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.

Mycobacterium welchii Vaccine Granuloma - A Cautionary Tale.

BACKGROUND: Mycobacterium welchii (Mycobacterium w) vaccine was one of the many strategies used to both treat and prevent coronavirus disease 2019 (COVID-19) infection. We report the results of a retrospective analysis of 15 cases with vaccine-site granulomas after administration of prophylactic Mycobacterium w vaccine as part of a trial for COVID-19 and our experience in managing those cases. METHODS: This was a retrospective analysis of 15 patients with vaccine-site granulomas who were given the vaccine as a prophylactic measure as part of a trial with informed consent. RESULTS: The mean average age of cases was 37 and the male-to-female ratio was 1:0.87. All of the patients developed erythematous tender nodules over the injection sites within a month of receiving the inoculations. Mycobacterial cultures and cartridge-based nucleic acid amplification tests yielded negative results. Skin biopsy revealed granulomatous dermatitis with acid-fast bacilli positivity. A diagnosis of noninfective granulomatous dermatitis was made. Treatment started with analgesics and anti-inflammatory agents. Systemic antibiotics were required in 9/15 patients. Patients are being followed up with no reported recurrence till date. CONCLUSION: The possibility of injection-site granuloma should be taken into the risk-benefit analysis for the administration of Mycobacterium w vaccine and the patients should be counseled as such. Patients with persistent ulceration respond to combinations of doxycycline, ofloxacin, and clarithromycin.

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.

Azathioprine-Induced Anagen Effluvium with Myelosuppression.

Anagen effluvium and myelosuppression are rare adverse effects of azathioprine. Hair loss due to azathioprine is more frequent in transplant than in nontransplant patients. We report three patients with azathioprine-induced anagen effluvium and myelosuppression, who were prescribed azathioprine for dermatologic conditions. (SKINmed. 2022;20:192-196).

Dermoscopy as an efficient aid to diagnose pigmentary and vascular component of periorbital melanosis: A cross-sectional study.

INTRODUCTION: Periorbital melanosis (POM) has a significant impact on quality of life. There is a dearth of literature regarding POM, especially in Asian population. Accurate classification of POM is contributory to the choice of therapy. The aim of this study was to assess the role of dermoscopy in etiologic classification of POM. METHODS: Two hundred and fifty adult patients (age > 18 years) of POM were enrolled over a period of 2 years. POM was classified clinically and re-evaluated based on their dermoscopic findings (pattern of pigmentary and vascular involvement, surface changes). RESULTS: Pigmented, vascular, structural, and mixed types of POM represented 6.4%, 4.8%, 0.4%, and 88.4%, respectively. Dermoscopy was found to be statistically more accurate in classifying pigmentary and vascular types of POM as compared to clinical examination with the naked eyes (p- value <0.05). Patchy or post-inflammatory pigmentation was the most common pigmentary pattern on dermoscopy (53.8%) followed by pseudoreticular (37.1%) and mixed pattern (9.1%). 80.4% patients had vascular involvement of which the most common vascular pattern was telangiectasia (58.8%). Wrinkling or increased skin laxity as a cause of shadow effect was found in 52% patients. Diffuse erythema and scaling suggestive of subtle inflammation was detected in 47.6% patients on dermoscopy. CONCLUSION: Dermoscopy as a diagnostic modality is more accurate in detecting pigmentary and vascular causes of POM and subtle signs of active inflammation in the form of erythema and scaling which is difficult to detect clinically. The major limitations of this study were lack of correlation of dermoscopic findings with the histological findings and the absence of any control group for comparison.

Grade 2 disability among leprosy patients: A pilot study from an endemic area of Central India.

Background and Aim: Deformities and disabilities in leprosy lead to significant morbidity to the individual and financial burden to the family. As the prevalence of leprosy is higher in central India, this study was conducted to know the burden of deformity and disability among leprosy patients in central India and the factors associated with it. Materials and methods: This was a hospital-based, cross-sectional study, conducted on 50 new or on treatment or released from treatment leprosy patients, attending the Dermatology OPD of a tertiary care institute in Central India. Disability was graded as per the WHO criteria for disability grading of hands and feet. Results: Grade 2 disability was found among 32% of the patients with leprosy, whereas a total of 60% of our patients had either grade 1 or grade 2 disabilities. Trophic ulcer was found among 20% and claw hand among 14% of leprosy patients. We found significant associations of lepromatous leprosy with trophic ulcer (p = 0.004) and grade 2 disability (p = 0.012). All patients with claw hands and 80% of the patients with trophic ulcers presented to the healthcare facility at least 6 months after the onset of symptoms. Conclusions: We found very high rates of disability and deformity among leprosy patients indicating possible huge burden of morbidity among leprosy patients in central India. The significant association of lepromatous leprosy with trophic ulcer and grade 2 disability indicated delayed presentation and diagnosis of lepromatous leprosy patients. Our results underlined the need for large scale community-based studies on disability and deformity among leprosy patients in Central India. These results also call for better training of primary level healthcare workers for early detection and management of deformities and disabilities as well as better patient education for leprosy patients regarding hand and foot care.

Dermoscopy in general dermatology (non-neoplastic dermatoses) of skin of colour: a comparative retrospective study by the International Dermoscopy Society.

BACKGROUND: Dermoscopy has been shown to be a useful supportive tool to assist the diagnosis of several non-neoplastic dermatoses (i.e. inflammatory, infiltrative and infectious skin diseases), yet data on skin of colour is still limited. OBJECTIVES: To characterize dermoscopic features of non-neoplastic dermatoses in dark-skinned patients in order to identify possible clues that may facilitate the differential diagnosis of clinically similar conditions. MATERIALS & METHODS: Members of the International Dermoscopy Society were invited to submit cases of any non-neoplastic dermatosis developing in patients with Fitzpatrick Phototypes V-VI whose diagnosis had been confirmed by the corresponding gold standard diagnostic test. A standardized assessment of the dermoscopic images and a comparative analysis according to clinical presentation were performed. Seven clinical categories were identified: (I) papulosquamous dermatoses; (II) facial hyperpigmented dermatoses; (III) extra-facial hyperpigmented dermatoses; (IV) hypopigmented dermatoses; (V) granulomatous dermatoses; (VI) sclerotic dermatoses; and (VII) facial inflammatory dermatoses. RESULTS: A total of 653 patients (541 and 112 with Phototype V and VI, respectively) were recruited for the analysis. Thirty-six statistically significant dermoscopic features were identified for papulosquamous dermatoses, 24 for facial hyperpigmented disorders, 12 for extra-facial hyperpigmented disorders, 17 for hypopigmented disorders, eight for granulomatous dermatoses, four for sclerotic dermatoses and 17 for facial inflammatory diseases. CONCLUSION: Our findings suggest that dermoscopy might be a useful tool in assisting the diagnosis of clinically similar non-neoplastic dermatoses in dark phototypes by revealing characteristic clues. Study limitations include the retrospective design, the lack of a direct dermoscopic-histological correlation analysis and the small sample size for less common diseases.

Sporotrichoid presentation of lupus vulgaris mimicking mycetoma.

Most common form of cutaneous tuberculosis (TB) is lupus vulgaris (LV). Atypical presentation of LV is rare and may lead to delay in diagnosis and hence increase in morbidity. Here, we report a case of sporotrichoid form of LV in a 38 year old male who presented as cutaneous lesions mimicking mycetoma. High index of clinical suspicion and relevant investigations play a vital role in confirmation of diagnosis wherever atypical form of cutaneous TB is suspected.

Lupus Vulgaris of the Pinna-A Case Report.

INTRODUCTION: Lupus vulgaris is the most common form of cutaneous tuberculosis caused by contiguous spread from an underlying infective focus or lymphatic or hematogenous spread. It can also develop at the site of direct inoculation (e.g., tattooing and ear piercing) or Bacillus Calmette-Guerin vaccination. The solitary involvement of the pinna is rare and may face clinicians with a diagnostic dilemma. Herein, we reported the case of a 37-year-old female presenting with lupus vulgaris of the left pinna with a history of ear piercing. CASE REPORT: Our case was a 37-year-old female presenting with asymptomatic erythematous plaques on the left pinna for 2 years. She had a history of ear piercing done 20 years ago. After 6 months of ear piercing, she suffered from recurrent infections at the site of piercing in the left ear, while the other ear was normal. Two years earlier, she developed a small erythematous papule, which slowly progressed in size to the present status. On examination, well-defined erythematous scaly plaques were noted on the left helix. The histopathology of the skin biopsy showed multiple confluent granulomas consisting of the epithelioid cells and lymphocyte with a focal area of necrosis in the dermis. Acid-fast bacilli were not seen in modified Ziehl-Neelsen (ZN) and routine ZN staining. A final diagnosis of lupus vulgaris was made, and the patient was started on antitubercular drugs. There was a significant resolution of the lesion after 2 months of treatment. CONCLUSION: Cutaneous tuberculosis should be considered in the differential diagnosis of chronic nonhealing granulomatous skin lesions developing at the site of ear piercing.