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Byline: Balachandra. Ankad, Varsha. Koti, Balkrishna. Nikam Dear Editor, Bowen's disease (BD) is a distinct type of squamous cell carcinoma (SSC) in situ, described by Bowen. It has the potential [...]

Byline: Balachandra. Ankad, Akash. Gupta, Balkrishna. Nikam, S. Smitha, Manjula. Rangappa Background: Discoid lupus erythematosus (DLE) is chronic dermatosis manifests as scaly indurated plaques with erythema and peripheral hyperpigmentation. Few [...]

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

Byline: Harsimran. Kaur, Balkrishna. Nikam, Varsha. Jamale, Mohan. Kale Introduction: Lichen planus is a chronic autoimmune inflammatory disorder. At present, there is a lack of any specific scoring system to [...]

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

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

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

Byline: Balkrishna. Nikam, Harsimran. Kaur, Varsha. Jamale, Mohan. Kale Sir, Piezogenic (Peizo – pressure, genic – giving rise to) pedal papules, usually present as skin colored painless bumps on the [...]

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

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

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

Byline: Balkrishna. Nikam, Ashok. Kshirsagar, Pratik. Shivhare, Amitoj. Garg Gorlin syndrome is a rare familial disorder characterized by numerous basal cell carcinomas along with facial and skeletal findings. Here, we [...]

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

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

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

Byline: Balkrishna. Nikam, Nishita. Singh, Deepa. Shetty Sir, Hypergammaglobulinemic purpura of Waldenstrom (HGPW) is characterized by hypergammaglobulinemia, recurring purpura particularly on lower extremities, leukopenia, anemia, an elevated erythrocyte sedimentation rate [...]

Byline: Balkrishna. Nikam, Sangeeta. Amladi, S. Wadhwa Isotretinoin, a first generation retinoid, was first synthesized in 1955 and its efficacy in treatment of acne and keratinization disorder was studied in [...]

Byline: Balkrishna. Nikam, Sangeeta. Amladi, Ganesh. Bingewar, Chitra. Nayak, S. Wadhwa A 16-year-old boy presented with a sudden onset of asymptomatic skin eruption since the past seven days. The lesions [...]

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

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