A multicentric study on dermoscopic patterns and clinical-dermoscopic-histological correlates of basal cell carcinoma in Indian skin.

BACKGROUND: Literature on the dermoscopic patterns of basal cell carcinoma (BCC) in India is limited. AIM: To describe the dermoscopic pattern and dermoscopic-histopathological correlation in a large cohort of patients with BCC from India, with a particular focus on skin of colour (SOC). METHODS: This retrospective study was conducted under the aegis of the Dermatoscopy Society of India. Clinical details were collected, and two lead authors independently analysed dermoscopic images of BCC for a predefined set of characteristics. Histopathological slides/blocks were reviewed, and dermoscopic-histological correlation attempted. RESULTS: In total, 143 patients with BCC and skin phototypes IV-VI were included. The mean largest BCC diameter was 3.10 ± 3.68 cm and there was a significant but weak association between duration and largest dimension of the lesion (Spearman ρ = 0.33, P < 0.01). Nearly half of the cases were diagnosed with pigmented BCC and the most common histological subtype was nodular BCC (37.9%). Dermoscopically, blue-grey dots and arborizing vessels were the most common features (60.0%). Pigmentary changes were found in the majority of cases, and included blue-white veil, blue-grey ovoid nests and maple leaf-like areas. A third of our patients had short linear telangiectasia, polymorphic vessels and regular dotted vessels, and another third exhibited a dermoscopic rainbow effect. Arborizing vessels were significantly more common with micronodular (78.9%) and nodular variants (74.1%, P = 0.05), whereas regular dotted vessels (68.4%, P = 0.04), blue-white veil (84.2%, P = 0.02) were significantly associated with micronodular variant. CONCLUSION: The dermoscopic patterns of blue-white veil and regular dotted vessels are indicators towards micronodular BCC in SOC and can help in prioritizing treatment.

Intralesional measles, mumps, and rubella vaccine immunotherapy in molluscum contagiosum: A retrospective observational study from a tertiary care center in north India.

Molluscum contagiosum (MC) is a mucocutaneous viral infection, often self-limiting but untreated lesions can often last for 2 months to 2 years. Previously intralesional measles, mumps, and rubella (MMR) vaccine has been tried for the treatment of warts but no studies exist of its use in MC. We report our experience with intralesional MMR in 22 patients of MC. The study was carried out to assess the efficacy and safety of intralesional MMR vaccine in patients of MC. We retrospectively analyzed records of patients who received intralesional MMR for MC from September 2018 to September 2019. Demographic characteristics, number, size, and site of molluscum lesions, number of MMR injections given, and response were recorded. Records of 22 patients were analyzed. There were 10 males and 12 females. The age of the patients ranged from 6 to 50 years with a mean of 19.72 ± 10.92. At the end of 12 weeks, 18 patients (81.8%) had complete clearance of lesions, with 4 patients (18.18%) having a partial response of more than 50%. No patient showed less than 50% or no response. In only one patient who had giant molluscum, postinflammatory hyperpigmentation was noted. No other adverse effect was seen in any of the patients. MMR is a safe, effective, easy to administer, time-saving, and inexpensive therapy for lesions of MC.

Idiopathic perniosis presenting as acral purpuric lesions: Clustering of cases before COVID-19 pandemic and their comparison with chilblain like lesions reported in the literature.

Perniosis/chilblains are the acral inflammatory skin lesions developing in susceptible individuals as an abnormal reaction to cold. In the absence of a discernible cause, it is labeled as idiopathic perniosis (IP). With the ongoing COVID-19 pandemic, there was an upsurge of reports of chilblain like lesions (CLL) especially in young patients possibly implicated to the SARS-CoV-2 virus. Twelve clinically suspected and histopathologically confirmed cases of IP seen from November 2019 through February 2020 were retrospectively recruited. Clinical, dermoscopic, and histopathological characteristics of these were reviewed and compared with CLL reported in the literature. Mean age of patients was 26.58 ± 15.18 years with an equal male to female ratio. Characteristic histopathology findings were spongiosis (100%), dermal edema (100%), perivascular lymphocytic infiltrate (100%) with peri-eccrine accentuation (66.7%), keratinocyte necrosis (50%), focal basal vacuolar damage (58.3%), and lymphocytic vasculitis (58.3%). Significant dermoscopy findings were variable background color ranging from dull red and violaceous to copper red and brown orange, coiled vessels (44.4%) and orange-red structureless areas (63.9%). Lesions over palms and soles preferentially had white dots/clods and lines (38.9%). There appears no exclusive histopathological as well as dermoscopy features of CLL and IP, yet certain clues can be appreciated. Keratinocyte necrosis and severe dermal edema favors IP, whereas fibrin thrombi with involvement of both superficial and deep dermal vessels favor CLL. Dermoscopically presence of irregular, linear or branching vessels, red/purple dots and clods and gray brown reticule supports CLL while white dots/clods and lines supports IP.

Dermoscopic characterization of guttate psoriasis, pityriasis rosea, and pityriasis lichenoides chronica in dark skin phototypes: An observational study.

Dermoscopy as a diagnostic tool is attaining impetus in inflammatory dermatoses with the cumulative description of characteristic findings in most dermatoses obviating at times the need of biopsy. In this retrospective observational study, 20 histopathology confirmed cases each of pityriasis rosea (PR), guttate psoriasis (GP), and pityriasis lichenoides chronica (PLC) seen over a period of 3 years were included. Dermoscopy images were extracted from photography archives for evaluation and three lesions from each patient (60 lesions each) were analyzed. Comparison of dermoscopy characters was done among PR, GP, and PLC in pairs using chi-square test and a P-value of less than .05 was considered significant. Most common background color in PR (86.7%) and PLC (96.7%) was yellow to yellow-orange and in GP was dull red to pink (70%). Vessels were visualized in all lesions of GP and most characteristic pattern was regular (93.3%), dotted vessels (95%). In PR 63.3% lesions had dotted vessels mostly in a patchy distribution (56.7%). Most prominent scale color in PR was yellow-white (88.3%) and in GP was white-gray (80%). In PLC varying colors were seen, most prominent being brown (53.3%). Characteristic findings seen only in PLC were hypopigmented areas (13.3%), brown dots and globules (53.3%) and orange-yellow structureless areas (61.7%) GP, PR, and PLC reveal specific dermoscopic findings that can help in differentiating them. Further, the known dermoscopic criteria for GP, PR, and PLC also apply for dark skin phototypes.

Dermoscopic findings of a congenital smooth muscle hamartoma in an infant.

Cutaneous smooth muscle hamartoma is an uncommon, benign tumor developing in the dermis as a result of disorganized hyperproliferation of arrector pili muscle fibers. We present a 1-month-old infant with a congenital smooth muscle hamartoma together with the dermoscopic findings of the case. Dermoscopy can be a helpful non-invasive tool in diagnosing congenital smooth muscle hamartoma due to its distinct findings that help to differentiate it from close mimickers like solitary mastocytoma.

Generalized Hailey-Hailey disease with flexural keratotic papules: An interesting presentation and remarkable response with minocycline.

Hailey-Hailey disease is a hereditary blistering disorder characterized by episodic vesicles, pustules, erosions, and maceration mainly in intertriginous areas with generalized eruptions encountered rarely. We present a case of generalized HHD with keratotic papules over flexural areas along with its dermoscopic features; treated successfully with minocycline alone.

Targeting brain tumors with innovative nanocarriers: bridging the gap through the blood-brain barrier.

Background: Glioblastoma multiforme (GBM) is recognized as the most lethal and most highly invasive tumor. The high likelihood of treatment failure arises from the presence of the blood-brain barrier (BBB) and stem cells around GBM, which avert the entry of chemotherapeutic drugs into the tumor mass. Objective: Recently, several researchers have designed novel nanocarrier systems like liposomes, dendrimers, metallic nanoparticles, nanodiamonds, and nanorobot approaches, allowing drugs to infiltrate the BBB more efficiently, opening up innovative avenues to prevail over therapy problems and radiation therapy. Methods: Relevant literature for this manuscript has been collected from a comprehensive and systematic search of databases, for example, PubMed, Science Direct, Google Scholar, and others, using specific keyword combinations, including "glioblastoma," "brain tumor," "nanocarriers," and several others. Conclusion: This review also provides deep insights into recent advancements in nanocarrier-based formulations and technologies for GBM management. Elucidation of various scientific advances in conjunction with encouraging findings concerning the future perspectives and challenges of nanocarriers for effective brain tumor management has also been discussed.

Investigating the Potential Therapeutic Mechanisms of Puerarin in Neurological Diseases.

Plants and their derived phytochemicals have a long history of treating a wide range of illnesses for several decades. They are believed to be the origin of a diverse array of medicinal compounds. One of the compounds found in kudzu root is puerarin, a isoflavone glycoside commonly used as an alternative medicine to treat various diseases. From a biological perspective, puerarin can be described as a white needle crystal with the chemical name of 7-hydroxy-3-(4-hydroxyphenyl)-1-benzopyran-4-one-8-D-glucopyranoside. Besides, puerarin is sparingly soluble in water and produces no color or light yellow solution. Multiple experimental and clinical studies have confirmed the significant therapeutic effects of puerarin. These effects span a wide range of pharmacological effects, including neuroprotection, hepatoprotection, cardioprotection, immunomodulation, anticancer properties, anti-diabetic properties, anti-osteoporosis properties, and more. Puerarin achieves these effects by interacting with various cellular and molecular pathways, such as MAPK, AMPK, NF-κB, mTOR, ß-catenin, and PKB/Akt, as well as different receptors, enzymes, and growth factors. The current review highlights the molecular mechanism of puerarin as a neuroprotective agent in the treatment of various neurodegenerative and neurological diseases. Extensive cellular, animal, and clinical research has provided valuable insights into its effectiveness in conditions such as Alzheimer's disease, Parkinson's disease, epilepsy, cerebral stroke, depression, and more.

Mechanistic insights into the potential role of dietary polyphenols and their nanoformulation in the management of Alzheimer's disease.

Alzheimer's disease (AD) is a very common neurodegenerative disorder associated with memory loss and a progressive decline in cognitive activity. The two major pathophysiological factors responsible for AD are amyloid plaques (comprising amyloid-beta aggregates) and neurofibrillary tangles (consisting of hyperphosphorylated tau protein). Polyphenols, a class of naturally occurring compounds, are immensely beneficial for the treatment or management of various disorders and illnesses. Naturally occurring sources of polyphenols include plants and plant-based foods, such as fruits, herbs, tea, vegetables, coffee, red wine, and dark chocolate. Polyphenols have unique properties, such as being the major source of anti-oxidants and possessing anti-aging and anti-cancerous properties. Currently, dietary polyphenols have become a potential therapeutic approach for the management of AD, depending on various research findings. Dietary polyphenols can be an effective strategy to tackle multifactorial events that occur with AD. For instance, naturally occurring polyphenols have been reported to exhibit neuroprotection by modulating the Aß biogenesis pathway in AD. Many nanoformulations have been established to enhance the bioavailability of polyphenols, with nanonization being the most promising. This review comprehensively provides mechanistic insights into the neuroprotective potential of dietary polyphenols in treating AD. It also reviews the usability of dietary polyphenol as nanoformulation for AD treatment.

Dermoscopy of Bacterial, Viral, and Fungal Skin Infections: A Systematic Review of the Literature.

Over the last three decades, the use of dermoscopy has been extended to inflammatory and infectious dermatoses. Regarding the latter, while the first applications concerned skin parasitoses, there has been a significant increase in the publication trend regarding nonparasitic dermatoses over recent years, yet data on this topic are sparse and often lack a standardized analytical approach. This systematic literature review summarizes published data on dermoscopy of bacterial, viral, and fungal dermatoses (dermoscopic findings, used setting, pathological correlation, and level of evidence of studies) and provides a homogeneous terminology of reported dermoscopic features according to a standardized methodology. A total of 152 papers addressing 43 different dermatoses and describing 184 different dermoscopic findings were included in the analysis. The majority of them displayed a level of evidence of V (107 single case reports and 40 case series), with only 5 studies showing a level of evidence of IV (case-control studies). Moreover, our analysis also underlined a high variability in the terminology used in published articles (even for the same dermatosis). Therefore, despite significant potential, future studies designed according to a systematic and standardized approach are required for a better characterization of dermoscopy of nonparasitic skin infections.

Dermoscopy in the Diagnosis of Palmoplantar Eczema and Palmoplantar Psoriasis: A Cross-Sectional, Comparative Study from a Tertiary Care Centre in North India.

Introduction: Palmoplantar hyperkeratotic lesions pose a diagnostic difficulty when differentiating clinically between palmoplantar psoriasis (PPP) and palmoplantar eczema (PPE). Dermoscopy can provide valuable clues in reaching the final diagnosis. Objectives: To identify and compare dermoscopic findings seen in PPP and PPE. Methods: This was a cross-sectional, comparative study carried out prospectively between March 2019 and June 2020. All adult, consenting patients visiting the dermatology outpatient department who were clinically diagnosed and histopathologically confirmed as PPP and PPE were recruited into two groups. The dermoscopic examination was done, and images were taken from the representative area. The findings were analysed by two dermatologists who were unaware of the diagnosis. The sensitivity, specificity, positive predictive value and negative predictive value of these findings were assessed. Result: A total of 81 patients were recruited (39 patients of PPP and 42 patients of PPE). Significant findings seen in psoriatic plaques were the presence of regular vessels (84.6%, P < 0.001), with diffuse scales (87.2%) over a dull red/pink background (69.2%, P < 0.001). Dermoscopy of PPE displayed a significant presence of yellowish scales (76.2%, P < 0.001), with focal (61.9%) or absent vessels (35.7%), brown/orange-brown dots and/or globules (66.7%), yellow/yellow-orange crusts (57.1%) over a yellow/yellow-brown background (88.1%). Conclusion: Distribution of vessels, distribution of scales and the colour of scales, presence of brown/orange-brown dots and/or globules, yellow/yellow-orange crust and background colour (dull red vs. yellow/yellow-brown) of the plaques can be useful clues in the diagnosis of PPP and PPE.

Synergistically Driven CoCr-LDH@VNiS2 as a Bifunctional Electrocatalyst for Overall Water Splitting and Flexible Supercapacitors.

Utilizing alternative energy sources to fossil fuels has remained a significant issue for humanity. In this context, efficient earth-abundant bifunctional catalysts for water splitting and energy storage technologies like hybrid supercapacitors have become essential for achieving a sustainable future. Herein, CoCr-LDH@VNiS2 was synthesized by hydrothermal synthesis. The CoCr-LDH@VNiS2 catalyst entails 1.62 V cell voltage to reach the current density of 10 mA cm-2 for overall water splitting. The CoCr-LDH@VNiS2 electrode illustrates a high electrochemical specific capacitance (Csp) of 1380.9 F g-1 at a current density of 0.2 A g-1 and an outstanding stability with 94.76% retention. Moreover, the flexible asymmetric supercapacitor (ASC) achieved an energy density of 96.03 W h kg-1@0.2 A g-1 at a power density of 539.98 W kg-1 with remarkable cyclic stability. The findings provide a new approach toward the rational design and synthesis of bifunctional catalysts for water splitting and energy storage.

International Dermoscopy Society (IDS) Criteria for Skin Tumors: Validation for Skin of Color Through a Delphi Expert Consensus by the "Imaging in Skin of Color" IDS Task Force.

INTRODUCTION: A structured set of eight basic dermoscopic parameters (lines, clods, dots, circles, pseudopods, structureless, else, and vessels) including a total of 77 variables with corresponding descriptive and metaphoric vocabulary has been released for evaluation of skin tumors by the International Dermoscopy Society (IDS). OBJECTIVES: To validate the aforementioned criteria for the use in darker phototypes (phototypes IV-VI) via an expert consensus. METHODS: The two-round "Delphi method" was adopted, with an iterative process including two rounds of email questionnaires. Potential panelists were asked to take part in the procedure via email on the basis of their expertise in the dermoscopy of skin tumors in dark phototypes. RESULTS: A total of 17 participants were involved. All the original variables of the eight basic parameters reached agreement during the first round, except for "pink small clods" ("milky red globules") and "structureless pink zone" ("milky red areas"). Moreover, during the first round, panelists proposed a change of three existing items and the introduction of four new items, i.e., "black, small clods" ("black globules"), "follicular plugs", "erosions/ulcerations", and "white color around vessels" ("perivascular white halo"). All such proposals achieved agreement, thus being included in the final list, for a total of 79 items. There was consistency between the descriptive and metaphoric approaches in terms of scoring. CONCLUSIONS: Albeit most of the original items were considered applicable even for skin of color, there are some points of differences that physicians need to know. No significant preference was found between descriptive and metaphoric terminology among panelists.

Dermoscopy of Cutaneous Neoplasms in Skin of Color - A Systematic review by the International Dermoscopy Society "Imaging in Skin of Color" Task Force.

Over the last few decades, dermoscopy has been showed to facilitate the non-invasive diagnosis of both benign and malignant skin tumors, yet literature data mainly comes from studies on light photo-types. However, there is growing evidence that skin neoplasms may benefit from dermoscopic assessment even for skin of color. This systematic literature review evaluated published data in dark-skinned patients (dermoscopic features, used setting, pathological correlation, and level of evidence of studies), also providing a standardized and homogeneous terminology for reported dermoscopic findings. A total of 20 articles describing 46 different tumors (four melanocytic neoplasms, eight keratinocytic tumors, 15 adnexal cutaneous neoplasms, seven vascular tumors, four connective tissue tumors, and eight cystic neoplasms/others) for a total of 1724 instances were included in the analysis. Most of them showed a level of evidence of V (12 single case reports and six case series), with only two studies featuring a level of evidence of IV (case-control analysis). Additionally, this review also underlined that some neoplasms and phototypes are underrepresented in published analyses as they included only small samples and mainly certain tones of "dark skin" spectrum (especially phototype IV). Therefore, further studies considering such limitations are required for a better characterization.

Dermoscopy of Hair and Scalp Disorders (Trichoscopy) in Skin of Color - A Systematic Review by the International Dermoscopy Society "Imaging in Skin of Color" Task Force.

Hair and scalp disorders are of significant interest for physicians dealing with dark phototypes due to their prevalence and potential aesthetic impact resulting from a higher tendency for scarring. In order to facilitate their non-invasive diagnosis, several dermoscopic studies have been published, yet data are sparse and no systematic analysis of the literature has been performed so far. This systematic literature review summarizes published data on trichoscopy of hair and scalp diseases (trichoscopic findings, used setting, pathological correlation, and level of evidence of studies). A total of 60 papers addressing 19 different disorders (eight non-cicatricial alopecias, nine cicatricial alopecias, and two hair shaft disorders) were assessed, for a total of 2636 instances. They included one cross-sectional analysis, 20 case-control studies, 25 case-series, and 14 single case-reports, so the level of evidence was V and IV in 65% and 33% of cases, respectively, with only one study showing a level of evidence of III. Notably, although there is a considerable body of literature on trichoscopy of hair/scalp diseases, our review underlined that potentially significant variables (e.g., disease stage or hair texture) are often not taken into account in published analyses, with possible biases on trichoscopic patterns, especially when it comes to hair shaft changes. Further analyses considering all such issues are therefore needed.

Dermoscopy of Infectious Dermatoses (Infectiouscopy) in Skin of Color - A Systematic Review by the International Dermoscopy Society "Imaging in Skin of Color" Task Force.

Dermoscopy has been showed to facilitate the non-invasive recognition of several infectious disorders (infectiouscopy) thanks to the detection of peculiar clues. Although most of the knowledge on this topic comes from studies involving light-skinned patients, there is growing evidence about its use also in dark phototypes. This systematic literature review summarizes published data on dermoscopy of parasitic, bacterial, viral and fungal dermatoses (dermoscopic findings, used setting, pathological correlation, and level of evidence of studies) and provides a homogeneous terminology of reported dermoscopic features according to a standardized methodology. A total of 66 papers addressing 41 different dermatoses (14 bacterial, 5 viral, 11 fungal infections, and 11 parasitoses/bites and stings) and involving a total of 1096 instances were included in the analysis. The majority of them displayed a level of evidence of V (44 single case reports and 21 case series), with only 1 study showing a level of evidence of IV (case-control analysis). Moreover, our analysis also highlighted a high variability in the terminology used in the retrieved studies. Thus, although promising, further studies designed according to a systematic and standardized approach are needed for better characterization of dermoscopy of infectious skin infections.

Dermoscopy of Inflammatory Dermatoses (Inflammoscopy) in Skin of Color - A Systematic Review by the International Dermoscopy Society "Imaging in Skin of Color" Task Force.

Dermoscopic patterns of inflammatory dermatoses (inflammoscopy) have been extensively studied in the recent years, though data on patients with darker phototypes (IV-VI) are sparse. The aims of this systematic review were to summarize the current state of knowledge on inflammoscopy applied to skin of color and provide a standardized nomenclature of reported findings. Besides dermoscopic features, type of setting and magnification, number of cases, and histopathological correlation were analyzed. Eighty-five papers addressing 78 different dermatoses (25 papulosquamous dermatoses, 19 hyperpigmented dermatoses, eight hypopigmented dermatoses, four granulomatous dermatoses, two sclerotic dermatoses, five facial inflammatory dermatoses, and 15 miscellaneous conditions) for a total of 2073 instances were retrieved. Only one study showed a level of evidence of III (cross-sectional study), whereas 10 and 74 displayed a level of evidence of IV (case-control studies) and V (case-series and case-reports), respectively. Moreover, our analysis also highlighted that most of papers focalized on a limited number of dermatoses, with several conditions having only single dermoscopic descriptions. Additionally, few studies compared findings among phototypes belonging to the "skin of color" spectrum. Further studies designed according to a systematic approach and considering the above-mentioned issues are therefore needed.

Dermoscopic Characterization of Zoon Balanitis: First Case Series from Asia.

Zoon balanitis is a rare chronic inflammatory dermatosis involving genitalia. It is often misdiagnosed or diagnosed late leading to significant patient distress. Dermoscopy can act as a useful modality in prompt diagnosis of zoon balanitis. Herein, we report dermoscopic findings in twelve lesions of zoon balanitis in seven patients.