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Author(s): BV Priyadhashini [1]; Ishan Agrawal [1]; Bijaylaxmi Sahoo [1]; Shramana Mandal [2] Sir, Amyloidosis cutis dyschromica (ACD) is a rare, chronic, progressive variant of primary cutaneous amyloidosis (PCA). It [...]

Background: With the rise in cosmetic usage, adverse reactions related to cosmetics have also risen. Photocontact dermatitis to cosmetics is a challenging entity to diagnose and manage. Objectives: To evaluate the clinical features and photocontact sensitivity patterns in patients with cosmetic dermatitis and establish their association based on patch and photopatch test results. Methods: A prospective observational study, where 80 patients with a clinical diagnosis of cosmetic dermatitis were patch or photopatch tested (as per indication) with the Indian standard series, Indian cosmetic and fragrance series, and the patient’s personal product(s). Results: A total of 104 positive reactions were observed in 57/80 patients, of which 50 were relevant to cosmetics usage. Sixty-five patients underwent a photopatch test, and 17 tested positive. Photosensitivity in patients was significantly associated with a positive photopatch test (p-value < 0.001). Various new photo-allergens were discovered, including propylene glycol, triethanolamine, chloroacetamide, isopropyl myristate, cetrimide and hexamine. Facial melanosis was a predominant clinical finding in 44 patients, with pigmented contact dermatitis detected in 19 (43.2%) of these cases. Limitations: Patients’ personal products could not be tested on every patient. Chemical analysis of indigenous products and the individual chemical ingredients of the patient’s personal products could not be patch-tested separately. Phototesting was not performed in patients with photosensitivity. Conclusion: In patients with suspected cosmetic dermatitis with history of photosensitivity or those with facial melanosis of unknown origin, a photopatch test is crucial to detect potentially hidden photo allergens. Many new photo allergens have emerged in the present study. Cosmetic companies should provide detailed information regarding each constituent of the cosmetic products. [ABSTRACT FROM AUTHOR]

The article presents a case study of a rare subtype of primary cutaneous amyloidosis known as amyloidosis cutis dyschromica (ACD) involving three patients aged 24, 28, and 34. Topics discussed include the clinical presentation and diagnostic challenges of ACD, its dermoscopic and histopathological features, and the various treatment options and their effectiveness.

This article discusses a case of bullous mastocytosis in a neonate. Mastocytosis is a group of disorders characterized by the infiltration of mast cells in various tissues. Bullous mastocytosis is a rare form of diffuse cutaneous mastocytosis that is characterized by the formation of bullae on the skin. The patient in this case had multiple plaques with a "peau d'orange" appearance and tense blisters. Treatment with prednisolone and antihistamines resulted in a decrease in blister count and resolution of the plaques. It is important for healthcare professionals to be aware of the different forms of cutaneous mastocytosis and their management. [Extracted from the article]

Background: Vitiligo is a cosmetically concerning common disorder of depigmentation. Narrowband Ultraviolet B (NB‐UVB) phototherapy is a well‐established mode of treatment for vitiligo. Microneedling is a simple method that has been used for vitiligo treatment in adjunct with NB‐UVB and has been shown to induce repigmentation in a few studies; however, there is limited study in the literature. Aims: To compare the efficacy of NB‐UVB alone versus NB‐UVB in conjunction with microneedling in patients of stable vitiligo. Methods: Thirty patients of non‐segmental vitiligo with patches tending toward symmetry, stable for at least 6 months were included. Patches on right side of body (side A) were subjected to both microneedling every 2 weeks and NB‐UVB three times a week, while patches on left side of body (side B) were subjected to NB‐UVB alone thrice weekly for 4 months or till complete resolution of lesions whichever was earlier. Patients were followed up for another 2 months. Response was assessed by photographic record and Vitiligo Area Severity Index (VASI score) calculated at baseline and every month for 6 months. Results: The mean VASI score improvement in both the groups as compared to baseline was statistically significant (p‐value <.01). However, the difference in mean VASI scores between the two groups was not statistically significant (p‐value =.17). Conclusion: NB‐UVB is an effective modality for treatment of vitiligo, but there is no additional benefit of combining microneedling with it. [ABSTRACT FROM AUTHOR]

This article presents a comparative observational study conducted in New Delhi, India, to assess the nailfold capillaroscopy (NFC) findings in psoriasis patients and healthy controls. The study recruited 75 psoriasis patients and 75 age and sex-matched healthy volunteers. NFC images were taken using a USB videodermatoscope and analyzed by two independent observers. The study found that psoriasis patients had significantly more capillary abnormalities compared to healthy controls, including dilated capillaries, tortuous capillaries, capillary dropouts, and avascular areas. The study suggests that NFC can aid in the early identification of psoriatic patients at risk of developing complications and that further research is needed to confirm this hypothesis. [Extracted from the article]

We describe the clinical and demographic characteristics, virological follow‐up, and management of five confirmed monkeypox cases from New Delhi, India without any international travel history. The viral load kinetics and viral clearance were estimated in oropharyngeal swabs (OPS), nasopharyngeal swabs (NPS), EDTA blood, serum, urine, and various lesion specimens on every fourth day of follow‐up ranging from 5 to 24 post onset day (POD) of illness. All five cases presented with mild to moderate‐grade intermittent fever, myalgia, and lesions on the genitals, groins, lower limb, trunk, and upper limb. Four cases had non‐tender firm lymphadenopathy. No secondary complications or sexually transmitted infections were recorded in these cases except for the presence of viral hepatitis B infection marker hepatitis B virus surface antigen (HBsAg) in one case. All the cases were mild and had a good recovery. A higher viral load was detected in lesion fluid (POD 9), followed by lesion roof (POD 9), urine (POD 5), lesion base (POD 5), and OPS/NPS (POD 5). The monkeypox virus (MPXV) DNA was detected in clinical samples from 5th to 24th POD. These monkeypox cases without international travel history suggest the underdiagnosed monkeypox infection in the community. This emphasizes the need for active surveillance of MPXV in the high‐risk population such as men having sex with men and female sex workers. [ABSTRACT FROM AUTHOR]

A 48 year old male developed erythema on the face and neck with infiltrated papulo-plaque lesions on the neck region. A diagnosis of reticular erythematous mucinosis (REM) was made clinically and with the help of histopathology. Treatment which chloroquine and physical sunscreen gave a good therapeutic response within 8 weeks.

A 91/2 year old female born of a nonconsanguineous marriage presented with macrodactyly, hypertrophy of the limb, lymphangioma circumscriptum and varicosities. Lymphangioma circumscriptum was confirmed by histopathology. X-ray of the right foot revealed hypertrophy of both subcutaneous tissue and the underlying bone. This is the second case report from India with the characteristic macrodactyly.

Introduction: Melasma is a relatively common hypermelanotic disorder characterized by symmetrical light to gray-brown macules and patches involving photoexposed areas. Multiple factors have been implicated in the etiopathogenesis, including genetic factors, UV radiation, pregnancy, oral contraceptive pills (OCPs), thyroid dysfunction, and cosmetics. However, the role of cosmetics has not been well studied in melasma patients. The present study was designed to study the contact sensitivity to cosmetic allergens in patients with melasma. Material and Methods: Thirty patients with and thirty without melasma who visited Dermatology OPD between October 2015 and March 2017 were recruited according to selection criteria and were sequentially patch and photopatched with Indian cosmetic and fragrance series. Results: The mean age of melasma patients was 32.10 ± 6.62 years with female to male ratio of 1.72:1. Sixteen (53%) patients were found to show positive reactions on patch and photopatch testing with Indian cosmetic and fragrance series. Among 32 allergens tested, 15 allergens were found eliciting positive reaction. Thiomersol was the most common contact sensitizer eliciting positive reaction in six (38%) patients, followed by cetrimide, hexamine, and sorbitan each in three patients (19%). In the control group, only one (3.3%) subject showed positive contact allergy pattern. The results were significant (P < 0.001). Conclusion: A possible consideration of the pigmented cosmetic dermatitis and cosmetic contact sensitivity is recommended in the etiologic factors of melasma especially, in nonpregnancy/ lactation induced melasma or when it is not associated with hormone therapy. Contact sensitizers might also have a role in melasma that is recalcitrant to all standard therapies. [ABSTRACT FROM AUTHOR]

Fixed drug eruption (FDE) is characterized by the development of well-demarcated erythematous to violaceous plaques, within minutes to hours of the intake of an offending drug. It is known as "fixed" because subsequent exposure to the implicated drug leads to the development of lesions at the same sites that were involved at the time of the previous drug exposure. Fluconazole, a widely used antifungal agent, has a good safety profile, and limited data exist on the development of bullous FDE due to fluconazole. Herein, we report a series of two cases presenting with a generalized bullous FDE (GBFDE), following the consumption of fluconazole. A temporal correlation, typical morphological features, symptoms, and a past history of FDE due to fluconazole were essential clues to the diagnosis. Furthermore, we utilized the Naranjo adverse drug reaction probability scale for causality assessment. Discontinuation of the drug was followed by the resolution of lesions in 7-10 days. GBFDE is an uncommon entity and requires immediate diagnosis as well as prompt discontinuation of the offending agent to minimize the complications. [ABSTRACT FROM AUTHOR]