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Reticular dermis and subcutis revealed a dense lymphohistiocytic infiltrate along with epithelioid cell granulomas, multinucleated giant cells, with foci of acute inflammatory infiltrate reaching the subcutis (Figure 2a-c). Verrucae (warts) are the manifestation of infection caused by human papillomavirus (HPV). The patient had undergone multiple treatments prior, including destructive therapies. [Extracted from the article]

Background: The International Dermoscopy Society (IDS) recently released a set of five basic dermoscopic parameters (vessels, scales, follicular findings, "other structures," and specific clues) encompassing a total of 31 subitems to standardize the use of dermoscopy in non‐neoplastic dermatoses, yet they have been developed taking into account Caucasian/Asian skin, with consequent possible limitations if used in dark skin. Objectives: To validate the abovementioned criteria for the use in dark‐skinned patients (phototypes IV–VI) through an expert consensus. Methods: The two‐round Delphi method was adopted, with an iterative process consisting of two rounds of email questionnaires. Potential panelists were recruited via e‐mail from all over the world based on their expertise on dermoscopy of non‐neoplastic dermatoses in skin of color. Results: Twenty‐two panelists took part in the validation process. All of the five originally proposed parameters and subitems reached agreement during the first round, aside from "follicular red dots." Additionally, during round 1, five new subitems were proposed (perifollicular scales distribution, follicular openings obliteration, broken hairs, eccrine pigmentation, and eccrine ostia obliteration), along with the possibility to change the denomination of parameter 3 (from "follicular findings" to "follicular/eccrine findings") and split it into two subparameters ("follicular findings" and "eccrine findings"). All such proposals reached agreement during the second round and therefore were included in the final list, for a total of 37 items. Conclusions: Although nearly all the dermoscopic criteria originally proposed by the IDS are applicable even to darker phototypes, several additional variables need to be assessed. [ABSTRACT FROM AUTHOR]

Background: Melasma is the commonest cause of facial hypermelanosis in skin type IV-VI. First-line treatment includes a triple combination containing topical corticosteroid and hydroquinone which have side effects on prolonged use. Chemical peels are a secondline management option with the laser being used in refractory cases, but the worsening of hyperpigmentation in darker skin types can occur following laser therapy. Sunscreen is a must to prevent relapses. Aims and Objectives: (i) To compare the effects of treatment with a proprietary combination (phenyl ethyl resorcinol, nonapeptide-1, aminoethyl phosphinic acid, antioxidants and sunscreen) versus sunscreen alone in limiting or reducing, melasma and preventing recurrence as a maintenance regimen after the initial use of triple combination,(ii) to evaluate the safety of the formulation studied, and (iii) to study the improvement of the quality of life of the patients after using the study formulation versus placebo. Methods: It was a prospective double-blinded parallel-group randomized controlled pilot study. A total of 46 subjects were recruited by consecutive sampling methods and randomized to 23 each in case and control groups. The study period was eight months with three phases. Phase 1 constituted the application of triple combination for eight weeks by both groups followed by phase 2 with the case group applying proprietary medicine and the control group applying sunscreen. Phase 3 was a follow-up period to see the sustenance of results in both groups as well as any evidence of relapses. Sunscreen was applied in all three phases. Results: Case group in the study showed improvement in the melasma severity score and mean melanin index as measured by mexameter but it did not attain statistical significance as compared to the control group. The melasma area and severity index score showed a consistent reduction in the case group, whereas it increased in the control group from baseline. Limitations: Small sample size and a short follow-up period of our study were major limitations. Conclusion: The proprietary combination, which has sunscreen as one of its constituents, is more effective in maintaining remission after triple combination without any added inconvenience of application of two separate preparations as compared to sunscreen alone. [ABSTRACT FROM AUTHOR]

Background: Paucity of literature and non consensus on clinicohistopathological features amongst the nonmelasma facial melanosis for example lichen planus pigmentosus (LPP), pigmented contact dermatitis (PCD), macular amyloidosis, acanthosis nigricans, pigmented demarcation line, post inflammatory hyperpigmentation, etc., make them difficult to diagnose and equally challenging to treat. Materials and Methods: It was a prospective, uncontrolled study, conducted at tertiary hospital at eastern India in 100 patients presenting with facial hyperpigmentation who agreed to undergo 3mm skin biopsy during Jan 2014 to Jun 2015. Cases of melasma were excluded by clinical, Woods lamp examination and if required dermoscopy. Details of history, physical examination, histopathological examination, and Immunohistochemical studies were recorded. Melan A was used as melanocytic differentiation marker while CD4, CD8 were used as inflammatory markers. Mean ± SD, chi-square test or Fisher's exact test, degree of agreement by Cohen's Kappa were calculated. P-value was considered significant if =0.05. Results: 44 males and 56 females (56%) (M: F=1:1.24) with mean age of 45.98 years and median duration of illness of 28 months (5 months-13 years) were studied. Out of 43 confirmed cases of PCD, 16 had associated hypothyroidism (chi square 6.11, P-value 0.0134). Maximum patients belonged PCD (n= 47) followed by LPP (n=27). Maximum concordance of clinical and histopathological diagnosis was present in PCD and LPP (Cohen kappa more than 0.9). Epidermal atrophy and band like inflammatory infiltrate were statistically significant features in LPP (P < 0.001). There was no histopathological and immunohistochemical correlation. Overall, clinical histopathological concordance rate was 77%. Conclusion: Subset of nonmelasma facial melanosis is difficult to diagnose clinically which require further confirmation by histopathological examination. Small number of patients in other groups apart from PCD and LPP and uncontrolled study were major limitations of this study. [ABSTRACT FROM AUTHOR]

Dermoscopy is a non-invasive tool for the diagnosis of skin diseases. Entomodermoscopy is a branch of dermoscopy that deals with infections and infestations. The use of dermoscopy for diagnosis of infections and infestations is rapidly increasing as it can provide useful clues related to diagnosis and effectiveness of treatment. It serves as a useful adjunct to microbiological and histopathological examination. In some cases, like scabies dermoscopy can even clinch the diagnosis. [ABSTRACT FROM AUTHOR]

Context: Ear piercing is a common practice in women seen in the Asian and African subcontinents. Traumatic elongation of ear lobe cleft is seen following long-standing use of heavy jewellery on the ear, or a tug on the earring. These inadvertent tears of the lobe have resulted in patients seeking earlobe repairs, which are routinely performed as an outpatient procedure. Various surgical methods exist for earlobe repair from the simple closure to modified flaps and Z-plasty. Certain methods with excessive tissue loss can result in elongation of the earlobe postprocedure. Aims and Objectives: This study aimed to compare the elongation of earlobe post repair with simple side-to-side closure versus closure with anterior-posterior flap modification. Settings and Design: A cohort study conducted at the outpatient department in a tertiary care hospital of Mumbai. Materials and Methods: A total of 30 women with bilateral, equal, or almost equal earlobe clefts were enrolled in this study. After informed consent, simple side-to-side closure was performed on one earlobe and closure with anterior-posterior flap modification was carried out on the other side in the same patient under strict aseptic precautions. Patients were followed up two weekly till 12 weeks postoperative for any possible elongation of earlobe. Statistical Analysis Used: The data were analyzed using Statistical Package for the Social Sciences (SPSS, IBM, New York, USA) software package for windows, version 20.0. Quantitative and qualitative variables were presented as mean ±standard deviation (SD) and as frequency with percentages. The comparison was done with paired t-test. Results: It was seen that earlobe repairs led to significant elongation of the lobe with simple closure, which did not occur with flap modification irrespective of cleft sizes. Conclusion: It is imperative to choose a correct method to avoid postprocedure elongation of earlobe. [ABSTRACT FROM AUTHOR]