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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]

Background: Melasma is a common hypermelanosis characterized by symmetrical brownish macules, especially on the face. Histologic analysis demonstrates increased epidermal and dermal melanin. Dermoscopy is useful to estimate the depth of the melanin and may help in the diagnosis and classification of melasma, with therapeutic importance. Objectives: To evaluate the diagnostic concordance of dermoscopic classification of epidermal or mixed subtypes of melasma and the correlation between dermoscopic and histopathological findings. Methods: Twenty‐eight women with facial melasma, phototypes III to V, ages between 30 and 61 years were selected. Based on the evaluation of clinical and dermoscopic images, two independent observers classified melasma into epidermal or mixed subtypes. The intra and interobserver concordances were calculated. Histopathological analysis of epidermal melanin extension and maximum number of melanophages per high‐power field (400×; HPF) have been assessed. Association between the melanophages count and the dermoscopic classification was evaluated. Results: Intraobserver agreement was 82.1%, and between observers, from 78.6% to 89.3%, according to the Kappa index. Histopathology revealed increased intraepidermal melanin and the presence of dermal melanophages in all the samples. Ten or more melanophages/HPF was significantly associated with mixed melasma. Conclusions: Moderate to substantial concordance in the dermoscopic classification of melasma was found, and the correlation between this classification and the dermal melanophages count have been suggested. Intradermal component of every case of melasma should be considered for therapeutic and prognostic purposes. [ABSTRACT FROM AUTHOR]

Confluent and reticulated papillomatosis (CARP) is a dermatosis that often presents during adolescence. Prior studies have linked CARP to metabolic syndrome and comorbidities associated with insulin resistance, such as acanthosis nigricans and type 2 diabetes. Despite this, few studies have evaluated the clinical relationship between glucose dysmetabolism and CARP. In this report, we describe the characteristics of a large cohort of pediatric patients with CARP to further evaluate the potential relationship between CARP and metabolic syndrome in children. [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]

Exogenous ochronosis is a potential side effect associated with hydroquinone, and treatment is often unsatisfactory. Our study objectives were to review data on hydroquinone‐associated ochronosis to determine risk factors for patients experiencing this adverse event. On September 27, 2020 (MEDLINE/PubMed), and October 30, 2020 (Scopus and Web of Science), databases were searched for "ochronosis + hydroquinone" by both authors to reduce risk basis. PRISMA reporting guidelines were used to select 56 articles with a total of 126 patients with hydroquinone‐associated ochronosis. Included articles described hydroquinone‐associated ochronosis. Articles were excluded if they had irrelevant content, were non‐English language text, and were non‐case studies. Full text articles were assessed and recorded. Cross‐tabulation analysis was performed on categorical data, and Fisher exact test was performed. Ochronosis was most often reported in middle‐aged women (53.2%), of African descent (45.2%), Black races (55.5%), and Fitzpatrick skin types V–VI (52.4%). It was most frequently reported with unknown and hydroquinone concentrations greater than 4% (32.5 and 35.7% cases, respectively). Median duration of use was 5 years, with only four cases reported with courses 3 months or shorter and eight cases reported with use 1 year or less. All patients presented with facial blue‐black or gray‐blue macules in a reticulate, lace‐like fashion. Histopathology consistently showed solar elastosis and brownish‐yellow, 'banana‐shaped' fibers between degenerated collagen fibers of the papillary dermis. Based on these findings, we conclude that hydroquinone in concentrations above 4% and in treatment courses longer than 3 months may be associated with new‐onset ochronosis. [ABSTRACT FROM AUTHOR]

Background: Melasma has a complex pathogenesis, and various aggravating factors contribute to its recalcitrance to treatments. A combination of isobutylamido thiazolyl resorcinol (ITR) and hyaluronic acid (HA) could increase melasma treatment efficacy. Aims: To compare the efficacy and safety of 0.15% ITR plus HA vs 0.15% ITR or HA alone in melasma treatment. Methods: Ninety‐two patients received ITR 0.15% plus HA (n = 30), 0.15% ITR (n = 31), or HA (n = 31) along with broad‐spectrum sunscreen application for 12 weeks. Treatment efficacy was determined using modified Melasma Area Severity Index (mMASI), average melanin and melanin variation with Antera3D®, and safety based on transepidermal water loss. Results: Compared with the HA group, the ITR+HA group showed significantly reduced mMASI at weeks 4, 8, and 12 (p = 0.026, 0.015, and 0.001, respectively), whereas the ITR group showed a significant reduction at week 12 (p = 0.027). There was no significant difference in the mMASI or average melanin level between the ITR+HA and ITR groups. Melanin variation was significantly lower in the ITR+HA group than in the ITR group at weeks 4, 8, and 12 (p = 0.027, 0.019, and 0.023, respectively). Conclusions: The combination of 0.15% ITR and 0.15% ITR+HA effectively reduced melasma severity. HA could synergistically improve melasma homogeneity. [ABSTRACT FROM AUTHOR]

Background: Trichophyton rubrum, an important aetiological agent of superficial dermatophytosis, occasionally penetrates into deeper tissues, causing inflammation and a granulomatous response. Only few case reports of T. rubrum granuloma with molecular evidence for autoinoculation have been published. Objectives: To find the genetic basis of adaptation to a different microhabitat following autoinoculation of Trichophyton rubrum. Methods: A case of Majocchi's granuloma is reported, with isolation of T. rubrum strains from foot and chin, respectively. Whole‐genome sequencing of the two strains has been performed. Phylogenetic reconstruction and SIFT analysis were conducted. Results: A phenotypic difference has been observed between the two isolates. 20 and 19 indels, 8 and 15 SNVs were found in foot and chin strains, respectively. Foot and chin strains formed a monophyletic group. Two non‐synonymous mutations of chin strains were observed in the TERG_06754 gene encoding cytochrome c peroxidase (CCP). The G293C amino acid change in TERG_03373 was predicted to affect protein function significantly. The mutated amino acid (cysteine) was only found in the chin strain in all dermatophyte non‐redundant sequences. Conclusions: Non‐synonymous mutations located in TERG_06754 and TERG_03373 were predicted to affect protein functions, which may facilitate the adaption for invasion of the superficial cutaneous strain. As the different living environments of these two strains (oxygenous, lower‐temperature for the pedal strain; hypoxia, higher‐temperature for the chin strain), a stratum corneum‐to‐dermal adaption hypothesis of T. rubrum was proposed. [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]

Mastocytosis is a heterogeneous group of diseases characterized by abnormal proliferation of neoplastic mast cells in the skin and/or other extracutaneous tissues. Most patients with skin involvement can be subclassified into one of the three subtypes of cutaneous mastocytosis currently recognized by the World Health Organization (i.e., mastocytoma, maculopapular cutaneous mastocytosis and diffuse cutaneous mastocytosis); however, some patients may occasionally present with atypical skin lesions that cannot be ascribed to any of these disease subtypes. Here, we report three patients diagnosed with mastocytosis and an unusual cutaneous involvement mimicking Kaposi's sarcoma. Skin biopsies showed neoplastic mast cell infiltrates together with features commonly seen in acroangiodermatitis, and immunohistochemistry for human herpesvirus 8 was negative. One patient fulfilled the criteria for aggressive systemic mastocytosis, showed no response to cytoreductive therapy, and died because of disease progression. The remaining two patients had indolent and smoldering systemic mastocytosis, respectively, but they showed several features associated with an unfavorable prognosis such as extensive involvement of the hematopoiesis by the KIT D816V mutation, increased serum β2‐microglobulin, and decreased serum lactate dehydrogenase. The presence of pseudo‐Kaposi's sarcoma skin lesions is an uncommon finding in mastocytosis which may alert physicians to the possible existence of underlying features indicative of a poor prognosis. [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]

Ochronosis is the blue‐gray discoloration of collagen‐containing tissues due to homogentisic acid (HGA) deposition, secondary to endogenous alkaptonuria or exogenous enzyme inhibition. In renal disease, accumulation of HGA in serum can cause methemoglobinemia. A 60‐year‐old woman with renal disease and anemia presented with 3 days of weakness and months of gray skin discoloration. Her hemoglobin was 8.1g/dl with 24.5% methemoglobin. Despite treatment with methylene blue, exchange transfusion, and continuous renal replacement therapy, the patient died. Autopsy revealed gray discoloration and ochronotic pigment in the ribs and cartilage. Based on these findings, the patient was diagnosed with ochronosis, suggestive of alkaptonuria, complicated by methemoglobinemia. The differential diagnosis for blue‐gray skin discoloration includes argyria, methemoglobinemia, and ochronosis. This patient's clinical and autopsy findings suggested alkaptonuria complicated by methemoglobinemia due to progressive renal dysfunction. Development of methemoglobinemia in the setting of chronic skin discoloration and renal failure should prompt consideration of alkaptonuria. [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]

Click here for the corresponding questions to this CME article. [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]

A 51-year-old female presented with a 10-year history of brownish skin marks on her cheeks. Dermatological examination showed malar brownish macular lesions with diffused reddish areas and superimposing brownish papules. Further dermoscopic examination showed short circinate brownish-red structures and cutaneous pseudo-rete accentuation. Histopathological examination confirmed Stage II exogenous ochronosis (EO). Hydroquinone is the most commonly used topical agent for hyperpigmentation skin disorders. One side effect of its long-term use is EO. Clinically, EO is difficult to diagnose, and clinicians should be more aware of this condition. Dermoscopy is an in vivo diagnostic tool that is used to enhance the visualization of cutaneous lesions. The use of this device can potentially assist in identifying the progress of melasma disorder into EO. [ABSTRACT FROM AUTHOR]

Reflectance confocal microscopy examination showed a honeycombed pattern of keratinocytes, visible as large cells with hyper-reflective contours in the epidermal level (d), and linear vessel and multiple roundish inflammatory cells in upper dermis (e). Potassium hydroxide examination showed dermatophytes (g) supporting the diagnosis of Majocchi's granuloma (MG). RCM can allow one to confirm the diagnosis of dermatophytosis during the dermatological consultation.[7] For example, in tinea incognito it detects the presence, in the stratum corneum, of highly refractive linear and branched structures corresponding to hyphae.[8]. [Extracted from the article]

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]

Lightening skin tone is an ancient and well-documented practice, and remains common practice among many cultures. Whitening agents such as corticosteroids, tretinoin and hydroquinone are medically applied to effectively lighten the skin tone of hyperpigmented lesions. However, when these agents are used cosmetically, they are associated with a variety of side-effect. Alternative agents, such as arbutin and its derivatives kojic acid and nicotinamide have been subsequently developed for cosmetic purposes. Unfortunately, some cosmetics contain whitening agents that are banned for use in cosmetic products. This article provides an overview of the mode of action and potential side-effects of cosmetic legal and illegal whitening agents, and the pattern of use of these types of products. Finally, an EU analysis of the health problems due to the presence of illegal products on the market is summarized. [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]

Majocchi's granuloma (MG) is a rare, well-recognized, deep skin infection caused by dermatophyte, which can be seen in immunosuppressed as well as immunocompetent individuals. It is primarily caused by dermatophytes, most commonly Trichophyton rubrum; however, occasionally other Trichophyton sp., Trichosporon sp., Aspergillus sp., and Phoma sp. are involved. Diagnosis is based on clinical, mycological, and histological characteristics. This review focuses on clinical characteristics of MG and diagnosis and therapeutic options of MG. [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]

Majocchi's granuloma (MG) is a rare deep skin dermatophyte infection that can occur either in immunocompetent or in immunocompromised individuals. Oral itraconazole or terbinafine is considered to be the first choice of treatment. We report an immunocompetent man with deep nodular form of MG, the form which is generally found in immunosuppressed individuals. Previous treatment with either oral itraconazole or terbinafine yielded no apparent improvement. After a series of examination, the man was diagnosed as having Trichophyton rubrum-induced MG mixed with bacterial infection as evidenced by growth of Klebsiella pneumoniae in tissue bacterial culture. The patient was treated with a combination of cefoselis and levofloxacin for bacterial clearance followed by voriconazole treatment. After approximately 4 months of voriconazole treatment, the lesions completely resolved. Alternative medicine (voriconazole) can be considered in case of refractory infections during MG treatment. [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]

Exogenous ochronosis (EO) can be an unintended psychologically troubling condition for patients who are already being treated for longer-term hyperpigmentation disorders such as melasma. Early diagnosis is key in order that the offending agent can be stopped to prevent further disfiguring discoloration. EO can be diagnosed in the right clinical setting with the aid of dermatoscopy, which can assist in early diagnosis and may negate the need for a biopsy. Laser modalities using Q-switched lasers of longer wavelengths and combination laser dermabrasion treatments have shown the most significant results with minimal adverse events. However, further large-scale studies are needed to determine optimal treatment modalities. Although considered uncommon, the incidence of EO will likely continue to increase with the growth of immigrant populations and the use of skin-lightening agents above the FDA's recommended over-the-counter concentrations, without the guidance of a dermatologist. [ABSTRACT FROM AUTHOR]

Background Various treatments are currently available for melasma. However, results are often disappointing. Objectives 1 To assess the efficacy and safety of combinations of hydroquinone, glycolic acid, and hyaluronic acid in the treatment of melasma after topical application. 2 To evaluate the dermoscopy as a tool in diagnosis and follow-up of melasma treatment. Patients and Methods One hundred patients with mild, moderate-to-severe melasma were divided into five groups. Group I (twenty patients were treated with cream formula containing 4% hydroquinone), group II (twenty patients were treated with cream formula containing 4% hydroquinone + 10% glycolic acid), group III (twenty patients were treated with cream formula containing 4% hydroquinone + 0.01% hyaluronic acid), group IV (twenty patients were treated with cream formula containing 4% hydroquinone + 10% glycolic acid + 0.01% hyaluronic acid), and group V (twenty patients were treated with placebo cream). All patients were subjected to dermoscopic examination and digital photographs before and after treatment. The response and side effects were evaluated. Results Groups I, III, and IV showed highly significant changes in modified Melasma Area and Severity Index ( mMASI) score after using the treatment. Group II showed significant change in mMASI score after using the treatment. The side effects were more reported in group II, followed by group IV, followed by group I, followed by group III. There was highly significant difference between the dermoscopic color findings before and after treatment. Vascularization was another dermoscopic finding. Conclusion A cream formula containing 4% hydroquinone + 10% glycolic acid + 0.01% hyaluronic acid was very effective in treatment of melasma with tolerable side effects. Dermoscope is a valuable noninvasive tool in the diagnosis and follow-up of melasma treatment. [ABSTRACT FROM AUTHOR]

Background: Confluent and reticulate papillomatosis of Gougerot and Carteaud (CRP) is a rare dermatological condition, which has not been reported widely in Asian populations. Aim: To characterize the clinicopathological and diagnostic features of CRP in a South-East Asian population. Methods: The medical records of 29 patients accorded the diagnosis of CRP at the National Skin Centre, Singapore, from 1990 to 2011, were analyzed. Results: The male to female ratio was 2.6:1. Eight patients were Indians. The mean age at the onset of skin eruptions was 29.1 years (range 16-55 years), while the mean duration was 19.9 months (range 0.5-120 months). CRP itself was the most common preliminary diagnosis. Fungal smears were negative in all 22 instances. All 29 patients had received a trial of antifungal therapy before being seen at our center. Antifungal therapy was repeated in three subjects, and the response was uniformly poor. Conversely, the treatment response with tetracyclines was excellent, yielding more than a 50 % response in all 14 patients. Four patients suffered recurrence of CRP. According to the diagnostic criteria set forth by Davis et al., 25/29 patients (86.2 %) and 19/29 patients (65.6 %) fulfilled at least three and four criteria, respectively. Conclusion: A predilection for male gender and Indian ethnicity were noted in our study. The diagnosis of CRP was often made clinically, and investigations were mainly ancillary. The treatment response was poor with antifungal agents but excellent with tetracyclines. The diagnostic criteria proposed by Davis et al. were found to be useful in our cohort of patients. [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]

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By midcentury, the U.S.A. will be more ethnically and racially diverse. Skin of colour will soon constitute nearly one-half of the U.S. population, and a full understanding of skin conditions that affect this group is of great importance. Structural and functional differences in the skin, as well as the influence of cultural practices, produce variances in skin disease and presentation based on skin type. In the skin of colour population, dyschromia is a growing concern, and a top chief complaint when patients present to the physician. A thorough understanding of the aetiology and management strategies of facial hyperpigmentation is of importance in caring for those afflicted and also in the development of new therapies. [ABSTRACT FROM AUTHOR]