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For an adnexal tumour in a fair-skinned individual, a white homogenous area under a dermoscope can be due to the normal skin colour of the patient (dermal tumour away from the epidermis) or due to the tumour (either epidermal, epidermo-dermal or dermal tumour close to the epidermis). Ehara et al. reported a similar pattern for a lesion over the leg.4 Other patterns observed by us were a skin-coloured homogenous area and white homogenous area with arborising vessels. A pattern, skin-coloured to white homogenous area with milia-like cysts, was a consistent pattern in our series of tumours differentiating towards the follicular bulb and papillae, trichoepitheliomas, both solitary and familial (Fig. [Extracted from the article]

Neurofibromas are common benign nerve sheath tumours. For non-epithelial and nonmelanocytic tumours, the relative distance of the proliferative tumour from the epidermis, and/or attachment to it, determines the dermoscopic feature contributed by the tumour mass. We observed a yellow to yellow-brown background/homogenous area, followed by skin-coloured to brown background/homogenous area as the common dermoscopic patterns. Conclusion In conclusion, the presence of a yellow, yellow-brown, brown, skin-coloured to grey background/homogenous area with exaggerated skin markings and absence of vascular structures can point to the diagnosis of solitary neurofibroma. [Extracted from the article]

Non‐segmental vitiligo (NSV) is an autoimmune skin disease. Genetics plays a predominant part in disease pathogenesis. Nucleotide‐binding and oligomerization domain (NOD)‐like receptors and pyrin‐containing protein (NLRP) and Toll‐like receptors (TLR) are pattern recognition receptors in mediating innate immunity. They participate in presenting pathogens and mediating the immune responses. NLRP and TLRs are involved in mediating immune response in various dermatological diseases. Understanding the influence of genetic polymorphisms of NLRP and TLRs associated with immune homeostasis might help us to understand the complex etiopathogenesis of NSV. Thus, we aimed to study the association of NLRP‐1 (rs2670660) and TLR‐4 (rs4986790) and the synergistic effects on disease spectrum, disease activity of NSV in South Indian population. This research was designed as a case–control genetic study with 264 patients and 264 controls. Genotyping of NLRP‐1 (rs2670660) and TLR‐4 (rs4986790) was performed by Taqman 5' allele discrimination assay and ARMS‐PCR. Plasma levels of proteins were measured by enzyme‐linked immunosorbent assay (ELISA). A statistically significant difference was observed with the frequency of homozygous GG genotype of NLRP‐1 (rs2670660) (17.8% in cases vs. 5.3% in controls) (p < 0.0001; OR‐3.73; 95% CI‐1.94–7.14). Allele G was significantly frequent in 38% of the cases than in controls with 30% (p = 0.004; OR‐1.46; 95% CI‐1.13–1.89). Plasma NLRP‐1 level was significantly higher in patients compared to controls (p < 0.05). Amongst cases, the plasma NLRP‐1 levels did not show any difference with respect to their genotypes (p > 0.05). In TLR‐4 (rs4986790), no significant difference in the frequency of genotypes and allele between cases and controls (p = 0.80) was observed; nevertheless, plasma TLR‐4 was analogous between cases and controls (p > 0.05). Influence of genotype on plasma TLR‐4 showed no significant difference in TLR‐4 levels between GG and ancestral genotype AA, whilst heterozygous AG genotype showed a significant increase of TLR‐4 compared to AA and GG (p = 0.02) amongst NSV cases. The obtained results suggest that NLRP‐1 (rs2670660), and not TLR‐4 ((rs4986790), is associated with increased risk of NSV in South Indian population. [ABSTRACT FROM AUTHOR]

Dear Editor, A 54-year-old woman with skin phototype IV had a slow-growing pigmented lesion over the inner lower quadrant of the left breast since 6 months. In the index case, the CD34 negativity may be due to a different clone (EP88).6 In conclusion, this report describes the clinico-dermoscopic features of pigmented trichilemmoma in a patient with dark skin that mimics other pigmented tumours. A discontinuous or absent basement membrane can be due to low cellular differentiation or inflammatory cells that degrade the basement membrane.4 In our case, the dense lymphocyte infiltration was probably responsible for the absent basement membrane. [Extracted from the article]

Differential diagnosis of malignant melanoma, pigmented Bowen disease / intraepidermal carcinoma and porokeratosis was considered. In India, differentiating pigmented Bowen disease / intraepidermal carcinoma from acral lentiginous melanoma is of utmost importance owing to their different management and therapeutic outcome. There was also a very strong clinical clue to differentiating pigmented Bowen disease / intraepidermal carcinoma from melanoma by the presence of pigmented keratin scales. [Extracted from the article]

A 24-year-old female with skin phototype-IV presented with a one-year history of multiple asymptomatic lesions over the nose. Cutaneous examination revealed multiple skin-coloured to translucent firm papules of size 2 × 2 mm to 4 × 4 mm over the bilateral alae nasi and tip of the nose (Fig. Histopathology demonstrated an atrophic epidermis, follicular plugging and a nodular collection of monomorphic small to medium size lymphocytes without any pleomorphism, increased/atypical mitosis or necrosis. [Extracted from the article]

The article describes the case of a 12-year-old boy who presented with six months history of reddish scaly lesions over bilateral upper and lower limbs and face associated with scalp scaling, diagnosed with psoriasis vulgaris with associated keratinocyte dystrophy (KD). Topics discussed include associated KD attributed to methotrexate, KD as histological marker of low dose methotrexate toxicity, and resolution of KD features with supplementation of folate.

Guttate hypopigmented macules and flat-topped papules pose a significant diagnostic challenge. Cutaneous examination revealed multiple guttate hypo-to-depigmented atrophic macules and flat-topped papules on the perioral area, bilateral hands, arms, feet, and lower legs (Fig. Keywords: dermoscopy; Lichen Sclerosus et Atrophicus; photosensitivity disorders EN dermoscopy Lichen Sclerosus et Atrophicus photosensitivity disorders 135 136 2 02/24/22 20220201 NES 220201 A 38-year-old woman presented with multiple itchy hypopigmented lesions on the face, upper and lower extremities for six months. [Extracted from the article]

Background and objectives Recent studies have implicated the association between oxidative stress and inflammation in pathogenesis of psoriasis and its associated comorbidities. Hence, we undertook to study inflammatory markers such as sialic acids and the oxidative stress index (OSI) in patients with psoriasis vulgaris. Methods Sixty cases and 60 healthy controls were included in this cohort study. Disease severity was assessed by psoriasis area severity index scoring. Serum levels of oxidative stress (total oxidant status, total antioxidant status) and inflammation (highly sensitive C-reactive protein [hs-CRP], total sialic acid, protein bound sialic acid) markers were estimated in controls and cases at baseline and on follow-up. OSI was calculated as the ratio of total oxidant status to total antioxidant status. Results Baseline serum levels of OSI, hs-CRP, and sialic acids were significantly higher in cases compared to controls. Baseline OSI and sialic acids demonstrated a significant correlation with disease severity. After 12 weeks of therapy, there was a significant decline in OSI and serum levels of hs-CRP and sialic acids. Conclusions Our results demonstrate that oxidative stress and inflammation are significantly associated with psoriasis, and treatment with methotrexate results in a significant decline of both the inflammatory and oxidative stress parameters. [ABSTRACT FROM AUTHOR]

Background Pyogenic granuloma ( PG) is a benign vascular tumor that can be treated by cautery (chemical or thermal), laser, excision, curettage, sclerotherapy, and cryotherapy. Topical timolol is emerging as a non-invasive modality for the treatment of PGs. Methods We recruited a series of 10 patients with PG, who received treatment with 0.5% timolol maleate ophthalmic solution applied 4 times a day, 2 drops per dose. No other medication, topical or systemic, was given. Pulse rate, blood pressure, and blood glucose were monitored at baseline and weekly thereafter for the duration of treatment. ECG was done at baseline. The efficacy of the treatment was evaluated by considering a complete response, a partial response, and no response. Results Of 10 patients, four showed complete response within 3-24 days, with no recurrence at 3-month follow-up. Three patients each showed partial or no response. No local or systemic side effects were reported in any of the patients. Conclusions The response of PGs to β blockers seems to be variable. Although topical timolol has the advantage of minimal adverse events, ease of administration, and better cosmetic outcomes, it's efficacy in PG may not be universal unlike in infantile hemangiomas. Topical timolol may be a treatment option in young children, incapacitated elderly, and over delicate areas like face, nails, and gums where invasive modalities are not desirable. [ABSTRACT FROM AUTHOR]

Background Skin biopsies are an invaluable tool in the diagnostic armamentarium of a dermatologist and have several factors that determine outcome. Objectives The aim of this study was to retrospectively assess the quality of data included in the pathology request forms and reports and to assess the level of clinicopathological correlation in the reported biopsy specimens. Methods We retrospectively analyzed 3006 histopathology request forms and reports of skin, mucosal, and nail biopsies to assess the quality of data included in them and assessed the level of clinicopathological correlation in these biopsies. Two hundred discordant histopathology slides were randomly reviewed by a pathologist in the presence of a dermatologist to analyze the causes for discordance. Results The pathological diagnosis was concordant with clinical diagnosis in 1798 (59.8%) biopsies, partially concordant in 228 (7.6%) biopsies, and discordant in 929 (30.9%) biopsies. In a clinicopathologically concordant category, the duration for reporting the biopsies was significantly shorter, and the definitive pathologist's diagnosis was frequently mentioned. Of the 200 discordant slides reviewed randomly by a pathologist in the presence of a dermatologist, 7.5% slides afterward turned out to be consistent and 15% partially consistent with the diseases in doubt. Conclusion Several deficits were identified that need to be rectified to improve the diagnostic accuracy of skin biopsy. A portion of discordant slides showing features compatible with the disease when reviewed by a pathologist and dermatologist together emphasizes the importance of a joint review by both in doubtful cases. [ABSTRACT FROM AUTHOR]

Objectives Lepra reaction in histoid leprosy (HL) is rare; there are few reports of type 2 lepra reaction in HL. We report a 42-year-old woman with HL in type 1 lepra reaction after 10 weeks of multibacillary multi-drug therapy (MBMDT). Case report A 42-year-old woman presented with asymptomatic multiple papules, plaques, and nodules over the face, trunk, and extremities and no history of prior treatment with anti-leprosy drugs. A biopsy of a skin nodule on the forearm revealed spindle-shaped, nonvacuolated histiocytes in a whorled pattern with abundant acid-fast bacilli (AFB). The patient was diagnosed with HL and started on MBMDT. Ten weeks later, she developed pruritic, painful, erythematous, and edematous papules, plaques, and nodules over the face, trunk, and extremities, without constitutional symptoms. Histopathology revealed an atrophic epidermis, preserved grenz zone, and papillary dermal edema. Elongated AFB were visible on Fite's stain. The MBMDT was continued, along with nonsteroidal antiinflammatory drugs and antihistamines, but pruritus, pain, erythema, and edema persisted, and new skin lesions appeared. The patient was started on prednisolone at 0.75 mg/kg body weight/day. Prednisolone resulted in symptomatic relief and the healing of ulcerated papules within four weeks. Treatment was tapered and stopped after 20 weeks. Conclusions Histoid leprosy is considered a variant of lepromatous leprosy, which rarely involves a lepra reaction. Pruritus and ulceration of skin lesions as manifestations of type 1 lepra reaction in HL have not been reported previously. These symptoms manifested after 10 weeks of MBMDT and responded well to oral prednisolone. [ABSTRACT FROM AUTHOR]

Comedonal Darier disease with multiple skin-coloured or erythematous papules on the face without any comedones has been described.4 Similarly, a case has been reported with only brownish, hyperkeratotic papules.2 (iii) The absence of nodules, cysts and scars was found in the index case in contrast to described before for comedonal Darier disease. Various morphological variants described are hypertrophic, cornifying, vesiculobullous, hypopigmented, linear or zosteriform, acute and flexural Darier disease.1 Comedonal Darier disease, a rare subtype, is characterised by the prominent follicular involvement and clinically presents as both open and closed comedones commonly over the face and scalp. In conclusion, we are reporting the clinical-dermoscopic features of a case of linear comedonal Darier disease, a rare morphological subtype, which was not associated with any other mucocutaneous features of Darier disease. [Extracted from the article]

The article presents a case study of a sex-year-old Indian male child whose parents was first cousins, was presented with a history of pigmentation of the skin. It states that the patient was diagnosed with insulin-dependent diabetes mellitus and genetic analysis revealed the novel homozygous missense mutation pArg134Cys in the SLC29A3 gene that encodes the human equilibrative nucleoside transporter 3 (hENT3). It mentions that the patient was suffering with H syndrome.

We report widely disseminated and disfiguring lesions of molluscum contagiosum occurring in a 4-year-old girl secondary to a primary immunodeficiency disorder. The child, born of consanguineous parents, had multiple, asymptomatic, raised, skin-colored and whitish lesions since 2 years of age. On physical examination she had growth retardation features with grade II protein energy malnutrition. Cutaneous examination revealed numerous, widespread, skin-colored to translucent, firm, umbilicated papules of varying sizes (pinpoint to larger than 10 mm). They were distributed bilaterally over all four limbs, including the dorsum of the hands and feet, trunk, face (including lips), eyelids, auriculae, and perineal and gluteal areas. In places, they were linearly disposed and had coalesced to form plaques. A biopsy specimen from a representative skin lesion (arm) demonstrated lobulated epidermal growth consisting of keratinocytes with large intracytoplasmic eosinophilic inclusion bodies and a central crater. These findings were consistent with the diagnosis of molluscum contagiosum. Topical therapies with phenol and trichloroacetic acid were ineffective The child succumbed to a fulminant systemic infection at home, 2 months after discharge from the hospital. The extent and distribution of molluscum contagiosum in our patient was remarkably vivid and has been hitherto reported only rarely. [ABSTRACT FROM AUTHOR]

Discusses the clinical syndrome of pellagra. Nutritional disorder that occurs as a result of niacin deficiency; Symmetric photosensitive skin eruptions; Gastrointestinal manifestations; Neurologic and psychiatric disturbances; Historical aspects; Sources of niacin, such as meat, poultry, fish, dry beans, nuts and eggs; Areas in Africa and Asia where pellagra is still endemic.

The article reports on the practice of cultural dermatology in India. Topics covered include skin problems that result from the presence of various socio-religious and cultural habits and the use of alternative medicine systems, reasons for the popularity of alternative medicine system in India, also known as ayurveda, yoga, and naturopathy, Unani, Siddha, homeopathy (AYUSH), as well as the adverse effects of AYUSH.

The article focuses on miliaria rubra which is a skin disease marked by small and itchy rashes formed like a white bull's-eye. It mentions that miliaria is a common disease in the tropics, and the summer season. It notes that miliaria is a skin disease caused by the obstruction of sweat glands and the extravasation of sweat into the dermis.

A 6-year-old girl presented to the pediatric surgery department with swelling of the right hand of 4 months’ duration. According to the patient’s parents, it started as a small nodule over the dorsum of the right hand which gradually increased in size covering nearly the whole of the hand. There was no history of preceding trauma or insect bite. She had no constitutional symptoms; however, she had limitation of movement of the fingers of the affected hand. The surgeon made a clinical diagnosis of synovial sarcoma. A biopsy specimen from the border of the lesion was obtained for histologic examination. Microscopic examination of the histologic section was not suggestive of this condition. Hence, she was referred to a dermatologist for expert opinion. On cutaneous examination, the right hand showed a single, large, well-defined, indurated mass involving the dorsal and ventral aspects, encircling the proximal portions of the fingers and thumb (Figs 1, 2). The skin over the swelling was nodular, shiny, and intact. On palpation, the mass was nontender, lying between the skin and the superficial fascia, and the examining fingers could be inserted under the smooth, well-defined upper edge. The patient’s general condition was good and regional lymph nodes were not enlarged. Laboratory data, including blood counts, erythrocyte sedimentation rate, stool examination for eggs and parasites, and fasting blood sugar, were all normal. X-Ray of the right hand showed soft tissue swelling without bone destruction or calcification. A repeat deep biopsy from the edge of the mass showed a dense granulomatous infiltrate in the dermis, consisting of plasma cells, histiocytes, neutrophils, and multinucleated giant cells, with a marked preponderance of eosinophils. A few large nonseptate hyphae were seen (Fig. 3), surrounded by bright granular eosinophilic material in the dermis. Culture for acid-fast bacilli and fungus was negative. The patient was treated with a saturated solution of potassium iodide. Initially, she was put on five drops of potassium iodide daily. Every week, the dose was increased by five drops until the patient started to complain of side-effects. The dose was then reduced by five drops and maintained. The maintenance dose was 30 drops, three times daily. There was complete regression of the mass after 3 months of therapy (Fig. 4). Maintenance therapy was continued for another 6 months. No recurrence of the lesion was noted during 11 months of follow-up. [ABSTRACT FROM AUTHOR]

The article describes the case of a 28-year-old man with a birthmark of hypopigmented areas on his back, hand tremors, and generalized tonic clonic seizures. He was diagnosed to have pigmentary twin spotting. It discusses the concept of twin spotting, nevus depigmentosus and nevus of Ito, and the difference of allelic and non-allelic twin spots.

Objectives Leprosy can have diverse cutaneous and occasionally perplexing presentations. We report an unusual case of lepromatous leprosy ( LL) with annular lesions resembling erythema gyratum repens. Report A 55-year-old man presented with a symmetrical, hypopigmented, and erythematous rash of bizarre appearance over the lateral aspect of the upper arm, and anterior and posterior aspects of the trunk of two months' duration. He gave a history of self-resolving episodes of bilateral pedal edema, and numbness and pricking sensations in both the hands and feet, which had occurred intermittently over the previous six years. An ulcer measuring 2 cm in size was present over the adjacent surface of the right first and second toes. The bilateral ulnar and radial cutaneous nerves were symmetrically thickened. Results Slit-skin smears revealed numerous acid-fast bacilli. Skin biopsy from the trunk showed collections of histiocytes, lymphocytes, and plasma cells in the dermis and around the blood vessels. The patient was diagnosed with LL and started on multibacillary multi-drug therapy. Conclusions Lepromatous leprosy can have varied clinical manifestations and is often a great imitator. However, the skin smear positivity, even in normal skin, symmetrical cutaneous and peripheral nerve involvement, and histopathology in the present patient were indicative of LL. This report highlights a rare presentation of leprosy. Clinicians should be aware of these rare manifestations as lepromatous cases still occur in certain regions. [ABSTRACT FROM AUTHOR]

A 2-year-old male child was diagnosed with erythrokeratoderma variabilis, and showed an excellent response to low-dose isotretinoin, with remarkable improvement in all the affected areas within just 2 weeks of treatment. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the presence of Demodex folliculorum in an aerobic environment which is the shaft of the eyelashes of a 22-year-old male suffering from chronic blepharitis.

A letter to the editor is presented in response to the article about the allergic reactions of cosmetics that was published in the previous issue of the journal.

Presents a case report of giant shagreen patch associated with spina bifida occulta in tuberous sclerosis. Results of physical examination; Results of routine hematologic and biochemical investigations.

Alteration in the color of lunula can be an indication of either a cutaneous or systemic disorder or a systemic drug side effect. Hydroxyurea, an antitumor systemic agent (a ribonucleoside diphosphate reductase inhibitor) used in the treatment of refractory psoriasis as well as in the variety of neoplastic disorders is known to cause brownish pigmentation of the nails but hydroxyurea induced blue lunula is very rare. It is being reported in a 45-year-old man with chronic recalcitrant plaque psoriasis on oral hydroxyurea 500 mg twice daily. Lunular pigmentation in finger and toenails developed two weeks later. During follow up, pigmentation remained localized to the proximal portion of nails.