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Dermatological disorders constitute a significant proportion of primary health care (PHC) setups. The pattern of dermatological disorders varies among different countries and different parts of the same country owing to climatic and geographical variations, level of education, access to health care, etc. To study the clinical spectrum of patients presenting with dermatological disorders at an urban health center (UHC) in East Delhi. To identify the various risk factors associated with dermatological disorders in study subjects. A total of 1,148 patients who reported skin diseases for the first time at the Dermatology Outpatient Clinic at UHC in East Delhi were recruited. Detailed demographic data, history, and examination and potential risk factors of skin diseases (socioeconomic status, level of education, occupation, comorbidities, and addictions) were recorded on a predesigned proforma. A total of 616 (53.7%) patients had infectious dermatoses and 532 (46.3%) had non-infectious dermatoses. Among the infectious dermatoses, fungal diseases (44.8%) were the most common followed by parasitic infections (31.17%) and bacterial infections (9.74%). Among the non-infectious group, eczematous disorders (28.01%) were the most common, followed by pigmentary disorders (21.62%) and acne (19.55%). A significant association between level of education, occupation, and comorbidities with the distribution of infectious and non-infectious dermatoses was found. As a significant proportion of patients with a vivid spectrum of dermatological disorders present at the PHC setups, therefore dermatologists supervise that specialty clinics should be held regularly at these centers along with the availability of all the basic investigations to aid diagnosis and management. [ABSTRACT FROM AUTHOR]

Introduction: Melasma is a common acquired pigmentation disorder over the sun exposed areas found commonly in our country. Oral tranexamic acid and glutathione have been shown to have significant efficacy when given along with topical modified Kligman regimen. Aims: To compare the efficacy of oral tranexamic acid versus oral glutathione given in combination with modified Kligman regimen in the management of melasma. Settings and Design: An open label randomized controlled trial was conducted in the skin OPD of a tertiary level hospital in Northern India. Materials and Methods: The study group consisting of 96 patients was categorized into two groups; group A received oral tranexamic acid 250 mg twice daily in combination with a modified Kligman regimen and group B received oral Glutathione 500 mg once daily with a modified Kligman regimen. mMASI score was used to make the assessment. mMASI scores were measured at baseline, 4th, 8th, and 12th week. Intragroup and intergroup comparison was done using analysis of variance (ANOVA) and Chi‑square test statistical methods. Results: Ninety patients completed the study. Both the groups showed a significant fall in the mMASI score; group A showed a statistically significant fall in the score vis a vis the group B. Conclusion: Oral tranexamic acid with a modified topical Kligman regimen has a slight edge over oral glutathione given with topical modified Kligman’s regimen in the treatment of melasma. [ABSTRACT FROM AUTHOR]

Linear and whorled nevoid hypermelanosis is a rare skin pigmentation disorder, characterized by linear streaks and whorls of hyperpigmented macules along Blaschko's lines. Lesions are commonly restricted to the trunk, neck, and extremities, sparing the face, palms, soles, and mucosae. Associated with this, certain cardiovascular, musculoskeletal, neurological, and developmental anomalies have been reported in the literature. Herein, we present a rare case of linear and whorled nevoid hypermelanosis involving the face, with musculoskeletal, genital, aural, and ocular abnormalities. [ABSTRACT FROM AUTHOR]

Nutritional status of patients, specially prolonged starvations is an important sub-component of the environmental factors, speculated to have indirect impact on the initiation, propagation, resolution, and exacerbation stages of autoimmunity. The study was based on the hypothesis of conscious, selective, and self-destruction, that is, deregulated autophagy of skin and hair in low dietary protein scenario triggered with prolonged starvations. It was aimed to reverse the self-destruction/deregulated autophagy by providing early morning, low carb-high protein nutrition, and correcting underlying micronutrient deficiency and studying its effect on reducing auto-immunity and eventually reducing disease burden and recurrence. Methods: In this retrospective study, patients were divided into two categories based on disease activity and nutrition. Group A: "novice group" of vitiligo patients who presented at an early stage of their disease were managed with basic standard of therapeutics. Group B: "stabilized group" of vitiligo who were given surgical treatment and followed up for 3 years for any recurrences. Personalized diet plan aimed at reversing high carb-low protein diet and avoiding prolonged overnight starvation adhering to early morning breakfast respecting the circadian rhythm and balanced with additional plant based protein was advised. All detectable underlying micronutrient deficiencies were corrected. Results: Thirty patients were enrolled in the study, 20 in group A and 10 in group B. We observed visible signs of improvement in group A, with early vitiligo (90%) with topical therapy and nutritional intervention as early as 3 weeks. Following surgical procedure in group B, 50% patients had near complete pigmentation at the end of 3 months and 30% within next 3 months. At the end of 6 months, all patients had significant improvement in VASI and VIDA score, however two patients in each group had recurrence at end of 1 year who deviated from nutritional protocol and were found to be deficient in protein intake and micronutrients deficiency was detected on blood investigation. The improvement in VASI scores with conventional treatment and nutritional intervention was found to be statistically significant at 6 months and 1-year interval in group A with paired t test (P=0.013). Similarly, improvement in VASI was statistically very significant at 6 months and 1- year duration in surgically treated vitiligo group B (P=0.001). These patients were put on immunosuppressive therapies in first group after correction of deficiencies and managed with supportive and conventional therapy in second group in subsequent 3 years follow up. Conclusion: Nutritious diet aimed at correction of underlying protein and micronutrient deficiency with special emphasis on circadian rhythm may arrest the natural progression of disease at an early stages of the disease and prime the body for oral immunosuppressive drugs. This approach may prevent the recurrence in patients already stabilized with standard care of therapeutics and surgery in future. [ABSTRACT FROM AUTHOR]

Pigmented purpuric dermatosis (PPD) comprises a group of skin conditions characterized by flat, nonpalpable petechiae and purpura as a result of capillaritis. Although the precise cause of PPD is as yet unknown, increased vascular permeability and capillary fragility are key factors in its pathophysiology. PPD has diverse clinical presentations, but the histopathology of all these variants essentially remains the same. The initial purpuric lesions develop a golden-brown hue owing to hemosiderin absorption and eventually progress to chronic pigmentary changes. These lesions, which often affect the lower limbs, are either asymptomatic or accompanied by moderate pruritus, and can be difficult to diagnose and treat. There are several subtypes of clinical presentations that have been documented over the years. In order to accurately diagnose PPD, a thorough clinical evaluation and, occasionally, a biopsy may be required. It is essential to identify the condition and reassure patients of its benign nature. Treatment is usually necessary due to the chronic nature of the condition, its consequences on physical and mental well-being, and the presence of significant lesions or itching. In this review, we outline the various prevalent PPDs and discuss their etiopathogenesis, clinical features, and diagnostic and treatment modalities. [ABSTRACT FROM AUTHOR]

Amyloidosis cutis dyschromica is a very rare form of primary cutaneous amyloidosis characterized by prepubertal onset of hyper and hypopigmented spots and amyloid deposits in the papillary dermis. We report two cases of this condition highlighting its dermoscopic findings. [ABSTRACT FROM AUTHOR]

The article presents a case study of a rare subtype of primary cutaneous amyloidosis known as amyloidosis cutis dyschromica (ACD) involving three patients aged 24, 28, and 34. Topics discussed include the clinical presentation and diagnostic challenges of ACD, its dermoscopic and histopathological features, and the various treatment options and their effectiveness.

The article focuses on lichen planus pigmentosus (LPP), an uncommon variant of lichen planus, presenting a case of a 34-year-old woman with brownish-black macules on her neck masquerading as nevus spilus (NS). It discusses the clinical presentation, dermoscopic features, and histopathological findings of LPP, emphasizing its differentiating features from NS and highlighting the various variants of LPP described in the literature.

Idiopathic eruptive macular pigmentation (IEMP) is a rare disorder of pigmentation presenting with asymptomatic hyperpigmentation mainly in children and adolescents over face, neck, trunk, and extremities. Epidermal basal-cell pigmentation is observed on histopathology. It usually resolves spontaneously over months to years. Lichen planus pigmentosus and erythema dyschromicum perstans should be differentiated from IEMP. We report four cases of IEMP fulfilling the criteria proposed by Sanz de Galdeano et al. in 1996. [ABSTRACT FROM AUTHOR]

Pigmentary disorders, especially vitiligo and melasma, are cosmetically disfiguring and have a profound impact on life quality. Various quality of life tools and questionnaires have been devised in order to objectively quantify this psychosocial morbidity, which can guide towards more comprehensive patient management. These include generic measures, dermatology-specific measures, and disease-specific measures. The latter are mostly developed for melasma and vitiligo. Most of these tools measure the impact on life quality across various psychosocial domains, particularly feelings of embarrassment about appearances and societal stigma. The present review consolidates the available literature on quality of life scales used in pigmentary disorders. [ABSTRACT FROM AUTHOR]

Incontinentia pigmenti (IP) is a rare X-linked dominant neuroectodermal dysplasia affecting almost exclusively females. It is caused by loss-of-function mutations in the inhibitor of kappa light polypeptide gene enhancer in B cells, kinase gamma gene, formerly known as NF-κB essential modulator. The disorder is typically identified by peculiar skin findings that develop throughout the 1st year of life. Approximately one-third of patients has ocular and neurologic abnormalities causing severe disability. Defects of hair, nails, and teeth can also occur. Among systemic complications, pulmonary arterial hypertension (PAH) is uncommon but potentially life-threatening. Only six cases have been described in the literature so far, and four of them died before reaching 1 year of age. Herein, we report the case of a 2-month-old girl with IP and severe PAH, successfully treated with pulmonary antihypertensive and anti-inflammatory therapy. [ABSTRACT FROM AUTHOR]

Gigantic melanocytosis is a rare and peculiar familial disorder of pigmentation. It presents as diffuse hyperpigmentation interspersed by raindrop-like hypopigmented macules predominantly involving the sun-exposed areas and later progressing to involve the photoprotected areas as well. All the cases described in the literature were observed to be commencing in the first year of life and were more common in males. Hereby, we report a 28-year-old female who presented with adult-onset gigantic melanocytosis with no similar familial history. [ABSTRACT FROM AUTHOR]

The article focuses on a case study of cutaneous angiosarcoma (CA) manifested as an erythematous plaque on the nose, discussing its rarity, clinical variants, and diagnostic challenges including dermoscopic and histological examinations. It emphasizes the importance of early diagnosis, outlines the pathological characteristics, and highlights the aggressive nature of this tumor, stressing the significance of comprehensive management for improved outcomes.

Objective: To evaluate the effects of phenolic acids (caffeic, ferulic, and coumaric acids) and flavones (luteolin and apigenin) on the proliferation and melanogenesis in murine melanoma B16-F10 cells. Methods: Cell proliferation was determined after 24 and 48 hours of incubation using MTT assay. The effects of these tested compounds on cell cycle progression were analyzed by flow cytometry. Moreover, the melanin content and tyrosinase activity were measured spectrophotometrically at 475 nm. Results: Luteolin and apigenin exhibited significant anti-proliferative activity against B16-F10 cells, while caffeic, ferulic, and coumaric acids induced slight inhibition after 24 and 48 hours of incubation. The tested compounds disturbed cell cycle progression of B16-F10, by a subsequent decrease in G1 and arrested cycle progression in either G1/S or G2/M phase. Furthermore, apigenin provoked an increase in melanin content of B16-F10 cells. In contrast, luteolin, caffeic, ferulic and coumaric acids induced a decrease in melanin content of B16-F10 cells by inhibiting tyrosinase activity. Conclusions: These active polyphenols may be used as skin whitening agents or natural tanning agents to treat skin pigmentation disorders. [ABSTRACT FROM AUTHOR]

Background: Interleukin 17 (IL-17) has recently been implicated in the pathogenesis of vitiligo by many studies but it is unclear whether it has any definitive role in causing depigmentation. IL-17 inhibitors have already been used in other inflammatory disorders with good results and may prove to be a valuable therapeutic modality in vitiligo. Thus, this study aims at adding to the existing data on the role of IL-17 in the pathogenesis of vitiligo. Objectives: (1) To determine the correlation between IL-17 and the extent of body surface area involvement. (2) To determine the correlation between IL-17 and the severity of disease activity. (3) To determine the correlation between IL-17 and serum vitamin D levels. Methodology: Thirty-two clinically diagnosed patients with vitiligo and 26 age- and sex-matched controls who fulfill the inclusion criteria were enrolled in the study. After obtaining a detailed history, a complete dermatologic examination was performed and vitiligo area severity index (VASI) and vitiligo disease activity score (VIDA) were assigned. The baseline serum IL-17 level was measured using Raybiotech serum IL-17 enzyme-linked immunosorbent assay kit. Serum vitamin D was measured for all cases and controls. Results: In our study, the mean VASI score of all the patients was 6.32 ± 10.14 and the mean VIDA score was 1.97 ± 0.999. The mean serum IL-17 levels were 155.72 ± 79.412 pg/mL in patients with vitiligo compared to 102.73 ± 56.478 pg/mL of the controls, with a mean difference of 52.99 pg/mL and the difference was statistically significant (P=0.008). Although, there is no significant correlation between the serum IL-17 levels with the VASI score, our study noticed slightly higher levels of IL-17 in generalized vitiligo and lowest levels were noticed in localized vitiligo. Limitations: Our study was limited by the small sample size of 32. Conclusion: Although, serum IL-17 levels were significantly higher in the patient group than the controls, there was no correlation with the disease extent or activity. Thus, it is difficult to establish a causal role of serum IL-17 in vitiligo. [ABSTRACT FROM AUTHOR]

Perioral pigmentation is a commonly encountered condition in the skin Out Patient Department (OPD), occurring due to a variety of primary as well as secondary causes. The affection of the perioral skin being readily visible negatively impacts the patient's quality of life. As the etiology of perioral pigmentation is multifactorial, treatment modalities vary according to the cause. The perioral skin, because of its location close to the mouth, is exposed to various allergens associated with food, saliva, toothpaste, cosmetics, etc., which can all lead to allergic manifestations resolving with pigmentation. Certain other dermatoses like melasma can first present with pigmentation over the perioral region. Infections like chikungunya and dengue and infestation with Demodex mite can also lead to pigmentation at this site. Perioral pigmentation can also be a marker of underlying systemic disease. Localized lentigines-like pigmentation can be associated with various cancer predisposition syndromes like Peutz-Jeghers syndrome. Diffuse pigmentation can occur due to Addison disease, vitamin deficiencies, or can be drug-induced. All these causes of pigmentation are seen more commonly in type IV and V skin. Currently, very little literature is available elucidating the cause of perioral pigmentation and the diagnostic approach. This article reviews the causes of perioral pigmentation and highlights their important features. [ABSTRACT FROM AUTHOR]

Background: Dyschromatosis symmetrica hereditaria (DSH) is a rare autosomal dominant skin disease. The mutation of the ADAR1 gene is the pathogenesis of this disorder. Aims: This study aimed to identify the mutations of the ADAR1 gene in two Chinese families with DSH. Methods and Materials: Eight patients from two Chinese families were diagnosed with DSH clinically. Blood samples were collected from the patients and unaffected individuals. Sanger sequencing for all polymerase chain reaction products of the whole coding regions of the ADAR1 gene was performed to identify the mutations. Mutation Taster software was used to predict the impact of the variant on the resultant protein. Results: The c.3358-3359insT (p.L1053fs-1092X) mutation in exon 12 was found in affected members of the pedigree1. In pedigree2, the c.3820-3821insG (p.G1207fs-1213X) mutation in exon 15 was found. These two mutations were not found in 100 unrelated healthy people. In this study, both mutations were damaged by the Mutation Taster software. Conclusions: We identified two novel frameshift mutations in the ADAR1 gene. Our study expands the database of ADAR1 gene mutations in DSH. [ABSTRACT FROM AUTHOR]

A 19-year-old female presented with off-white colored depigmented macules over her laft fore arm. A clinical diagnosis of nevus depigentosus was made. As the patient had cosmetic concern regarding that lesion, she was treated with noncultured epidermal suspension technique. She had more than 90% repigmentation after 6 months of the procedure and the pigment was retained at 1-year follow-up. We also discussed briefly regarding the available literature on surgical treatment options. [ABSTRACT FROM AUTHOR]

Introduction: Melasma is a common acquired disorder of pigmentation that presents as hyperpigmented macules and patches predominately in the sun exposed areas of the face. It is more commonly seen in women. Objective: To compare the woods lamp and dermoscopic features of melasma. Materials and Methods: A total of 50 patients were enrolled in this cross-sectional analytical study in a tertiary care hospital setting for over a duration of 3 months. Melasma was clinically classified as centrofacial, malar and mandibular and the patients were then examined using the woods lamp (Dermaindia) and dermoscope (Dermlite DL4). Patients were classified into epidermal, mixed, and dermal melasma based on the level of melanin pigment. Statistical analysis was done using IBM SPSS software (version 22) to find the Cohens kappa coefficient. (The degree of agreement between different methods of assessment/different observers.) Results: The level of agreement between the two methods was done with the help of Kappa coefficient. The Cohens kappa coefficient was 0.534 with a P = 0.00 (p <.05), which indicated a moderate strength of agreement. Conclusion: Among the two diagnostic tools, there was a moderate degree of agreement between dermoscopy and woods lamp in the analysis of melasma. Limitations: Both woods lamp and dermoscopy are tools that are subjective in nature. There was a lack of comparison with histopathology or newer diagnostic techniques like reflectance confocal microscopy (RCM). [ABSTRACT FROM AUTHOR]

Salient nail unit changes serve as pointers toward systemic disease. On similar lines, salient nail changes are associated with pigmentary disorders, and can help toward diagnosis. Nail changes form a part of various physiologic pigmentary changes including racial pigmentation, pregnancy, or neonatal period. At the same time, a number of nail changes can be valuable clues toward disorders of pigmentation associated with genetic syndromes (Laugier–Hunziker syndrome, incontinentia pigmenti, and tuberous sclerosis), endocrine disorders, disorders of metabolism (alkaptonuria), infections (HIV-AIDS), internal malignancies, etc. Nail changes are especially useful if cutaneous pigmentary changes are suspected to be drug-induced based or associated mucosal and/or cutaneous hyperpigmentation. Various drugs that can cause cutaneous pigmentary alterations along with nail changes include cyclophosphamide, adriamycin, vincristine, docetaxel, paclitaxel, carboplatin, psoralens, hydroxyurea, bleomycin, etc. Nail changes are also associated with disorders of hypomelanosis, for example, vitiligo. Pigmentary changes due to endogenous and exogenous pigments are again diagnosable based on the nail changes they induce. This narrative review highlights the importance of nail changes in suspecting and diagnosing various disorders of pigmentation. It also points toward areas which need future research. [ABSTRACT FROM AUTHOR]

Lichen sclerosus (LS), also known as Csillag's disease, is an autoimmune, chronic inflammatory dermatosis with predilection for localized involvement of anogenital skin. However, extragenital LS is not uncommon. There is strong association of autoimmune disorders with LS. Vitiligo is an autoimmune disorder characterized by progressive loss of melanocytes causing appearance of localized and/or generalized depigmentation of the skin and/or mucous membranes. There have been a few reported cases in the literature of the coexistence of acrofacial vitiligo and LS. Here, we report a case of 70 year old female with coexistence of extragenital lichen sclerosus and generalised vitiligo. Interestingly in our patient LS lesions developed over generalised vitiligo patches. Histopathology confirmed the coexistence of vitiligo and LS. [ABSTRACT FROM AUTHOR]

Context: Vitiligo is the most common acquired disorder of pigmentation. The treatment options for vitiligo are either medical or surgical modalities. Noncultured epidermal cellular grafting is an innovative surgical technique that can be used for the treatment of stable vitiligo. Aim: To evaluate the effect of noncultured epidermal cellular grafting in stable vitiligo utilizing normal saline as a trypsin inhibitor. Materials and Methods: Thirty-three patients with stable vitiligo for the past 2 years were recruited in the study. Noncultured epidermal cell suspension grafting was done with normal saline as trypsin inhibitor. Result: Out of 33 patients, maximum patients had focal vitiligo (21), followed by segmental (7) and generalized (5). Response was excellent in 7 patients (21%), good in 16 (48%), regular in 7 (21%), and poor in 3 patients. Thus, 23 (69%) patients had a satisfactory (excellent to good) response. Satisfactory pigmentation over trunk was seen in 83%, face and neck in 90%, and limbs in 57%. Three patients had lesions involving the fingertips and toes and only one of them had a good response with the other two patients showing a poor response. Conclusion: The noncultured epidermal cell suspension grafting is an effective surgical procedure for stable vitiligo patients. In this study, we have tried to simplify the procedure by utilizing only normal saline as a trypsin inhibitor. [ABSTRACT FROM AUTHOR]

Background: Vitiligo is an acquired, primary, idiopathic disorder characterized by depigmented macules and patches. Melanin, a natural pigment of skin, requires amino acid tyrosine for its synthesis. Tyrosinase, a key regulatory enzyme, is a copper (Cu) dependent enzyme. Thus, Cu plays a role in melanogenesis however, we need to look at the role of Cu in the pathogenesis of vitiligo. Aim: To estimate serum and tissue copper levels in vitiligo patients, and to compare with first degree relatives of patients and control group. Materials and Methods: All cases of vitiligo attending tertiary care hospital were included in the study. Venous blood samples were collected from subjects, first degree relatives and controls, punch biopsy specimens were collected from lesional and non-lesional skin of cases, controls and were analysed using inductively coupled plasma emission spectrometry. Results: Of 60 patients, serum Cu levels in cases were found to be low in 35, normal in 22 and high in 3. Mean serum Cu of first degree relatives was also low. Mean lesional Cu was 1.3 µg/g and nonlesional Cu was 1.4µg/g in vitiligo patients, which was lower than tissue Cu levels of controls(1.9 µg/g) (p value > 0.05). Conclusions: In our study the lesional and non-lesional Cu levels were lower in vitiligo patients. This low Cu levels may lead to reduced activity of enzyme tyrosinase, which is essential in the process of melanogenesis. Though role of Cu in melanogenesis is proven, its role in pathogenesis of vitiligo needs to be studied further. [ABSTRACT FROM AUTHOR]

Background: Idiopathic guttate hypomelanosis (IGH) is a common pigmentary disorder encountered in older age group, causing cosmetic disfigurement with considerable psychological impact. Diagnosis is generally based on history and clinical features. In the situation of diagnostic dilemma, dermoscopic examination is the quick and easiest method to solve the clinical uncertainty and thereby avoid unnecessary biopsies. Objectives: The aims of the study were to describe the varied clinical presentations and to enumerate the dermoscopic features of IGH. Methods: Study was conducted after obtaining approval from Institutional Ethics Committee. All the patients presenting with IGH attending the Department of Dermatology were examined and enrolled for the study after taking written informed consent. Each subject was evaluated by detailed personal history, clinical examination and dermoscopic examination. Results: A total of 100 patients of IGH were included in the study. The most affected age group was 46-65 years (52%). Females were most commonly affected with M: F ratio 1:1.17. Different dermoscopic patterns of IGH documented were amoeboid (58.2%), feathery (19.1%), petaloid (14.5%) and nebuloid (8.2%). Ten percent of the patients showed more than one patterns. Conclusion: Dermoscope aids in evaluation of different patterns of IGH lesions, which helps to differentiate it from other hypopigmented conditions with considerable overlap in the site, morphology and clinical features. Dermoscopic analysis makes it easier to diagnose the disorder and subsequently plan for the appropriate treatment. [ABSTRACT FROM AUTHOR]

Humanity has been obsessed with the partiality towards fair skin since time immemorial leading to unhealthy practices. The recent manifestation of this obsession is the huge number of fairness creams which has flooded the Indian cosmetic market. Some corticosteroid creams are also used as fairness creams because of the side-effect of hypopigmentation which is mistaken for fairness. Such misuse of topical corticosteroids leads to unwanted physical and psychological side-effects which have been collectively described as "Topical steroid dependent/damaged face" (TSDF). Concerted efforts by professional and social organizations [such as IADVL and Pigmentary Disorders Society (PDS)], politicians and media representatives, to fight this social menace of fairness craze and fairness creams have started yielding some positive results recently. [ABSTRACT FROM AUTHOR]

Laugier–Hunziker syndrome (LHS) is lesser known and important differential of the multifocal mucocutaneous pigmentation. Essentially idiopathic in nature, this syndrome is characterized by multiple melanotic macules on the oral mucosa, lips, perioral region, and melanonychia. A young Indian male reported to us with a complaint of multiple brown-black spots on the lips and inner surface of the cheeks accompanied by the pigmentation of fingernail. The patient was evaluated for the possible causes of multifocal oral pigmentation. After taking an exhaustive clinical history and thorough investigations, no exact cause for this condition could be definitively ascertained. Eventually, he was diagnosed as a case of LHS, a rare cause of idiopathic oral pigmentation. The various differential diagnoses for the condition are also discussed. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 25-year-old man with hyper-pigmented lesions over the dorsum of the left foot. Topics include showing no history of dilated tortuous vein, pedal edema or involvement of contralateral foot; and physical examination revealing multiple, discrete, as well as coalescent pinhead-sized speckled blue-gray macules over the proximal part of the toes.

Aim: Ashy dermatosis (AD) is a cutaneous pigmentation disorder with unknown etiology characterized by ash-colored hyperpigmented macules. The diagnosis of Ashy dermatosis is primarily based on the clinical and histopathological findings. In this study, we aimed to identify the dermoscopic features of AD, which may facilitate the diagnosis by reducing the need for invasive procedures. Material and Methods: The study included the patients diagnosed with Ashy dermatosis. Demographic, clinical, dermoscopic and histopathological features of the lesions were reviewed and the findings observed were recorded. Results: A total of 60 lesions from 15 patients were included. The most common dermoscopic finding were irregular linear dots and globules, pinkish brown color was the predominant color of the background, and found to be associated with early lesions. Among the vascular structures observed, irregular linear vessels were the most prevalent. There were no significant differences in terms of dermoscopic structures according to age and localization of the lesions. Conclusion: Dermoscopy can serve as a noninvasive helpful tool for the diagnosis of Ashy dermatosis. [ABSTRACT FROM AUTHOR]

Vitiligo is an acquired disorder of skin pigmentation that produces significant psychological impact especially in those with skin of color. Narrow-band ultraviolet B (NB-UVB) therapy, which was first used in vitiligo in 1997 by Westerhof and Nieuweboer-Krobotova, has emerged as one of the safest and most effective therapy for this dermatosis. The light source used for NB-UVB phototherapy is the TL-01 lamp, and the most common model of the NB-UVB phototherapy device is the upright in-office booth or chamber which has 24–48 such lamps. In recent years, there have been several advances in the understanding of the mechanism of action of NB-UVB and the use of combination treatments, many of which increase the efficacy of NB-UVB. In 2017, the Vitiligo Working Group made vital recommendations on the dosage, frequency, and safety of NB-UVB in vitiligo. Furthermore, home phototherapy devices are gaining popularity as they lead to an improved patient compliance. There is still need for large multicenter randomized controlled trials to assess benefits of home phototherapy in vitiligo and studies investigating additional benefits of phototherapy following surgical therapy. [ABSTRACT FROM AUTHOR]

Naegeli–Franceschetti–Jadassohn syndrome is a rare autosomal dominant form of ectodermal dysplasia affecting sweat glands, nails, teeth, and skin. We report a case of 16-year-old female who had generalized reticulate pigmentation, dental changes, nail changes, and absence of dermatoglyphics and hypohydrosis. [ABSTRACT FROM AUTHOR]

Calcifying cystic odontogenic tumor (CCOT) is a rare lesion accounting for only 2% of all odontogenic cysts and tumors. CCOTs can occur alone or in association with other odontogenic tumors such as odontomas. Pigmented intraosseous odontogenic lesions are rare. Among them, pigmented CCOT is known to occur with greater frequency. Only six cases of combination of pigmentation CCOT associated with odontoma have been reported in the literature. We herein present such a rare case occurring in the maxillary anterior region in a 13-year-old female patient. [ABSTRACT FROM AUTHOR]

The mast cell is a critical mediator of the inflammatory response by secreting histamine. While histamine is currently not regarded as a melanogen, recent studies have shown histamine release to induce melanogenesis, melanocyte proliferation and migration. Herein, we discuss the current evidence of the complex relationship between the mast cell and melanocyte, and its impact in pigmentation disorders. [ABSTRACT FROM AUTHOR]

A case study of a 22‑year‑old woman who is diagnosed with neurofibromatosis type 1 (NF‑1) and Becker's nevus (BN), is presented. Topics discussed include soft skin‑colored nodules which were found initially during adolescence increased; histological examination of one of the nodules on patient abdomen revealed a tumor consisting of wavy cells and different manifestations of hamartoma arising from the differentiation of neural crest cells.

Context: "Dark circles" are esthetic concerns that can affect individuals of any age, gender, or race. They can be familial, physiological, or associated with various medical illnesses. Aim: To study the clinicopathological correlation of periorbital hyperpigmentation. Patients and Methods: Fifty patients affected with periorbital melanosis (POM) were enrolled for the study after obtaining informed consent. Details regarding history, demographic data, and physical examination of POM were recorded, and a 2-mm punch skin biopsy was taken from the affected skin under local anesthesia and stained with hematoxylin and eosin (H and E), Fontana Masson (Melanin), Perls Prussian blue (Hemosiderin). Results: Twenty-three (46%) patients with POM had history of chronic illness before developing POM; 18% patients were atopic, 16% had jaundice, 18% had associated pigmentary demarcation lines (PDL) of type F and G, 8% had acanthosis nigricans, 22% patients had anemia, 16% patients gave positive family history of POM, and menstrual irregularity was seen in 16%. Histopathology revealed dermal melanin deposition with melanophages along with predominantly increased epidermal melanin and melanin in vellus follicular epithelium. Prussian blue for hemosiderin was negative in all cases. Conclusions: The study has elicited the multifactorial origin of POM; females are affected more than males. Dermal melanin deposition is a constant feature. Hemosiderin is not found in POM. Increased pigmentation of the vellus follicular epithelium is a feature of POM. [ABSTRACT FROM AUTHOR]

Spiegler-Fendt sarcoid/lymphocytoma cutis, presenting as an asymptomatic, slowly progressive, erythematous macule of the size of a guinea over the left cheek, is presented in a 7-year-old girl, the diagnosis of which was complimented by lymphocytic exocytosis with spongiosis of the epidermis. Immunohistochemistry revealed wide-ranging T-cell variations, which was more positive for T-cell markers, CD3, of which predominance of CD4 subset was seen, emphasizing its role as a diagnostic tool. [ABSTRACT FROM AUTHOR]

Introduction: Acanthosis nigricans (AN) is a frequently encountered entity. Facial AN (FAN) is a subset of AN which is being increasingly recognized. Recently, reports hypothesizing the association of FAN with features of metabolic syndrome have been published. Aims and Objectives: The aim of this study was to study the clinicodemographic profile of patients with FAN, and to assess the correlation of hypertension, increased waist-hip ratio (WHR), increased body mass index (BMI), type 2 diabetes mellitus, deranged lipid profile, serum insulin, and impaired oral glucose tolerance test (OGTT) (parameters of metabolic syndrome) in these patients, as well as to determine the most significant predictor (highest relative risk) of development of FAN. Methods: A multicentric case-control study was conducted (123 cases in each group) over a period of 2 years. Data were obtained on the basis of history, examination, and relevant laboratory investigations. Statistical analysis was done using Statistica version 6 (StatSoft Inc., 2001, Tulsa, Oklahoma, USA), SPSS statistics version 17 (SPSS Inc., 2008, Illinois, Chicago, USA), and GraphPad Prism version 5 (GraphPad Software Inc., 2007, San Diego, California, USA). Results: Mean age of the patients with FAN was 38.83 ± 8.62 years. Mean age of onset of the disease was 30.93 ± 8.18 years. The most common site of face involved was the forehead and temporal region. The most common pigmentation was brown-black. Male sex, positive OGTT, increased WHR, and increased BMI were most significantly related to FAN. Smoking was found to have a protective effect against the development of FAN. Conclusion: Here, we document a significant association between male patients with positive OGTT, increased WHR, and BMI and FAN. Thus, we propose that FAN could be considered a morphological marker of metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is one of the most common cancers in India. Most of the patients with breast cancer are treated with chemotherapy which has multiple oral complications.Aims: The objectives of this study were to describe the occurrence of taste disturbances, xerostomia, oral mucositis, oral pigmentation, and candidal and salivary changes among patients receiving chemotherapy for breast cancer.Methods: Fifty-two women with newly diagnosed breast cancer (without distant metastasis), eligible for adjuvant/neoadjuvant chemotherapy (cyclophosphamide and adriamycin, 4 cycles × 3 weeks), were included in this study. All the observations were noted before, during (after 6 weeks of starting chemotherapy), and after the completion of chemotherapy (after 12 weeks of starting chemotherapy).Statistical Analysis Used: Variables such as mucositis, salivary flow rate, salivary pH, and candidal carriage rate were compared at baseline, and at 1st and 2nd follow-ups using Wilcoxon signed-rank test (P value corrected for α for pair-wise comparisons).Results: Mean unstimulated whole salivary flow rate reduced from 0.5 ml/min to 0.3 ml/min, and the mean colony-forming units of Candida reduced from 32.3 × 103 cells/ml to 13.1 × 103 cells/ml at the end of the study period. Xerostomia, taste disturbances, and oral mucosal pigmentation increased from 28.8% to 50%.Conclusions: There was a discernible change in oral mucosal, salivary, and candidal status during the course of the study. [ABSTRACT FROM AUTHOR]

Background: Hypopigmentory and depigmented lesions are common among children and adolescent group. The parents are very much concerned about the condition and they seek dermatologist advice without fail. Aims and Objectives: To evaluate the Epidemiology and clinical characteristics of Hypopigmented and Depigmented Lesion in patients of Children and Adolescent age group in Hadoti region in Rajasthan. Materials and Methods: The study was conducted for the period one year from April 2015 to March 2016. This planned study is to be undertaken in children age 0-19 yr with hypopigmented and depigmented lesions irrespective of sex. Results: The most common disorder was Pityriasis alba, seen in 27.33%, followed by Pityriasis versicolor in 21%, Vitiligo 19.33%, Post inflammatory hypopigmentation in 14%, Primary disorders of hypopigmentation in 13%, Hansen's disease in 1.33%, and miscellaneous conditions in 4% of the cases. Conclusion: The most common hypopigmentary disorders are seen in our study is Pityriasis alba and other causes of hypopigmentary and depigmentory disorders are in decreasing order are Pityriasis versicolor, Vitiligo, Postinflammatory hypopigmentation, Primary causes of hypopigmentation and less common are Leprosy. [ABSTRACT FROM AUTHOR]

Background: Xanthelasma palpebrarum (XP) is a metabolic disorder involving the eyelids. Radiofrequency(RF) surgery and trichloroacetic acid (TCA) applications have been listed among the procedures for XP, but comparative studies are not available. Aim: To compare the efficacy of radiofrequency surgery versus trichloroacetic acid application in the treatment of XP. Settings and Design: 20 consecutive cases of XP attending dermatology, medicine and endocrinology out-patient departments of M.S.Ramaiah teaching hospital were enrolled for the study. It was an open-label clinical trial conducted in our hospital for a duration of 1 year . Materials and Methods: 20 consecutive patients conforming to inclusion criteria were selected for the study. For each patient, lesions were treated with radiofrequency ablation on one side and TCA application on the other side. Results: RF ablation was done for 12 patients over right eye lesions and 8 patients over the left eye lesions. TCA applications were done for 8 patients over right eye lesions and 12 patients over left eye lesions. 70% of lesions treated with RF ablation had a score of improvement of 4 and 70% of lesions treated with TCA application had a score of improvement of 4, at 4 weeks of follow-up. At four weeks of follow-up 40% in RF group and 15% in TCA group had scarring and 45% in RF group and 30% in TCA group had pigmentation. Conclusion: RF ablation as compared to TCA application, required fewer sessions for achieving more than 75% clearance of lesions. However, TCA applications were associated with fewer complications comparatively. [ABSTRACT FROM AUTHOR]

Infantile tremor syndrome (ITS) is defined by the tetrad of pallor, developmental delay/regression, skin pigmentation, and brown scanty scalp hair. Involuntary movements in the form of tremors supervene in the natural course of the illness in a significant number of cases. The disorder occurs in exclusively breast‑fed infants of vegetarian mothers belonging to economically deprived sections of society. Most of the children eventually recover but are frequently left with long‑term cognitive and language neurodeficits. ITS continues to be seen in clinical practice, but there has been no consensus on its causation. Last comprehensive review was published in 1987 describing the ITS as a syndrome of unknown or multiple etiologies. Several important papers have been published since then. This review attempts to provide comprehensive and up‑to‑date information on the subject incorporating recently published studies. In the end, the issue of etiology is objectively re-examined in the light of available evidence some of which has been published in recent years. [ABSTRACT FROM AUTHOR]

Background: The cone adaptation test is to detect retinitis pigmentosa (RP) cases confirmed by electroretinogram (ERG). We present the validity and cost-effectiveness of cone adaptation test as a screening tool for detecting RP. Methods: This cross-sectional study was conducted between November 2013 and December 2013. All RP cases diagnosed by ophthalmologists of H. V. Desai Eye Hospital in the last 5 years were participated in this study. The cone adaptation test was done in photopic and scotopic illumination. Failed test means 10 s or more to complete the test under scotopic illumination. A technician who was masked for cone adaptation test finding carried out ERG. Demographics, symptoms, and history of treatment were inquired. Those with flat ERG wave in scotopic condition and corresponding clinical findings were defined as having RP. Sensitivity, specificity, and false-positive and false-negative parameters of validity were estimated. The unit cost of performing test and ERG was calculated. Results: All 32 RP patients (28 male, age median 23.5 ± 14.5 years) had a vision more than 6/60 and flat wave in ERG under mesopic/scotopic illumination. Thirty-one participants failed cone adaptation test. The sensitivity was 31/32 x 100 = 97%. The specificity was 100%. There was no false-positive case. Consanguinity rate among parents was 43%. The cost of testing one child using "cone adaptation test kit" was 2.5 US $. The unit cost of diagnosing RP using ERG was 10 US $. Conclusion: Cone adaptation is a valid and cost-effective screening tool test for RP. The consanguinity rate among parents of an RP patient was high. [ABSTRACT FROM AUTHOR]

Skin pigmentation is one of the most strikingly variable phenotypes in humans, therefore making cutaneous pigmentation disorders frequent symptoms manifesting in a multitude of forms. The most common among them include lentigines, postinflammatory hyperpigmentation, dark eye circles, and melasma. Variability of skin tones throughout the world is well-documented, some skin tones being reported as more susceptible to pigmentation disorders than others, especially in Asia and India. Furthermore, exposure to ultraviolet radiation is known to trigger or exacerbate pigmentation disorders. Preventive strategies for photoprotection and treatment modalities including topical and other medical approaches have been adopted by dermatologists to mitigate these disorders. This review article outlines the current knowledge on pigmentation disorders including pathophysiology, molecular profiling, and therapeutic options with a special focus on the Indian population. [ABSTRACT FROM AUTHOR]

A pigmented variant of lichen planus (LP) was first reported from India in 1974 by Bhutani et al. who coined the term LP pigmentosus (LPP) to give a descriptive nomenclature to it. LP has a number of variants, one of which is LPP. This disease has also later been reported from the Middle East, Latin America, Korea, and Japan, especially in people with darker skin. It has an insidious onset. Initially, small, black or brown macules appear on sun-exposed areas. They later merge to form large hyperpigmented patches. The disease principally affects the sun-exposed areas of the body such as the face, trunk, and upper extremities. The oral mucosa may rarely be involved. However, the palms, soles, and nails are not affected. Histologically, the epidermis is atrophic along with vacuolar degeneration of basal cell layer. The dermis exhibits incontinence of pigment with scattered melanophages and a sparse follicular or perivascular infiltrate. There is a considerable similarity in histopathological findings between LPP and erythema dyschromicum perstans. However, there are immunologic and clinical differences between the two. These observations have led to a controversy regarding the identity of the two entities. While some dermatologists consider them to be the same, others have opined that the two should be considered as distinctly different diseases. A number of associations such as hepatitis C virus infection, frontal fibrosing alopecia, acrokeratosis of Bazex and nephrotic syndrome have been reported with LPP. A rare variant, LPP inversus, with similar clinical and histopathological findings was reported in 2001. As opposed to LPP, this variant occurs in covered intertriginous locations such as groins and axillae and mostly affects white-skinned persons. [ABSTRACT FROM AUTHOR]

Background: Coats' disease diagnosed in adulthood is an idiopathic, retinal exudative vascular disease without an inciting factor and has retinal features different from the childhood disease.Aim: To describe clinical features, treatment, and outcomes of eyes with Coats' disease first diagnosed in patients 35 years or older.Materials and Methods: Retrospective chart review of patients first diagnosed with Coats' disease at the age of 35 years or more at a tertiary eye care center between January 1995 and 2012. Eyes with retinal exudation or Coats'-like response from secondary causes were excluded.Results: Forty-five of 646 patients (7%) diagnosed with Coats' disease had adult-onset disease. Mean age at presentation was 47 years. Systemic hypertension was the most common (22%) systemic association and decreased vision the predominant presenting feature (83%). Localized (<6 clock h) presentation (74%) was unique to adults as against diffuse involvement (69%) in children (P < 0.001). Eyes were treated with laser photocoagulation 29 (60%), cryotherapy (4%), or both (2%) with surgical intervention in three (6%) eyes. Following treatment eight (35%) eyes improved, 11 (48%) eyes were stable while four (12%) eyes worsened due to complications.Conclusion: Adult-onset Coats' disease has less extensive involvement, more benign natural course, and a more favorable treatment outcome as against the childhood-onset disease. The bilateral presentation emphasizes the need for regular follow-up to detect possible future involvement of the fellow eye. [ABSTRACT FROM AUTHOR]

Dowling-Degos disease (DDD) is a rare autosomal dominant condition characterized by multiple, small, round pigmented macules usually arranged in reticular pattern, chiefly distributed in axillae and groins. Here we are reporting three atypical cases of DDD in a family. They had hypopigmented macules with typical features of DDD indicating generalized DDD. Histopathology confirmed the diagnosis. We present these three cases to stress the existence of generalized DDD phenotype in the Indian population. [ABSTRACT FROM AUTHOR]