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The diagnosis of bullae can be a challenge. The proper diagnosis and prompt treatment is mandatory because most of these diseases are associated with a significant degree of morbidity. The authors present the case of a 76-year-old woman admitted for treatment of anasarca. She also exhibited a bullous eruption localized to the right upper limb.

In Brazil, without considering the non-melanoma skin tumors, bladder cancer in men is the eighth most common, and the urothelial carcinoma or transitional cell carcinoma is the most common among these. Cutaneous metastases from urothelial neoplasms appear as single or multiple erythematous, infiltrated nodules or plaques, and like other cases of distant disease, it is indicative of poor prognosis. The invasive urothelial carcinoma is recognized for its ability to present divergent differentiation and morphological variants. The sarcomatoid urothelial carcinoma is a rare cancer that consists of two different components: one composed of epithelial tissue and the other with sarcomatoid features of mesenchymal origin. The authors describe a case of cutaneous metastasis of sarcomatoid urothelial carcinoma in a 63-year-old male patient.

Pemphigus vulgaris is an autoimmune disease characterized by suprabasal blisters with acantholysis, which has a fatal course in a large number of untreated patients. Systemic corticosteroid therapy is considered first-line therapy. Adjuvant treatment with the goal of sparing corticosteroids include, among others, dapsone. This drug is not without side effects and its use requires clinical and laboratory control. We present a patient with PV initially managed with suboptimal dose of prednisone, evolving into drug-induced hepatitis after introduction of dapsone.

We report the case of a three-year-old child who, following long term treatment with topical corticosteroids and their associations for a case of ringworm on the face developed a form of folliculitis known as Majocchi's Granuloma. Treatment with oral Griseofulvin was successful.

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Acroangiodermatitis is an angioproliferative disease usually related to chronic venous insufficiency, and it is considered a clinical and histological simulator of Kaposi's sarcoma (KS). Immunohistochemistry is the suitable method to differentiate between these two entities. It reveals the following immunostaining profile: immunopositivity with anti-CD34 antibody is restricted to the vascular endothelium in acroangiodermatitis, and diffuse in the KS (endothelial cells and perivascular spindle cells); immunopositivity with anti-HHV-8 only in KS cases. We report the case of an HIV seropositive patient without apparent vascular disease, who presented violaceous and brownish erythematous lesions on the feet, and whose histopathology and immunohistochemistry indicated the diagnosis of acroangiodermatitis.

Confluent and reticulated papillomatosis of Gougerot and Carteaud is a dermatosis that despite showing characteristic clinical signs is often poorly recognized and diagnosed. The authors present a case with extensive skin involvement, discuss its association with obesity and describe dermoscopic findings making the histopathological correlation.

Over the last few centuries, the expansion of urbanization brought bats closer to urbanized areas, increasing the risk of accidents by bat bites. The morphology of bat bites can be varied, usually having an elliptical shape, about 0.5 cm along its greatest length, and the characteristic corkscrew bite pattern. The authors present the case of a patient who was repeatedly bitten by vampire bats for two months. A polymerase chain reaction was performed in the cutaneous nerves at the base of the hair follicles which showed negativity towards the rabies virus. The authors highlight the public health importance of this case, and discuss the morphological characteristics of these hematophagous bat bites.

Sebaceous carcinoma is a rare and aggressive skin tumor. It can be located in any area of the body, the most commonly involved area being the periorbital region. It does not entail a typical clinical presentation, which explains the often late diagnosis. The aim of this report is to outline the rarity of the disease and its atypical clinical description, since to this day, inguinal ulcers with clinical manifestation have not been reported. We present and discuss a case of sebaceous carcinoma with an unusual clinical presentation, in an elderly male patient. The precise approach to genital ulcers, as shown in this case, is a diagnostic challenge that requires a great deal of effort on the part of the clinician.

Clinically and histopathologically paucibacillary leprosy shows similar features with initial morphea. In this case we report a 24 yr-old male patient who presented to our dermatology department with diagnosed paucibacillary leprosy by his local dermatologist, and confirmed by perineurovascular lymphocytic infiltrate in the histopathological exam. On physical examination we found new plaque lesions that were suggestive of morphea with alteration of sensitivity. A new biopsy was performed showing sclerotic superficial dermis with thickening of the collagen bundles in deep dermis and linear arrays lymphocytic infiltrate between the collagen bundles that confirm the diagnosis of morphea.

Poroma is a rare, benign, appendage tumor. Clinically, it presents as a solitary, slowly growing tumor situated mostly on the palms and soles of adults. Occasionally, poroma mimics malignant tumors. Histological examination reveals aggregations of poroid cells extending into the epidermis. Dermoscopy may be useful in some cases. Treatment is by surgical excision. We report a case of a typical clinical and histopathological presentation in a 26-year-old woman and emphasize the importance of this lesion in the differential diagnosis of other tumors on the palms and soles.

Extraocular sebaceous carcinoma (ESC) is a rare, aggressive malignant tumor that originates from the adnexal epithelium of the sebaceous gland. We present herein one of the largest cases reported in the literature until now. We also review briefly the relevant aspects including clinical presentation, differential diagnosis, histopathological features, inmunohistochemical profile, and therapeutic options.

Tufted angioma is a rare acquired vascular tumor. It is characterized by painful purplish macules that may progress to plaques containing angiomatous papules. The condition is benign; however, it often affects extensive areas of the skin, leading to functional disability of the affected limb if painful. The present report describes a case of a tufted angioma associated with myofascial pain syndrome in which the predisposing element was the presence of this tumor since childhood. Pain at the site of the lesion affected muscle use and led to the onset of the associated syndrome. Complete relief from symptoms was achieved by blocking the trigger points of the affected limb with anesthesia.

Sebaceous carcinoma (SC) is a rare malignant skin neoplasm derived from the meibomian gland of adnexal epithelium, which is frequently confused with basal cell carcinoma (BCC), exhibiting sebaceous differentiation and commonly found in the head and neck regions. We report a case of penile sebaceous carcinoma, an extremely rare anatomical site for SC. A 68-year-old man presented with a 4- month history of painless, non-healing ulcerated nodules over the left side of the penile shaft. Wedge biopsy showed adenocarcinoma with signet ring differentiation. We proceeded with wide local excision (WLE) of the lesion with the inclusion of the indurated skin and 5 mm of normal margin, followed by primary closure of the scrotal defect and split skin grafting of the penile shaft by using a thigh skin donor. The final histopathological examination revealed sebaceous carcinoma with pagetoid spread. The patient achieved recurrencefree survival without any form of adjuvant therapy after 4 years of follow-up. [ABSTRACT FROM AUTHOR]

Background: There is a lack of evidence on the therapeutic efficacy of topical tranexamic acid (TA) for the treatment of acne-related postinflammatory hyperpigmentation (PIH). The current study aimed to assess the efficacy of twice-daily administration of 20% azelaic acid (AZA) cream versus 5% TA solution for the treatment of PIH in patients with acne vulgaris. Materials and Methods: Patients in the present single-blinded randomized clinical trial were randomized into AZA or TA groups for 12 weeks. The rate of healing was assessed by scoring recorded photographs based on postacne hyperpigmentation index (PAHI) at baseline, 4th, 8th, and 12th weeks. The frequency of side effects was examined and recorded at each study time point. Results: Thirty volunteers in each treatment group completed the intervention. PAHI score in both AZA and TA groups improved during the study course (Ptime < 0.001, for both groups). However, mean PAHI scores were comparable in the two groups (Pgroup = 0.05). No significant interaction was also found between time and treatments in terms of PAHI score (Ptime - group = 0.66). The frequency of treatment-related side effects was significantly higher in the AZA group compared to the TA group at week 4 of treatment (P < 0.05). However, no significant difference was observed in the frequency of reported side effects at weeks 8 and 12 of the treatment (P > 0.05). Conclusion: Topical administration of 20% AZA cream and 5% TA solution was comparably efficient in the treatment of acne-related PIH with a significantly better safety profile of TA in the 1st month of the treatment. [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]

Background: Cutis verticis gyrate (CVG) is a rare morphologic syndrome that presents with hypertrophy and folding of the scalp. CVG can be classified into three forms: primary essential, primary non-essential, and secondary. Cerebriform intradermal nevus (CIN) is a rare cause of secondary CVG. We are here to report a rare case of CVG with an underlying CIN and discuss the clinical course, treatment options, and critical screening guidelines for these patients.Case Presentation: A 25 year-old male patient presented with a chief complaint of generalized hair loss in the scalp parietaloccipital region for a duration of 1 year and the hair loss area was occasionally accompanied by mild itching. The hair loss started gradually and worsened over time. In addition, he had scalp skin folds resembling the ridge and furrow of the cerebral cortex in the parietaloccipital region since birth. Physical examination revealed hypertrophy and formation of folds in the parietal-occipital area, forming 5 to 6 furrows and ridges. The size of the cerebriform mass was about 12.0 cm × 8.5 cm, without other skin lesions. Diffuse non-scarring hair loss was distributed on the posterior-parietal scalp, mid-parietal scalp and superior-occipital scalp. The diseased tissue of the patient's parietaloccipital area was excised under general anesthesia. The postoperative pathological examination of the tissue excised showed that there were dense intradermal melanocytic nevus, so the patient was diagnosed with secondary CVG caused by CIN. At the 2 year follow-up, there were no obvious changes in the lesions.Conclusions: CIN must be differentiated from other conditions that manifest as CVG, including primary essential or non-essential CVG and secondary CVG caused by other reasons. Each CIN patient requires a specific decision of whether to excise the lesion surgically or follow a wait-and-see policy, depending on the patient's will and specific condition. Surgical treatment may be performed when there is an aesthetic demand. However, clinical observation and close follow-up is also a good treatment choice for patients with stable disease or mild symptoms. [ABSTRACT FROM AUTHOR]

A 24-year-old man presented with multiple pigmented lesions on his neck, trunk, and upper limb. The lesions were hyperpigmented, coalescent macular to papular lesions with scaling in a reticulate pattern. The patient was diagnosed with confluent and reticulated papillomatosis (CRP) of Gougerot and Carteaud. CRP is a rare disease that primarily affects young individuals and can be caused by bacteria or noninfectious factors such as diabetes and obesity. The patient was treated with oral minocycline, which resulted in complete clearing of the lesions. [Extracted from the article]

Background: Pityriasis versicolor (PV) is a superficial mycosis caused by Malassezia yeast; a lipophilic fungus. Dermoscopy may be a value addition in the diagnosis of PV in some cases, where results of KOH (potassium hydroxide) examination are ambiguous. There is paucity of Indian data on dermoscopy of PV. Materials and Methods: Thirty consecutive patients diagnosed clinically with pityriasis versicolor were recruited in this pilot cross sectional study.Patients were subjected to KOH mount of the skin scrapings from the lesions which were positive in all the patients.Dermoscopy was performed in all using Universal Serial Bus (USB) dermoscope [Dinolite AMZT 73915, Edge 3] and features were recorded for analysis. Results: Hypopigmented variant was the most common type (80%). Dermoscopic analysis revealed altered pigmentary network as most common finding (100%) followed by scaling seen in 25 cases (83.33%). Folliculocentric pattern was appreciated in 20 cases (66.67%). A characteristic contrast halo ring around the primary altered pigmentation was observed in 20 cases (66.67%). Invasion of hair follicles by yeast was evident in 6 patients (20%). Conclusion: Dermoscopy with characteristic features such as folliculocentricity, contrast halo sign, and yeast invasion of hair follicles can be a very useful aid in contributing towards diagnosing pityriasis versicolor. [ABSTRACT FROM AUTHOR]

Sebaceous carcinoma is a rare cutaneous malignant neoplasm with an estimated incidence rate of approximately 1–2 per 1 000 000 per year. It rarely presents as an extra-ocular type and it affects patients in between the sixth and eighth decades of life. This is a case of a 31-year-old male with a 10-year history of a right axillary mass with an incisional biopsy of a sebaceous carcinoma. The mass was 10 × 6 cm in largest diameter, erythematous, non-tender and irregularly shaped. The patient underwent wide excision of the right axillary mass with negative margins confirmed by frozen section under general anesthesia. A parascapular fasciocutaneous flap was done in order to provide coverage for the defect. The patient was then discharged improved on the fourth postoperative day. Although there has been no established clinical protocol for the staging, medical and surgical management for extra-ocular sebaceous carcinoma, early diagnosis accompanied with the proper surgical intervention, such as oncologic wide excision with negative margins, were both adequate and paramount to the diagnosis, course and treatment of this patient, given its rarity. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to analyze a parallel system consisting of n dependent components with lifetimes following Weibull distribution. FGM Copula in multivariate case is used to generate the reliability function of the original system. A reduction method is introduced to improve system reliability. Other methods of hot, cold and warm duplication are established to improve system reliability. An application is introduced to show the results and compare between different improvement methods.Design/methodology/approach In this paper, a study of a parallel system consisting of n dependent and non-identical components is introduced. Reliability function of the original system is derived by using the concepts of copula, subject to Weibull distribution. Reliability function of the original system is improved according to reduction, hot duplication, warm and cold duplication methods. Reliability equivalence factors are introduced to compare between different system designs. Numerical illustration and real-time data application are discussed to show the results obtained in this paper.Findings Copulas can be used to model the reliability of systems with dependent units.Originality/value This paper is original. Improvement of the reliability of dependent systems is not discussed in literature. Copula is a useful tool to analyze the reliability of dependent systems. The introduced model is considered as a generalization of the models discussed in literature. [ABSTRACT FROM AUTHOR]

MajocchiÃ��s granuloma (MG) is a rare fungal infection of the dermis that is mainly caused by dermatophytes (in Ã�¥95% of cases); the most frequently identified cause is anthropophilic Trichophyton rubrum. In the rest of the cases, the causes are non-dermatophytic fungi such as Aspergillus species. This review aimed to provide information about the current perspectives on MG regarding its clinical characteristics, predisposing factors, laboratory diagnosis, and treatment strategies. Although the lower extremities were reported to be the most common site of infection, facial involvement has been predominant in the past 5 years. Our literature research showed that the most common predisposing factor (55%) is the use of topical steroid creams without potassium hydroxide examination during treatment of erythematous squamous dermatoses. A reliable diagnosis of MG is based on histopathological examination, including fungal culture and molecular analyses. MG should be treated not only with topical agents but also with systemic antifungal agents that are continued until the lesions are completely resolved. In systemic treatment, the most preferred drug is terbinafine, because of its efficacy, side effects, and safety. [ABSTRACT FROM AUTHOR]

Confluent and reticulated papillomatosis (CRP) of Gougerot and Carteaud was first typified in 1927. With the help of electron microscopy, it has been elucidated that CRP arises due to aberrant keratinization. However, till date, there is no clear consensus on the etiologic trigger for CRP. Prevailing postulates include a bacterial trigger by Dietzia papillomatosis (type strain N 1280T), an exaggerated cutaneous response to Malassezia furfur, an endocrine basis stemming from insulin resistance, ultraviolet light-induced epidermal change, amyloid deposition, and a loss-of-function mutation in keratin 16. CRP typically presents as asymptomatic hyperpigmented papules and plaques with peripheral reticulation over the nape, axillae, upper chest, and upper back, occasionally with extension superior to the forehead and inferior to the pubic region. Dermoscopy may be used in the evaluation of CRP, but its diagnosis is made on clinical grounds given its nonspecific histopathological findings. Although successful treatment with topical keratolytics, retinoids, or antifungals has been reported, antibiotics, such as minocycline, at anti-inflammatory doses have emerged as a preferred therapeutic option. In this article, we review the diagnostic considerations in CRP and its therapeutic options. [ABSTRACT FROM AUTHOR]

Confluent and reticulated papillomatosis (CRP) is an uncommon, progressive, distinctive dermatosis. It is characterized by persistent brown, scaly macules, papules, patches and plaques. It appears as tinea versicolor or acanthosis nigricans resulting in delay in the diagnosis. Hence a diagnostic tool which could help to diagnose this condition is dermoscopy. We reported a 24 year old male with skin lesions on upper back, neck and shoulders. Dermoscopic examination demonstrated fissures and ridges. Whitish structures were present on the ridges which are surrounded by grayish globules. These globules were lined by brown lines at the periphery. Fissures were brown in color. Global appearance was 'crocodile skin-like' pattern. Ridges and furrows in dermoscopy of CRP correspond to rete ridges in the histology. Whitish structures were there around follicular ostia which represent hyperkeratosis and acanthosis of follicular epidermis. Authors also observed sparse hairs in the involved area and V-sign under dermoscopy. Hence, pathogenesis of CRP probably revolves around hair follicles. CRP demonstrates specific dermoscopic patterns which correlate well with histopathologic changes. Therefore, authors propose that these patterns would aide in the diagnosis of CRP. [ABSTRACT FROM AUTHOR]

Confetti-like leukoderma and exogenous ochronosis are two of the rarest side effects of a long-term use of hydroquinone (HQ). HQ is the first choice of topical bleaching agents used in the treatment of melasma. Confetti-like leukoderma is characterized as mottled depigmented spots, whereas exogenous ochronosis presents as gray-brown or blue-black hyperpigmentation. Both disorders are especially found in the area where HQ is applied. We report two cases of women with these two rare pigment disorders, who had a history of using HQ for more than 8 years. The dermoscopic examinations show dark-brown globular-like structures on a diffuse fine brown reticular patterns background, multiple guttate depigmented macules, and prominent telangiectasias which are characteristics for melasma, ochronosis, and confetti-like leukoderma. Both patients were advised to stop HQ and treated with sunscreen, 0.05% retinoic acid cream, 2% kojic acid cream, and 20%-35% glycolic acid chemical peel. [ABSTRACT FROM AUTHOR]

Exogenous ochronosis (EO) is a cutaneous disorder characterized by blue‑black pigmentation resulting as a complication of long‑term application of skin‑lightening creams containing hydroquinone but may also occur due to topical contact with phenol or resorcinol in dark‑skinned individuals. It can also occur following the use of systemic antimalarials such as quinine. EO is clinically and histologically similar to its endogenous counterpart viz., alkaptonuria, which, however, exhibits systemic effects and is an inherited disorder. Dermoscopy and in vivo skin reflectance confocal microscopy are noninvasive in vivo diagnostic tools. It is very difficult to treat EO, a cosmetically disfiguring and troubling disorder with disappointing treatment options. [ABSTRACT FROM AUTHOR]

Background: Melasma is a common acquired cause of facial hyperpigmentation with no definitive therapy. Tranexamic acid, a plasmin inhibitor, has demonstrated depigmenting properties and combining this oral drug with other modalities of treatment has shown promising results. Objectives: To compare the efficacy of a combination of oral tranexamic acid and fluocinolone-based triple combination cream with that of fluocinolone-based triple combination cream alone in melasma among Indian patients. Materials and Methods: 40 patients of melasma of either sex attending to dermatology OPD were enrolled in this study. Participants were randomly divided into two groups with 20 patients in each group. Group A patients were asked to apply the cream only and Group B patients received oral tranexamic acid 250 mg twice daily and applied a triple combination cream containing fluocinolone acetonide 0.01%, tretinoin 0.05%, and hydroquinone 2% once daily for 8 weeks. Response was evaluated using melasma area severity index (MASI) at baseline, 4 weeks, and 8 weeks. Results: 40 ts completed the study. The MASI scores at baseline, 4 weeks and 8 weeks in group A were 15.425 + 1.09, 11.075 + 9.167 and 6.995 + 6.056 respectively and in group B 18.243 + 1.05, 6.135 + 4.94 and 2.19 + 3.38. Intergroup comparison showed a faster reduction in pigmentation in Group B as compared to Group A and the results were statistically significant at 4 weeks (P value 0.014) and 8 weeks (P value 0.000). The efficacy was maintained throughout the 6-month follow-up period. Conclusion: Addition of oral tranexamic acid to fluocinolone-based triple combination cream results in a faster and sustained improvement in the treatment of melasma. [ABSTRACT FROM AUTHOR]

Background: Colloid milium is a rare cutaneous deposition disorder characterized by translucent papules developing on sun-exposed regions such as the face, neck and dorsal aspects of the hands and back. Exogenous ochronosis is caused by the accumulation of homogentisic acid resulting from long-term application of certain topical agents. Histology is characterized by yellow-brown pigment deposits in the papillary dermis. Prolonged use of hydroquinone may result in the development of the pigmented form of colloid milium, sometimes in association with ochronosis. Case report: A 53-year-old man presented with a 3-year history of multiple slow spreading pigmented papules on the dorsa of his hands, nose and ears. The patient had a long history of exposure to sun and fertilizers with no history of using hydroquinone bleaching creams. A later biopsy revealed the diagnosis of pigmented colloid milium associated with exogenous ochronosis. Conclusion: UV light damage and long contact with fertilizers may have a role in the development of pigmented colloid milium associated with exogenous ochronosis. [ABSTRACT FROM AUTHOR]

Background: Numerous therapeutic options have been tried in the management of melasma. Aims and Objectives: This prospective randomized study was planned to assess the efficacy of low potency triple combination (TC) cream (TC‑hydroquinone 2%/tretinoin 0.05%/fluocinolone 0.01%) versus glycolic acid (GA) peels/azelaic acid (AA) 20% cream (GA/AA) combination in melasma. Materials and Methods: Forty patients with melasma were recruited into this study and randomized into two groups. Group A consisting 20 patients received TC cream once a day for night time application for 3 months. Group B comprising of 20 patients received GA/ AA 20% cream combination for 3 months. The disease severity was monitored with digital photography, melasma area and severity index (MASI) score, which was calculated at baseline, 6 weeks and 12 weeks, and visual analog scale (VAS) score, which was calculated at baseline and 12 weeks. Results: Of 40 patients, 38 were completed the study. A significant reduction in MASI and VAS was recorded after 6 weeks and 12 weeks of treatment in both groups A and B (P = 0.001). However, there was no significant difference in the mean MASI scores between the two groups at baseline, 6 weeks and 12 weeks. Similarly, there was no difference in the mean VAS scores between the two groups at baseline and 12 weeks. Four patients in group A and 3 in group B experienced adverse effects such as irritation, dryness, and photosensitivity. Conclusion: Both low potency TC cream and GA/AA 20% cream combination are effective in treating melasma among Indian patients. [ABSTRACT FROM AUTHOR]

Cutis verticis gyrata is a rare skin condition characterized by convoluted folds and furrows formed from thickened skin resembling a cerebriform pattern. The condition is usually but not exclusively limited to the scalp. It may present in either primary form with or without any associations or in secondary forms with a wide variety of causes. Cerebriform intradermal nevus is one such rare cause of this unusual condition. We present a case of cerebriform intradermal nevus involving scalp and the upper half of left cheek which had both cerebriform appearances as well as the smooth surface. [ABSTRACT FROM AUTHOR]

The article offers information on several appearances that could be observed in a clinical dermatology which could help in clinical diagnosis of skin diseases. Topics discussed include asbestos-like thick scales that is present in pityriasis amiantacea tine amiantacea, beefy red appearance that could mean vitamin B12 deficiency, and genital wart that presents a cauliflower-like fleshy growth.

Man is always obsessed with fair skin since ages. Beauty, it is said, is skin deep. Not so anymore for consumers especially in India who demand from their beauty products more than just a superficial whitening of their skin tone for a short duration. Hydroquinone is the ?rst choice of topical bleaching agents used in treatment of melasma. It is widely prescribed by physicians and often used by patients without prescription. The principal adverse effects of its chronic use are confetti-like depigmentation and exogenous ochronosis. Exogenous ochronosis is an infrequent dermatosis characterized as a dark blue hyperpigmentation localized where the causing agent was applied. It may be caused by the use of systemic medications such as antimalarials and by the use of topical substances such as phenol, resorcinol, benzene, hydroquinone, which is a phenolic compound with depigmenting action. The pathophysiology of this process is not well clear up to this moment, and the therapeutic measures are not satisfactory either. We hereby, reporting a case of 29 years old female who had been using hydroquinone continuously for six years for fairer complexion and ended up with a night mare. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding a 16-year-old girl with tiny hyperpigmented spots and was diagnosed with LEOPARD syndrome (LS), along with electrocardiographic (ECG) changes suggesting Wolff-Parkinson-White (WPW) syndrome.

The author discusses the importance of manuscript revision in the publication process to improve the paper's quality and suitability for publication and mentions several tips to revise to manuscript. Topics discussed include the types of revisions such as major, minor, and optimal, tips which include answering the question completely, politely, and with evidence, and the characteristics of the author to have a successful manuscript revision such as acceptance of criticism and perseverance.

There are 'n' number of names and terminologies in dermatology. The real and unreal names lead to lot of confusion to the residents and practitioners of dermatology. The word 'pseudo' means 'unreal', 'false' or 'fake', and it has deep roots in dermatology providing herculean task to differentiate and understand the real conditions/diseases/signs in dermatology. We have made an attempt to list and describe the pseudo and associated real conditions in dermatology. [ABSTRACT FROM AUTHOR]

Depigmentation therapy in vitiligo is an option in those with extensive vitiligo who have failed to respond to medical therapy and have obvious cosmetic disfigurement due to intervening patchy pigmented areas. Various aspects of this therapy such as the cost, treatment time, course, permanency of depigmentation, side effects, and the possibility of repigmentation should first be discussed with the patient. At present, there is no ideal depigmenting therapy available, but many agents in the market have been in use for many years. Monobenzyl ether of hydroquinone (MBEH) is the mainstay and Food and Drug Administration (FDA) approved in USA but takes many months to depigment and is associated with local side effects and risk of repigmentation. Other agents which are also used are 4-methoxy phenol and 88% phenol. Physical therapies for depigmentation include Q-switched ruby and alexandrite lasers and cryotherapy. Second-line agents which can be explored for depigmentation include imatinib mesylate, imiquimod, and diphencyprone. Many possible experimental agents are being explored like various phenol derivatives, melanoma vaccines, interferon gamma, busulfan, etc. A major lacuna still exists in this area and a lot more research is desirable to give satisfactory cosmesis to these patients with extensive vitiligo. [ABSTRACT FROM AUTHOR]

Sebaceous carcinoma is an uncommon malign tumor arising from sebaceous glands. Sebaceous carcinoma typically occurs on the eyelid as a slow growing, pink-yellow, painless subcutaneous papule or nodule. Although it is rare, sebaceous carcinoma can also be seen on head, neck, trunk, extremities, breasts, oral mucosa and external genitalia. Sebaceous carcinoma is a locally aggressive tumor, moreover it can metastasize to regional lymph nodes and distant organs. Hereby, we report a 91-year-old Caucasian female with sebaceous carcinoma on the forehead. The extraocular 1,9 cm large sebaceous carcinoma on the forehead was removed surgically with wide local excision under local anesthesia. [ABSTRACT FROM AUTHOR]

Sebaceous carcinoma is a rare, aggressive cutaneous tumor most commonly involving the head and neck, especially the periorbital area. It has been associated with Muir-Torre syndrome, human papillomavirus infection, and radiotherapy. This case report describes an unusual clinical presentation of a large sebaceous carcinoma on the abdomen of an African-American male patient who was successfully treated with Mohs micrographic surgery. The case is reported due to the unusual location of the lesion on the abdomen and the rare occurrence of this tumor type in an African-American male. [ABSTRACT FROM AUTHOR]

Exogenous ochronosis is an infrequent dermatosis characterized by dark blue hyperpigmentation. It may be caused largely by hydroquinone, a fenolic compound which is used in the treatment of melasma and other skin hyperpigmentation. The exact etiopathology is still not understood and the results of various treatments offered are unsatisfactory. We present a case of exogenous ochronosis which resembled melasma but clinicopathologic evaluation led to the correct diagnosis. We also emphasize the need to restrict the indiscriminate use of hydroquinone containing compounds without medical prescription. [ABSTRACT FROM AUTHOR]

Porokeratosis are morphologically distinct keratinization disorders, characterized clinically by papules or hyperkeratotic plaques surrounded by a linear raised border. Sometimes the border (the most characteristic change in porokeratosis, and practically the definition of diagnosis) is not easily identifiable. We demonstrated a clinical maneuver that facilitated the visualization of this more typical aspect in frame. A wooden tongue depressor was used to gently scratch one of the lesions. This maneuver revealed a desquamative halo in the hyperkeratotic lesion - better identifying the clinical aspect typical of the porokeratosis. The use of scratching may play a fundamental role in the diagnostic suspicion of porokeratosis and should be applied whenever the clinical history suggests this hypothesis as a differential diagnosis. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the cases of a 48-year-old Indian woman and a 42-year-old man diagnosed with dermoscopic criteria following the use of skin lightening agents to treat melasma.

Dowling Degos disease is a rare, reticulate pigmentary disorder with variable phenotypic expression that manifests as hyperpigmented macules and reticulate pigmentary anomaly of the flexures. Many variants of this condition and its overlap with other reticulate pigmentary disorders have been reported in the literature. We present here two cases of DDD with follicular localization, both clinically and histologically. It was associated with ichthyosis vulgaris in one case. Follicular DDD is an uncommon variant of this evolving dermatosis. Our report supports the possible role for disordered follicular keratinisation in its pathogenesis. [ABSTRACT FROM AUTHOR]