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A letter to the editor is presented on a case study of a 55-year-old woman with Gali-Gali disease, a type of skin disease.

The article focuses on utility of whole exome sequencing in the molecular characterization of the genetic defect in a case of reticular pigmentation disorder. It mentions mutation resulted in the substitution of glutamine by a stop codon at fourth residue and evidence for genetic variants associated with Dowling–Degos disease. It also mentions selection of the technique was guided by the fact that reticular pigmentation disorders have overlapping phenotypes and genes.

A case study of a middle-age Indian woman with a multiple non-scaly, non-tender hypopigmented macules and papules is presented. Histopathological examination of the punch biopsy from the hypopigmented macules found hyperkeratosis, parakeratosis, suprabasilar separation, acantholytic dyskeratosis and corp ronds with grains, all consistent with the diagnosis of Darier disease.

Pyoderma gangrenosum is a rare noninfective neutrophilic dermatosis, characterized by progressive painful ulceration. It is frequently associated with systemic disorders like inflammatory bowel disease, rheumatoid arthritis and myeloproliferative diseases. However, its association with infectious diseases in particular with tuberculosis is extremely rare. Diagnosis is based on the history of an underlying disease, a typical clinical presentation, histopathology and exclusion of other diseases leading to ulcerations of similar appearance. Immunosuppression with corticosteroids remains the mainstay of treatment. We report a case of a 49-year-old male with long-standing ulcerative colitis, associated with tuberculosis of hip, who presented with nonhealing ulcers over the lower extremity. [ABSTRACT FROM AUTHOR]

A quiz about the condition of a patient with multiple hypopigmented truncal papules is presented.

BACKGROUND: Vitiligo-affected individuals, especially patients with darker skin tones, can suffer from negative psychosocial impacts due to unpredictable development of the condition and perceived cosmetic concerns. However, given that spontaneous repigmentation can be gained in vitiligo, many patients ask for treatment due to these cosmetic concerns. In the literature, only a few studies have been documented focusing on the outcome of various treatment modalities for vitiligo. OBJECTIVE: This article highlights the retrospective response of various treatment modalities in Indian patients with vitiligo. METHODS: A retrospective chart review was performed from July 2017 to August 2018 at our private dermatology clinic. A total of 3,000 patients were enrolled in this observational study. Patient characteristics and details of phototherapy (psoralen and ultraviolet A, narrow-band ultraviolet B, excimer laser) were noted as per a predefined format. The clinical response was evaluated as a marked response, defined as repigmentation in more than 75% of the initial lesional area. RESULTS: Of those included in this retrospective analysis, 1,996 patients received phototherapy and 1,004 patients were treated with topical monotherapy. Patients treated with phototherapy only and those treated with a combination of phototherapy and topical agents showed significantly higher clinical response rates relative to patients treated with topical monotherapy only (marked response rate: 47.8% vs. 8.7%; P<0.001 and 23.4% vs. 8.7%; P<0.001). Disease subtype predominately affected the treatment response. CONCLUSION: In Indian patients with vitiligo, phototherapy appears to be an effective treatment option for both focal and vitiligo vulgaris. Due to its reliability and minimal side effects, it can be considered a preferable treatment modality for vitiligo. [ABSTRACT FROM AUTHOR]

A quiz about the case of a 30-year-old male who presented with multiple, non-pruritic hypopigmented papules on his chest is presented.

An answer to a photoquiz related to a case of a 23-year old man who had developed fluid-filled skin lesions, patchy pigmentation and skin breakage in response to trivial trauma, is presented.

Cancer metastases represent the most devastating aspect of malignancy, since the mortality of cancer patients is mainly related to the metastatic behavior of the primary neoplasm. Skin metastases are usually late events in the course of tumor progression. Excluding melanoma, the most common tumor to metastasize to the skin is breast cancer. Patients who develop cutaneous metastases rarely present with a zosteriform distribution. Herein, we present a 60-year-old female, an undiagnosed case of breast cancer, with zosteriform metastases along her right T2-T3 dermatome. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 59-year-ole male with history of concurrent asymptomatic swellings in the left lumbar region and on the right mandible characterized with protuberant mass. It notes that the abdominal swelling began 5 years ago and has progressed gradually in the preceding months after confinement. The patient was diagnosed to have multifocal dermatofibrosarcoma protuberans (DFSP). Moreover, the case confirms its rare occurrence that is multicentric in origin.

A letter to the editor is presented in response to the issue concerning the clinical patterns of molluscum contagiosum in various patient population in India.

Background: Melasma is a relatively common, acquired symmetric hypermelanosis characterized by irregular light to gray-brown macules involving sun-exposed areas. Kojic acid, with its depigmenting potential due to tyrosinase inhibition and suppression of melanogenesis, has become a vital component of the dermatologists' armamentarium against melasma. Aim: To study and compare the efficacy of kojic acid 1% alone, vis-a-vis its separate combinations with 2% hydroquinone or 0.1% betamethasone valerate and a combination of all these three agents with respect to the duration of symptoms and level of pigmentation in the therapy of melasma. Materials and Methods: Eighty patients from a single tertiary care center objectively assessed by calculating the melasma area severity index (MASI) and randomized (simple randomization) into four parallel groups (A, B, C, and D) of 20 each were prescribed once daily local application at night, (participants blinded regarding the difference in identity of interventions), as follows: Group A--kojic acid 1% cream. Group B--kojic acid 1% and hydroquinone 2% cream. Group C--kojic acid 1% and betamethasone valerate 0.1% cream. Group D--kojic acid 1%, hydroquinone 2%, and betamethasone valerate 0.1% cream. Strict photoprotection and use of a SPF 15 sunscreen was advised during the day. Patients were evaluated every 2 weeks and a fall in MASI score was calculated at the end of the study period of 12 weeks by the same investigator. Results: The response was compared according to percentage decrease in MASI score. Efficacy was evaluated among the groups at the end of 3 months using bivariate analysis and calculated by using the paired 't' test. The clinical efficacy of group B was the highest followed closely by group D and group A, that of group C being the lowest. Conclusion: Kojic acid in synergy with hydroquinone is a superior depigmenting agent as compared with other combinations. [ABSTRACT FROM AUTHOR]