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Cutaneous epithelioid angiomatous nodule (CEAN) is an uncommon benign vascular proliferation that presents as a reddish solitary nodule. Less than 60 cases have been reported in the literature. As it is benign, the prognosis is good, but it is sometimes difficult to differentiate it from other vascular neoplasms. A 16-year-old male presented with a single, large, brownish multinodular swelling over the left pinna. Biopsy showed conglomeration of epithelioid endothelial cells with eosinophilic cytoplasm in the dermis. These cells stained positive for CD31 and CD34. Diagnosis of CEAN was made

Dermatophytes are pathogenic fungi that infect human skin, nails, and hair. Dermatophytes very rarely invade the epidermis below the stratum corneum in an immunocompetent host. Herein, we report a case of invasive cutaneous dermatophytosis in a 30-year-old immunocompetent male who had a history of intermittent mixed cream application on the lesion. Biopsy from the plaque showed neutrophilic spongiosis with superficial perivascular infiltrate of neutrophils, eosinophils, and lymphocytes. On periodic acid–Schiff staining, multiple branched septate hyphae in the stratum corneum were seen. Some of them were seen invading the stratum granulosum and upper spinous layer. On culture, Trichophyton schoenleinii species was isolated.

Smooth muscle hamartoma (SMH) is a benign hamartomatous condition that consists of a dermal proliferation of smooth muscle cells. We hereby report a case of multiple, acquired SMHs on scalp. A 25-year-old male had a 6-year history of multiple, asymptomatic, hyperpigmented plaques on the scalp which were progressively increasing in number and size. Histopathological examination revealed large thick-walled blood vessels, in addition to the haphazardly arranged discrete smooth muscle bundles in the reticular dermis. This case of SMH is unusual in being acquired, having multiple lesions, involving scalp, and having thick-walled blood vessels apart from arrector pili muscle bundles. It emphasizes the wide spectrum of clinical and histopathological variations that may be associated with acquired SMH.

Verruciform xanthoma (VX) is an uncommon benign lesion that can affect oral, genital mucosa, and rarely skin. The characteristic foam cells seen in papillary dermis are a hallmark for diagnosing this entity. A 42-year-old male, tobacco-chewer presented with asymptomatic white-circular plaques on the bilateral buccal mucosa and yellow papules on retromolar area which on histopathological evaluation showed parakeratotic epithelium with surface and deep invagination of columns of parakeratosis throughout the hyperplastic epidermis, few neutrophils in upper spinous layers, and uniform elongation of rete ridges. The rete ridges showed numerous lipid-laden CD 68-positive foam cells. Punch excision coupled with cryotherapy was done, which resulted in the complete resolution of lesions. We publish this uncommon benign entity for increased awareness among physicians to consider it as a differential of verrucous lesion in the mucosa. Our patient had two different morphology of lesions, both suggestive of VX with characteristic foam cells on histopathology.

Masson's tumor is a rare, benign, reactive proliferating vascular lesion. The most commonly affected sites are the head, neck, and extremities. We present a 29-year-old male, a case of Masson's tumor over the forehead. Masson's tumor, with the involvement of the forehead is rare and intriguing in this case. Masson's tumor is a benign tumor that may get confused on histopathology with malignant tumors; hence, dermatologists need to understand this entity to avoid unnecessary confusion.

Linear and unilateral basaloid follicular hamartoma (BFH) is a rare disease that manifests with papules and plaques with distribution along lines of Blaschko. It runs a benign course but with the risk of basal cell carcinoma (BCC) in long term course. BCC can be differentiated from BFH with histopathology and immunohistochemistry. Dermoscopic features of BCC are well studied. Dermoscopic features of BFH are not yet described in literature in detail probably due to rarity of the disease. Here, we present a case of extensive linear and unilateral BFH with its clinicohistopathological and dermoscopic features. The lesions were extensive to involve scalp, face, neck, upper, and lower trunk. Dermoscopy revealed features similar to that of BCC including brown-grey globules and dots, in focus dots, brown linear and arciform structures, crown vessels, short fine telangiectasias, spoke wheel like structures without central dark point, white structureless areas with telangiectasias and keratotic plug. Other dermoscopic features of BCC like arborizing vessels, blue-grey ovoid nests, maple leaf-like areas, concentric structures, ulcerations, erosions and white streaks were absent in this case.

Dermatopathology involves study of the microscopic morphology of skin sections. It mirrors pathophysiologic changes occurring at the microscopic level in the skin and its appendages. Sometimes, we come across certain morphologic features that bear a close resemblance to our physical world. These close resemblances are referred to as "appearances" in parlance to dermatopathology. Sometimes, these "appearances" are unique to a certain skin disorder and thus help us to clinch to a definitive diagnosis (e.g., "tadpole" appearance in syringoma). However, frequently, these appearances are encountered in many other skin conditions and can be therefore be misleading. In this paper, we attempt to enlist such "appearances" commonly found in the dermatopathologic literature and also enumerate their differential diagnoses.

Ectodermal dysplasia-skin fragility (EDSF) syndrome is a rare and first described inherited disorder of desmosomes. It occurs due to loss-of-function mutations in PKP1 gene resulting in poorly formed desmosomes and loss of desmosomal and epidermal integrity. We report a case of a 2-year-old Indian male child who presented with palmoplantar hyperkeratosis with fissuring, short, sparse, and easily pluckable scalp hair, nail dystrophy, and multiple erosions over the skin. Skin biopsy showed epidermal hyperplasia with widening of intercellular spaces. His developmental milestones were delayed but intelligence was normal. Echocardiography, X-ray chest, and electrocardiogram were normal. Very few cases of this syndrome have been reported in the literature. We consider this as the first case report from India.

Background: Mycosis fungoides (MF) is cutaneous lymphoma of the T-cell lineage. Hypopigmented MF is a clinical variant of MF, described mainly in Asians. This is a retrospective clinicopathologic analysis of hypopigmented MF at a tertiary care center. Aims: To describe the clinicopathologic profile of hypopigmented MF. Methods: Records of clinicopathologic notes over a 5-year period ranging from January 2005 up to December 2009 were reviewed over a period of 3 months, of which 15 cases were diagnosed with hypopigmented MF based on clinicopathologic correlation. Results: Hypopigmented MF was found to be more common in males, and between second and fourth decades of life. The latent period between onset and diagnosis was around 3.83 years. Most of the patients were asymptomatic 80% (12/15), with skin changes of subtle atrophy in 46.66% (7/15), scaling in 20% (3/15) and focal changes of poikiloderma in 26.66% (4/15) patients. Most common sites of distribution of the lesions were the trunk and extremities. Many of the cases had been clinically mistaken for Hansen′s disease prior to correct diagnosis. Marked epidermotropism and tagging of epidermis by large lymphocytes characterizes the condition histopathologically. Of the 15 cases, immunohistochemistry was possible in 10 cases, of which 8 showed predominant CD8 positive epidermotropic infiltrates and two cases showed absence of CD8 positive and CD4 positive lymphocytic infiltrate in the epidermis. Conclusion: Hypopigmented MF presents as hypopigmented asymptomatic patches without any erythema or infiltration in its early stage and mimics Hansen′s disease. Skin biopsy clinches the diagnosis.

Background: Patients receiving phototherapy for various dermatoses are at increased risk of eye damage due to ultraviolet (UV) rays. They are prescribed UV protective sunglasses by dermatologists but their exact protecting effects are not known. Aim: To study the ultraviolet protective properties of branded and unbranded UV protective sunglasses available in the Indian market, in UV phototherapy chambers. Methods: Sixteen different branded and unbranded UV protective sunglasses were collected from two opticians in Mumbai. Baseline irradiance of the UV chamber was calculated by exposing the photosensitive probe of UV photometer in the chamber. Then, the photosensitive probe of the UV photometer was covered with the UV protective glass to be studied and irradiance was noted. Such readings were taken for each of the UV protective sunglasses. The percentage reduction in the UV rays' penetration of different UV protective sunglasses was calculated. Results: Thirteen sunglasses provided > 80% reduction in UVA rays penetration, of which four were branded (out of the four branded studied) and nine were unbranded (out of the 12 unbranded studied). More than 70% reduction in UVB penetration was provided by 12 sunglasses, which included 10 unbranded and two branded sunglasses. Conclusion: All branded sunglasses provided good protection against UVA penetration, but UVB protection provided by both branded and unbranded sunglasses was not satisfactory. A few unbranded sunglasses had poor efficacy for UVA and UVB spectra; one branded glass had poor efficacy for protection against the UVB spectrum. The efficacy of sunglasses used for phototherapy should be assessed before use.

Tattooing has been practiced in India since ancient era. It has tremendous religious and spiritual significance. In addition, tattooing for cosmetic purposes has become quite popular in recent times. With this increasing trend, there is also an increased risk of adverse effects. Here, we have described two cases of lichenoid reaction developing to red ink in double- colored tattoos and a case of sarcoidal reaction to green tattoo.

Acute hemorrhagic edema of infancy is one of the clinical forms of leukocytoclastic vasculitis seen in children. The condition runs a benign course. We report two male children who presented with upper respiratory tract infection followed by limb swelling and purpuric and ecchymotic lesions on the skin. Skin biopsy revealed leukocytoclastic vasculitis in both patients. In both cases, the lesions resolved completely without any sequelae.

Background: Lepra reactions are not always diagnosable under the microscope. We analyzed skin histopathology in 64 cases of lepra reaction. Aim : To make detailed observations on histopathologic features of type 1 and type 2 lepra reaction (erythema nodosum leprosum, ENL). Materials and Methods : In this retrospective study, we included 64 patients diagnosed during a 3-year period as lepra reaction based on clinico-pathological co-relation. Results : Out of the 64 patients, 22 were of type 1 reaction and 42 of ENL. The most consistent finding in type 1 reaction was papillary dermal edema (86%) followed by pyknosis of lymphocytes (77%) and intercellular edema within granuloma (73%). Surprisingly, folliculotropism of lymphocytes was seen in 55% and subcutaneous infiltration in 36%. In ENL, the most common finding was presence of neutrophils within the granuloma (100%), followed by leukocytoclasia (81%), papillary dermal edema (81%), and neutrophilic panniculitis (69%). Fibrin in the vessel wall or/and granulomas was noted in only 38% while fibrin thrombi in the vessel walls were seen in only 12% of cases. Conclusion: Infiltration of macrophage granulomas by neutrophils is a reliable sign of ENL. Classical signs of vasculitis are not always present in ENL. Folliculotropism and lymphocytic panniculitis were frequent in type 1 reactions while neutrophilic panniculitis was common with ENL.

Epidemic Kaposi's sarcoma is one of the malignant neoplasms, which can develop in HIV-infected patients. Although the prevalence of HIV infection is reported to be high in Asian countries, Kaposi's sarcoma is rarely reported. We report a case of Kaposi's sarcoma involving the skin and oral mucosa along with extensive bilateral lymphedema of lower extremities, treated successfully with paclitaxel and antiretrovirals.