An updated clinico-investigative approach to diagnosis of cutaneous hyperandrogenism in relation to adult female acne, female pattern alopecia & hirsutism a primer for dermatologists.

INTRODUCTION: Hyperandrogenism is a clinical state consequent to excess androgen production by the ovary, adrenals, or increased peripheral conversion of androgens. The varied manifestations of hyperandrogenism include seborrhea, acne, infertility, hirsutism, or overt virilization of which adult female acne, hirsutism, and female pattern hair loss are of clinical relevance to dermatologists. AREAS COVERED: We limited our narrative review to literature published during period from 1 January 1985 to Dec 2022 and searched PubMed/MEDLINE, Web of Science (WOS), Scopus, and Embase databases with main search keywords were 'Hyperandrogenism,' 'Female,' 'Biochemical,' 'Dermatological', and 'Dermatology.' We detail the common etiological causes, nuances in interpretation of biochemical tests and imaging tools, followed by an algorithmic approach which can help avoid extensive tests and diagnose the common causes of hyperandrogenism. EXPERT OPINION: Based on current data, total testosterone, sex hormone binding globulin, DHEAS, prolactin, free androgen index, and peripheral androgenic metabolites like 3-alpha diol and androsterone glucuronide are ideal tests though not all are required in all patients. Abnormalities in these biochemical investigations may require radiological examination for further clarification. Total testosterone levels can help delineate broadly the varied causes of hyperandrogenism. Serum AMH could be used for defining PCOM in adults.

Reverse Koebner's phenomenon in a case of Lymphohemangioma circumscriptum: A diagnostic clue representative of the Whimster hypothesis.

BACKGROUND: Lymphangioma circumscriptum are benign hamartomatous lymphatic growths, diagnosed clinically by the morphology of groups of clear fluid filled to serosanguinous fluid vesicles. MRI is an essential investigation to assess the depth of the lesions. AIM: To report an interesting hitherto unreported observation of Reverse Koebner's phenomenon, which can be used as a new diagnostic technique in Lymphohemagioma. METHOD: Biopsy was taken for the confirmation of the lesion which is an inflicted iatrogenic trauma which showed Reverse koebner's phenomenon in the lesion. RESULTS: Irregular shaped reddish blue painless plaque with rough lobulated surface with discrete firm reddish-blue painless papules, of varying sizes were biopsied. Post biopsy, significant reduction in size and redness of the lesions noticed. CONCLUSION: Disappearance of the lesions on biopsy indicates reminiscensce of the reverse koebner's phenonmenon.

Exploring the combination of SSKI and topical heparin in a case of erythema nodosum migrans.

Erythema nodosum migrans (subacute nodular migratory panniculitis) is an uncommon type of panniculitis characterized by migrating subcutaneous nodules or plaque on the lower extremity. There are a very few cases of Erythema nodosum migrans reported and thus its appropriate treatment modality is not defined. We describe a case of a 30-year-old male with idiopathic erythema nodosum migrans which was manifest centrifugally spreading, slightly morpheaform erythematous plaque on the lower left leg. The patient was diagnosed initially and treated as a case of furunculosis with poor clinical response. The skin biopsy showed features consistent with subacute nodular panniculitis. Saturated Solution of Potassium Iodide along with topical Heparin successfully treated the patient, when the conventional treatment modalities failed. In a morpheaform centrifugally expanded plaque, erythema nodosum migrans should be kept in mind in the differential diagnosis, especially in the lower extremities in cases of unknown etiology.

Nonfamilial Multiple Trichoepithelioma: Few and Far Between.

Trichoepithelioma is a rare benign adnexal tumor which may be of solitary nonfamilial type or multiple familial trichoepitheliomas. Here, we describe a rare presentation of nonfamilial case of trichoepithelioma in a 50-year-old female with multiple skin colored facial papules and nodules over the face, upper back, and extremities.

Narrowband UVB phototherapy in pityriasis rosea.

OBJECTIVE: Pityriasis rosea (PR) is an acute self-limiting disease. Despite vigorous efforts by generations of researchers since nearly 150 years, present treatment modalities for PR are not very gratifying. Ultraviolet radiation has been recommended in PR, although only a few studies validate this proposal. This study was conducted to explore the therapeutic effect of NBUVB on the symptoms, course, and severity of PR. MATERIALS AND METHODS: This study involved a hundred patients who were randomly divided into two groups, using computer-generated randomization chart. Group A underwent treatment with fixed dose NBUVB of 250 mJ/cm(2) three times (nonconsecutive) a week for 4 weeks. Group B formed the placebo group who did not receive any treatment. The two groups were compared with each other for the intensity of pruritis, course and duration of disease, and PR severity score (PRSS). RESULTS: The t values of improvement in PRSS score in Group A (t = 12.796) were higher as compared with that in Group B (t = 10.066). Similarly, the t value of the pruritus scale in Group A (t = 7.758) was higher than Group B (t = 5.754) indicating the symptomatic improvement in itching. CONCLUSION: Fixed-dose NBUVB phototherapy resulted in marked improvement in the severity and symptoms of the disease as quantitatively assessed by PRSS.

Is sclerotherapy useful for cherry angiomas?

BACKGROUND: Sclerotherapy is a safe, effective, and easily available treatment modality, its role in cherry hemangioma is still unexplored. OBJECTIVE: This study aims at establishing the role and efficacy of sclerotherapy in treating cherry angiomas and its dermatological complications. MATERIALS AND METHODS: This prospective study included 20 patients with 100 lesions of cherry hemangiomas of size >0.2 mm. Intralesional injection of 0.1 mL of 3% sodium tetradecyl sulfate was used. Scarring, if any, was evaluated using "The Stony Brook Scar Evaluation Scale." Patients were called for weekly sessions for a maximum of 4 weeks. RESULTS: Of 100 lesions treated, 42 lesions responded with a single dose of sclerosant, 44 lesions required a second setting. Remaining lesions were injected for 3 weeks, of which 14 lesions did not remit completely and required a fourth sitting. Depending on response to sclerotherapy, patients were divided into 2 groups (Group A and Group B). On comparing these groups, no statistically significant (χ test) difference in the rate of healing was observed. CONCLUSION: Sclerotherapy with sodium tetradecyl sulfate 3% is effective in the treatment of cherry hemangiomas. It offers an economical alternative to other available conventional methods.

Lyme disease in Haryana, India.

Lyme disease is a multiorgan animal-borne disease caused by the spirochete Borrelia burgdorferi. This case series highlights its presence in Haryana, a nonendemic zone. The first case was a 27-year-old housewife who presented with an annular erythematous patch with a central papule following an insect bite on the left upper arm. The second case was a 32-year-old farmer who gave a history of insect bite on the right arm followed by the development of an erythematous patch with a central blister. The third case, a 17-year-old boy presented with a history of tick bite over right thigh and a typical bull's eye lesion with central ulceration. These cases were managed with oral doxycycline 100 mg twice daily for 14 days. The fourth case was a 7-year-old boy with typical erythema migrans on the right check and neck while the fifth case, a 30-year-old housewife, presented with an erythematous patch with a central papule on the right buttock. These patients were treated with oral amoxycillin 25 mg/kg, thrice daily for 14 days. All patients showed IgM antibodies to B. burgdorferi. Treatment led to clearance of lesions in all the patients. Lyme borreliosis was diagnosed in these patients based on the history of established exposure to tick bites, presence of classic signs and symptoms, serology and the response to treatment.

Correlation of Vitamin D Levels with Pigmentation in Vitiligo Patients Treated with NBUVB Therapy.

Cholecalciferol (vitamin D) might play a physiological role in photo-induced melanogenesis in human skin. We estimated the levels of 25-hydroxy vitamin D [25(OH)D] before, during, and after Narrow Band Ultraviolet B (NBUVB) radiation in patients of vitiligo and their correlation with NBUVB induced pigmentation. Thirty patients of vitiligo and equal number of age and sex matched controls were recruited for the study. Vitiligo patients were treated with NBUVB thrice weekly for 12 weeks. [25(OH)D] levels and Vitiligo Area and Severity Index (VASI) were calculated at 0 (baseline), 6, and 12 weeks. Baseline [25(OH)D] levels were measured in controls. Significant reduction in VASI score was observed after 12 weeks of therapy. Comparison and correlation between mean improvement in VASI and [25(OH)D] levels at 12 weeks showed moderate correlation, and the results were statistically insignificant. Mean reduction in VASI and increase in [25(OH)D] levels after 12 weeks of NBUVB showed moderate correlation. Thus, vitamin D might play a significant role in photo-induced melanogenesis. However, there might be additional effects of the phototherapy on melanogenesis. The complete mechanism of NBUVB induced pigmentation in vitiligo needs to be elucidated.