy tissue samples from patients with AA or healthy controls from the Gene-Cloud of Biotechnology Information database were analyzed using bioinformatics analysis methods. Molecular network analysis of the differentially expressed genes (DEGs) was conducted by Cytocluster using the Molecular Complex Detection (MCODE) algorithm. Results: The gene expression profile of skin lesions from patients with AA was significantly altered, with 111 DEGs found in the skin lesions of AA, compared with that of the healthy skin. The DEGs were mainly related to biological processes such as the development of the epidermis and inflammatory reaction. The protein–protein interaction network analysis of DEGs revealed bone morphogenetic protein 2 (BMP2) as a core protein interaction network. BMP2 acted not only via the inflammatory response but also via the signaling pathways in epithelial cell development and epidermal cell differentiation to affect the epidermal development. MCODE analysis further showed that keratins (KRTs) and keratin-associated proteins (KRTAPs) can affect the epidermal development via the epidermal development pathway. Conclusions: The abnormal development of the epidermis and inflammatory reactions in skin tissue play important roles in the pathogenesis of AA and are closely related to BMP2, KRTs, and KRTAPs genes. Limitations: Our study was limited by experimental verification. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 54‑year‑old man former smoker with a history of hypertension and high blood cholesterol referred to hospital with a lesion in his palate of 4 months evolution and also associated weakness, odynophagia, cervical adenopathies, and loss of 6 kg in the past months; physical exploration revealed an 8‑mm ulcerated lesion in his soft palate with well-demarcated border and also evidenced a 3 cm infiltrated erythematous plaque on the left scapular regio.

The article presents useful dermoscopic findings for differentiating Rosacea from Seborrheic Dermatitis. It discusses that Rosacea and seborrheic dermatitis as chronic inflammatory skin disorders that cause redness, scales, and itching in the face or scalp. It mentions that diagnosis on the basis of clinical features.

The article discusses Bowen's disease is a form of cutaneous squamous cell carcinoma in situ more commonly developing on sun‑exposed sites; the pagetoid growth pattern mimics mammary Paget's disease and superficial spreading melanoma; histopathological features for PBD include the existence of dyskeratotic cells; and the lesion only involved the areola and left the skin of the nipple uninvolved.

Langerhans cell histiocytosis (LCH) is a proliferative disease commonly seen in the pediatric population but rarely encountered in the adult population. The exact etiology remains unclear. It has various clinical features and is very likely to be misdiagnosed. Histopathology and immunohistochemistry are very important for the diagnosis of LCH. Treatment protocols remain controversial. Herein, we report a rare adult onset LCH, which is confined to the skin. A 50-year-old Chinese man presented with a nodule with itchy rashes on the left lower leg, which gradually grew in size for the last 6 months. He also had multiple scattered rashes on the right lower leg. The skin biopsy demonstrated Langerhans cells infiltrating the superficial dermis, and the tumor cells were positive for CD1a and S-100 expression. The diagnosis was LCH based on the histopathological and immunohistochemistry results. [ABSTRACT FROM AUTHOR]

A lady presented with indolent slowly spreading erythematous nodule on the left external ear which on histopathology showed dense monomorphic lymphoid cells in the dermis. No epidermotropism or angioinvasion was seen. Immunohistochemistry showed that the infiltrating lymphoid cells were CD8+ but CD4-. Majority of the cases of cutaneous T-cell lymphomas have a CD4+, CD8- T-cell expression. Few cases have been reported with similar CD8-positive lymphoid proliferation with a curious ear tropism. [ABSTRACT FROM AUTHOR]

Background: Vitiligo is a common pigmentary disorder. Studies on its pathogenesis extensively investigated melanocytes' abnormalities and few studies searched for keratinocytes' role in disease development. Liver X receptor-α (LXR-α) is a member of nuclear hormone receptors that acts as a transcription factor. Its target genes are the main regulators of melanocyte functions. Aim: The aim of this study is to investigate keratinocytes' role in vitiligo pathogenesis through immunohistochemical expression of LXR-α in lesional, perilesional, and distant nonlesional vitiligo skin. Materials and Methods: This case–control study was carried out on 44 participants. These included 24 patients with vitiligo and 20 age- and sex-matched normal individuals as a control group. Biopsies, from cases, were taken from lesional, perilesional, and distant nonlesional areas. Evaluation was done using immunohistochemical technique. Results: Keratinocyte LXR-α expression was upregulated in the lesional and perilesional skin (follicular and interfollicular epidermis) compared with control skin (P<0.001 for all). There was significant association between higher histoscore (H-score) in lesional epidermis (P<0.001) and in hair follicle (P=0.001) and the presence of angiogenesis. There was significant association between higher H-score in lesional epidermis and suprabasal vacuolization (P=0.02). No significant association was found between H-score or expression percentage and clinical data of selected cases. Conclusion: LXR-α upregulation is associated with keratinocyte damage in vitiligo lesional skin that leads to decreased keratinocyte-derived mediators and growth factors supporting the growth and/or melanization of surrounding melanocytes. Therefore, melanocyte function and survival are affected. [ABSTRACT FROM AUTHOR]

Interstitial granulomatous dermatitis (IGD) was first described in 1993 by Ackerman as a cutaneous reactive disease in patients with arthritis. Since then, numerous cases associated with different hematological and rheumatic disorders have been reported. IGD is a polymorphic entity that usually involves the upper part of the trunk. Histologically, it is defined as a diffuse dermal histiocytic infiltrate of different densities surrounded by fragmented collagen. We report the case of a 56-year-old man with pruritic papules affecting neck, proximal arms and thorax associated with weight loss and chronic fatigue for six months. Two punch biopsies were taken and the specimens showed lymphohistiocytic interstitial infiltrates with fragmented collagen and elastic fibers in dermis. IGD was diagnosed as first manifestation of a rare chronic myeloproliferative hematologic disorder (cMPD) with rearrangement of beta-receptor for platelet-derived growth factor (PDGFRB). After two months of imatinib, lesions regressed completely. [ABSTRACT FROM AUTHOR]

Background: The skin produces cortisol by itself and regulates its own proliferation and differentiation. There is a possibility that topical corticosteroids (TCSs) influence the cortisol homeostasis in the skin. Aims and Objectives: The author described the density and distribution of cortisol and its parties in the epidermis after application of topical steroids immunohistologically. Materials and Methods: The forearm skin was biopsied before and after 2 weeks' application of clobetasol propionate 0.05% two times a day in one healthy volunteer. The biopsied skin was stained immunohistologically by ant-MLN64, StAR, CPY11A1, cortisol, HSD11B1, HSD11B2, glucocorticoid receptor alpha, glucocorticoid receptor beta (GRB), and mineralocorticoid receptor (MCR) antibodies. The skin biopsy was performed similarly in 19 adult patients with atopic dermatitis who had used TCS for a considerable period. They were 4 TCS present users (TCS+), 12 TCS nonusers with skin manifestation on the biopsied site (TCS-E+) and 3 TCS nonusers without skin manifestation on the biopsied site (TCS-E-). Results: The staining density increased during TCS application in MLN64, cortisol and HSD11B2 in a healthy volunteer. The staining density was stronger in HSD11B2 of the basal layer and MCR of the spinous layer in the TCS-E+ patients than in the TCS+ and TCS-E- patients. The staining density was weaker in MLN64 of the basal and granular layers, HSD11B1 of the basal layer and GRB of the whole layer in the TCS-E+ patients than in the TCS+ and TCS-E- patients. Conclusion: The hypertrophy of the epidermis and insufficient keratinization recognized in the TCS-E+ patients might be caused by the decreased cortisol synthesis regulated by MLN64 and the increased cortisol inactivation by HSD11B2. Decreased GRB and increased MCR might enhance the reactivity of cortisol in the keratinocytes. [ABSTRACT FROM AUTHOR]

Reactive perforating collagenosis (RPC) is a rare disorder of transepidermal elimination in which genetically altered collagen is extruded out through the epidermis. This disease usually starts as asymptomatic or pruritic umbilicated papules on extensor aspects of extremities and face, and the lesions become more conspicuous with age. It has two forms: Acquired and inherited form, of which inherited form is extremely rare. Here, we document a case of inherited form of RPC in a 13-year-old boy having multiple asymptomatic hyperpigmented umbilicated papules with a central keratotic plug distributed chiefly over face and extensor aspect of upper and lower extremities since his infancy, with history of similar lesions in his 18-year-old elder brother. [ABSTRACT FROM AUTHOR]

Context: In vivo epidermal nuclear staining (ENS) can be found in patients with autoimmune connective tissue diseases (CNTDs) and other diseases. Aims: The aim of this study was to reveal the underlying diseases and direct immunofluorescence (DIF) characters of patients with in vivo ENS and association of in vivo ENS with circulating autoantibodies. Settings and Design: A retrospective analysis was conducted involving skin biopsy specimens submitted for DIF study at the Dermatoimmunology Laboratory at Siriraj Hospital between 2002 and 2012. Subjects and Methods: The findings of DIF study, clinical manifestations, and diagnosis of patients who had positive ENS were investigated. Statistical Analysis Used: The SPSS software version 18.0. Descriptive statistics were used to report demographic data, clinical characteristics, and laboratory investigation results. Moreover, Chi-squared test or Fisher's exact test were used to compare the categorical variables. Results: One hundred and thirty-eight out of 3735 submitted specimens (3.7%) showed positive ENS. The most common diagnosis was CNTD (79%) followed by vasculitis (10.1%). Lupus erythematosus was the most common diagnosis among CNTD (78%). No association between levels of serum antinuclear antibodies (ANA) titer and intensity of ENS (P = 0.660). However, we found that patients with positive in vivo ANA had lower prevalence of systemic involvement. Conclusions: Although lupus erythematosus was the most common diagnosis among patients with in vivo ENS, the presence of ENS does not indicate any specific diagnosis. However, patients with ENS tend to have less systemic involvement. [ABSTRACT FROM AUTHOR]

Background: Pemphigus is an acquired irnrnunobullous disorder in which antibodies are directed against epidermal cadherins. Despite the commercial availability and less cost of enzyme-linked immunosorbent assays (ELBAs) to detect antidesmoglein 1 (Dsgl) and anti-Dsg3, immunofluorescence is still widely used for confirmation of diagnosis. Aims: (1) To compare the usefulness of indirect immunofluorescence (IIF) and ELBA tests in the diagnosis of pemphigus. (2) To find the clinical correlation between the tests and severity of the disease. Materials and Methods: Sixty-one patients (27 women and 34 men, age distribution from 20 to 75) were clinically diagnosed as pemphigus (pemphigus foliaceus - 11, pemphigus vulgaris - 50) and were recruited for the study. IIF and Dsg ELBA were performed and the findings were compared with each other and with the pemphigus area activity score. Data were entered in SPSS and were analyzed using Kruskal-Wallis test. Results: There was a moderate positive correlation between the cutaneous score and Dsgl titer, and mucosal score and Dsg3 titer. The titer of IIF showed statistically significant positive correlation with the cutaneous score but not the mucosal score. Dsg ELBA showed higher sensitivity (90.2%) than IIF (75.4%) in the diagnosis of pemphigus. Conclusions: Dsg ELBA is a more sensitive method than IIF and shows more correlation with the disease severity. [ABSTRACT FROM AUTHOR]

Conventional technique of dermal grafting for acne scars where the source of filler material used is the patient's own dermis requires longer surgical time, recovery period and can result in unsightly scars at the donor area. Hence, it is not suitable for treating a larger number of scars. Furthermore, these dermal grafts are firm and cannot be contoured to fit all types of acne scars. Occurrence of epidermal cyst and secondary infection is another complication if epidermis is not completely removed. Enzymatic techniques need trypsinisation which is expensive and requires laboratory facilities. [ABSTRACT FROM AUTHOR]

Cooling devices and methods are now integrated into most laser systems, with a view to protecting the epidermis, reducing pain and erythema and improving the efficacy of laser . On the basis of method employed, it can be divided into contact cooling and non-contact cooling. With respect to timing of irradiation of laser, the nomenclatures include pre-cooling, parallel cooling and post-cooling. The choice of the cooling device is dictated by the laser device, the physician's personal choice with respect to user-friendliness, comfort of the patient, the price and maintenance costs of the device. We hereby briefly review the various techniques of cooling, employed in laser practice. [ABSTRACT FROM AUTHOR]

A case study of a 12-year-old boy presented with an asymptomatic skin nodule on his cheek, diagnosed as an unruptured epidermal inclusion cyst. Dermoscopy revealed peripheral linear branched vessels, a white structureless background and a punctum, aiding in the accurate diagnosis and differentiation between ruptured and unruptured cysts, influencing treatment decisions.