A Delphi consensus on the nomenclature and diagnosis of lichen planus pigmentosus and related entities.

BACKGROUND: Although well known in clinical practice, research in lichen planus pigmentosus and related dermal pigmentary diseases is restricted due to lack of consensus on nomenclature and disease definition. AIMS AND OBJECTIVES: Delphi exercise to define and categorise acquired dermal pigmentary diseases. METHODS: Core areas were identified including disease definition, etiopathogenesis, risk factors, clinical features, diagnostic methods, treatment modalities and outcome measures. The Delphi exercise was conducted in three rounds. RESULTS: Sixteen researchers representing 12 different universities across India and Australia agreed to be part of this Delphi exercise. At the end of three rounds, a consensus of >80% was reached on usage of the umbrella term 'acquired dermal macular hyperpigmentation'. It was agreed that there were minimal differences, if any, among the disorders previously defined as ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis and pigmented contact dermatitis. It was also agreed that lichen planus pigmentosus, erythema dyschromicum perstans and ashy dermatosis did not differ significantly apart from the sites of involvement, as historically described in the literature. Exposure to hair colours, sunlight and cosmetics was associated with these disorders in a significant proportion of patients. Participants agreed that both histopathology and dermatoscopy could diagnose dermal pigmentation characteristic of acquired dermal macular hyperpigmentation but could not differentiate the individual entities of ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis, lichen planus pigmentosus and pigmented contact dermatitis. LIMITATIONS: A wider consensus involving representatives from East Asian, European and Latin American countries is required. CONCLUSION: Acquired dermal macular hyperpigmentation could be an appropriate conglomerate terminology for acquired dermatoses characterised by idiopathic or multifactorial non-inflammatory macular dermal hyperpigmentation.

Microdroplet Botulinum Toxin: A Review.

Microbotox is the administration of multiple microdroplets of botulinum toxin in intradermal plane. It is increasingly becoming popular owing to its more favorable outcome and better safety profile than the conventional technique. The intention is to treat fine lines and wrinkles without imparting an undesired "frozen face like" appearance. Besides facial rejuvenation, it has found its way into the management of other indications such as rosacea, hyperhidrosis, keloid, and seborrhea. Being a relatively newer method, knowledge about the various dilution methods, desired volume, and correct depth of injection involved in this technique remain scarce. In this article, the authors have highlighted various indications, procedures, adverse effects, and contraindications of microbotox.

Onabotulinumtoxin Type A Dosage for Upper Face Expression Lines in Males: A Systematic Review of Current Recommendations.

BACKGROUND: Botulinum toxin injection is the most commonly performed minimally invasive aesthetic procedure in men. Despite various recommendations by experts on the use of onabotulinumtoxin type A in the literature, distinct guidelines for its use in males and females do not exist. OBJECTIVES: The aim of this study was to delineate safe and effective doses for the use of onabotulinumtoxin type A in males for correction of upper facial expression lines. METHODS: PubMed (MEDLINE), Embase, the Cochrane database, and Google Scholar were searched from 2002 to 2019 inclusive. Three researchers independently assessed trials for inclusion, extracted data, checked for accuracy, and assessed the evidence with AGREE II. RESULTS: Average dosing recommended for the treatment of upper face expression lines was specific to glabellar frown lines, crow's feet, and horizontal forehead lines. Changing trends and gender variation was noted in each of the studies. Six of the 11 recommendations suggest the need to alter dosing in male patients, although do not give separate recommendations. CONCLUSIONS: There is an urgent need for up-to-date recommendations for the use of onabotulinumtoxin type A in upper face expression lines of male patients.

The changing paradigm of an aesthetic practice during the COVID-19 pandemic: An expert consensus.

Until vaccination for the SARS-CoV-2 becomes a reality, it appears that the infection is here to stay. With many countries lifting lockdown restrictions, aesthetic clinics have started reopening with strict standard operating procedures in place. It is pertinent that the physician today understands the infection, disinfection measures, and personal protective equipment to reduce chances of viral transmission and provide safe clinical settings for oneself, the staff and the patients. An online meeting of eight experts in the field of aesthetic dermatology was convened, which particularly focussed on PPE in detail, risk categorization of aesthetic procedures, preprocedure recommendations, and generalized and specialized SOP's for aesthetic procedures. These recommendations were aimed to bridge the gap between published guidelines and clinical practice and are by no means fully conclusive, but signify learnings over the past few months in an active clinical aesthetic practice.

A clinical, dermoscopic, histopathological and immunohistochemical study of melasma and facial pigmentary demarcation lines in the skin of color.

Melasma and facial pigmentary demarcation lines (FPDL) are common causes of patterned facial pigmentation that may mimic each other. There is a paucity of studies investigating these two conditions. The objective of this study was to make a detailed comparative analysis of these disorders. A clinical, dermoscopic, histopathological and immunohistochemical analysis of lesional and perilesional skin was conducted in 20 patients each of melasma and FDPL. The most common morphological patterns were centrofacial in melasma and W-shaped pattern in FPDL. Dermoscopy in melasma revealed similar patterns in lesional and perilesional skin, whereas FPDL did not. Histopathology of melasma revealed increased melanin in the suprabasal and basal layers (100%), melanophages in the upper dermis and solar elastosis (65%) in contrast to FPDL, wherein increased basilar melanin (75%) and dermal melanophages were the key findings. Expression of vascular endothelial growth factor and stem cell factor was slightly increased in lesional melasma skin, but not in FPDL. The study was limited by its small sample size and immunohistochemistry carried out in a few patients. Melasma and FPDL, although similar in presentation, are distinct entities. Dermoscopy, histology and immunohistochemistry reveal subtle differences.

Mesococktails and mesoproducts in aesthetic dermatology.

Mesotherapy is a convenient, safe and relatively painless non-surgical procedure. It has found its way into the aesthetic world and is employed for various indications such as lipolysis, skin rejuvenation, pigmentation and hair loss. The procedure involves delivery of mixture or cocktail of different compounds (plant extracts, nutrients, enzymes, homeopathic agents, pharmaceuticals, vitamins, amino acids and other bioactive substances) into the dermis or subcutaneous layer. A variety of techniques have been employed. The newer no-needle and micro-needle techniques are less invasive. Ingredients of the chosen mesococktail depend on the indication and play a major role in the outcome. Despite its popularity, mesotherapy has a scarcity of large scale studies on its efficacy and safety profile. Nevertheless, the choice of the mesoproduct and technique must be done with great detail to achieve the best desired effect.

Safer Practice of Aesthetic Dermatology during the COVID-19 Pandemic: Recommendations by SIG Aesthetics (IADVL Academy).

The COVID-19 pandemic caused by the SARS-CoV-2 virus, has changed the homeostasis of the medical world. In this critical phase, in addition to the general recommendations issued by World Health Organization (WHO) for medical practitioners and health care givers, certain other precautions and safe care practices need to be emphasized which are unique to each branch of medicine. Aesthetic dermatology is no exception. With aesthetic treatments on the rise, it is pertinent to formulate safe practices for aesthetic dermatology to protect the doctor, health staff and the patients from getting exposed during this phase and in the aftermath of the pandemic. Recommendations for surgical and dental procedures advice to defer such procedures. This can be extrapolated to aesthetic dermatology also, but once health care services start, there should be some safety recommendations to be followed until we have definitive management or a vaccine for it.

Use of a Hyaluronic Acid Soft-tissue Filler to Correct Congenital and Post-traumatic Lip Asymmetry.

BACKGROUND: The use of hyaluronic acid soft-tissue fillers for enhancement of lip features is a popular and minimally invasive office-based procedure used worldwide due to its relative simplicity and favorable safety profile. MATERIALS AND METHODS: Hyaluronic acid was used in illustrative cases to attempt correction of congenital and acquired lip asymmetries. RESULTS: In the cases presented, accurate and cosmetically acceptable results were attained and maintained for the duration of the product life. CONCLUSIONS: Hyaluronic acid may be used successfully when lip asymmetry is evident and is a relatively simple nonsurgical alternative.

Borrelial lymphocytoma cutis: a diagnostic dilemma.

Lymphocytoma cutis (LC) is one of the most common types of cutaneous B cell pseudolymphoma. Borrelial LC occurs most commonly in areas endemic for Ixodes ricinus tick in Europe, and it is rare in North America. The disease is rarely seen in India and may cause diagnostic difficulties for dermatologist residing in parts of the world that are not endemic for Lyme disease. The diagnosis is critical as LC may present as the only early manifestation of Lyme disease. Herein, we have presented a case of borrelial LC in an 11-year-old boy of German descent, residing in India.

A generalized, non-pruritic variant of lichen amyloidosis: a case report and a brief review.

Lichen amyloidosis (LA) has been considered a highly pruritic dermatosis, and the deposition of fibrillar material has generally been considered to be secondary to the scratching. Focal epidermal damage and chronic scratching have been implicated as the pathogenetic factors in the occurrence of LA, although they may not be able to explain the occurrence of a widespread variant of this dermatosis. There are few case reports describing the occurrence of a non-pruritic variant of LA. We hereby report a case of non-pruritic, generalized variant of lichen amyloidosis.

Glomeruloid hemangioma in normal individuals.

Glomeruloid hemangioma is a rare, histologically distinctive, cutaneous, benign vascular tumor, originally described by Chan et al. Glomeruloid hemangioma appears specific to polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome (POEMS), and is usually, but not always, related to Castleman's disease. We herein report two cases with glomeruloid hemangioma, without any features of the POEMS syndrome. Glomeruloid hemangioma requires a high index of suspicion for diagnosis. It could rarely present as a solitary finding, without any evidence of an underlying POEMS syndrome.

Ingrown toenails.

Onychocryptosis or ingrown toenail is a very common pathology of the toenail unit, chiefly affecting adolescents and young adults. The ingrown toenail is responsible for disabling complaints like pain and difficulty in walking. It is associated with significant morbidity, hampering the quality of life as it interferes with sporting activities, school, or work. It principally occurs in the hallux. It is ascribed to poor trimming of the nails in combination with local pressure due to ill-fitting footwear, hyperhidrosis, poor foot hygiene and nail abnormalities. Pain, swelling and discharge are the main clinical features. Four stages of the condition have been described. Diagnosis is usually evident, but it should be differentiated from subungual exostosis and tumors of the nail bed. The current standard of care focuses on conservative treatment like the gutter splint technique in the initial stages, and in cases that are resistant to medical management or recurrent, surgical correction is the treatment of choice. There are various surgical techniques that are described in literature. Although there is no ideal technique, lateral nail plate avulsion with lateral matricectomy by phenol is commonly used and reported to be more effective in reducing recurrences. The aim of this review article is to focus on this common pathology of the nail, the various techniques employed in management and aid in the selection of treatment according to the stage and severity of the disease.