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.

[Hansen Disease: A Type of Figurate Erythema]. / Doença de Hansen: Uma Forma de Eritema Figurado.

N/a.

Annular Lesions: Diagnosis and Treatment.

Annular lesions can present in a variety of diseases. Knowledge of the physical appearance and history of presentation of these skin findings can help in the diagnosis. A pruritic, annular, erythematous patch that grows centrifugally should prompt evaluation for tinea corporis. Tinea corporis may be diagnosed through potassium hydroxide examination of scrapings. Recognizing erythema migrans is important in making the diagnosis of Lyme disease so that antibiotics can be initiated promptly. Plaque psoriasis generally presents with sharply demarcated, erythematous silver plaques. Erythema multiforme, which is due to a hypersensitivity reaction, presents with annular, raised lesions with central clearing. Lichen planus characteristically appears as planar, purple, polygonal, pruritic papules and plaques. Nummular eczema presents as a rash composed of coin-shaped papulovesicular erythematous lesions. Treatment is aimed at reducing skin dryness. Pityriasis rosea presents with multiple erythematous lesions with raised, scaly borders, and is generally self-limited. Urticaria results from the release of histamines and appears as well-circumscribed, erythematous lesions with raised borders and blanched centers. Annular lesions occur less commonly in persons with fixed drug eruptions, leprosy, immunoglobulin A vasculitis, secondary syphilis, sarcoidosis, subacute cutaneous lupus erythematosus, and granuloma annulare.

A retrospective study of the utility of targeted phototherapy in vitiligo.

BACKGROUND: Targeted phototherapy is a recent advance in the treatment of vitiligo, involving selective treatment of vitiligo patches with no effect on surrounding areas. Although it has been in use for a few years, little data is available regarding its safety and efficacy. AIMS: A retrospective study to determine efficacy and safety of targeted phototherapy in vitiligo. METHODS: One hundred and thirty four patients (male: 53, female: 81) who received targeted phototherapy and completed 11 or more sittings were included. Treatment was given once a week using the Lumera phototherapy system, a broadband ultraviolet B source, starting at 150 mJ/spot and after excluding a sunburn reaction, with increments of 50 mJ every week up to a maximum of 1000 mJ/patch. Chi-square test for linear trends was used for statistical analysis. RESULTS: The most common sites involved were the legs and a majority (70.9%) had non-segmental vitiligo. Response was mild in 78 (58.2%) patients, moderate in 50 (37.3%) and excellent in 6 (4.5%) patients. Response was directly proportional to the number of sittings with more patients showing moderate and excellent responses with an increase in the number of sittings. The most common site for an excellent response was the trunk while the lower limbs were involved in most cases with a moderate or mild response. Side effects were seen in 27 (20.2%) patients, the commonest being erythema. LIMITATIONS: This is a retrospective uncontrolled study. Further, the effects of adjuvant treatment were not assessed. CONCLUSIONS: Targeted phototherapy is a useful treatment for vitiligo with mild adverse effects, though response is mild or moderate and appears to be directly proportional to the number of treatments received.

Evaluation of an ablative and non-ablative laser procedure in the treatment of striae distensae.

BACKGROUND: Striae distensae or stretch marks are atrophic linear dermal scars with epidermal atrophy. There are many therapeutic options for management, but no consistently effective modality is available yet. OBJECTIVE: We compared the efficacy of 1064 nm long pulse (LP) Nd: YAG laser and 2940 nm variable square pulse (VSP) erbium: YAG laser in the treatment of striae distensae. METHODS: Twenty female volunteers (Fitzpatrick skin types II-V) aged between 20 and 40 years with striae (3 patients with the rubra type and 17 with the alba type) were enrolled in the study. The duration of striae ranged from 4 months to 12 years. Lesions were located on the abdomen in all patients except one patient who had striae on the arms and two patients with striae in the lumbar region. Treatments were randomly allocated to both sides of the body in each patient, one side being treated with VSP erbium: YAG laser and the opposite side with LP Nd: YAG laser. All subjects were treated monthly for a total of three treatments. Two 3-mm punch biopsies were obtained from six subjects, both of the same striae, one before the first treatment and one 4 weeks after the last session. RESULTS: Response was evaluated clinically by photographic comparison and was found to be poor in 17 subjects, both on the LP Nd: YAG laser treated side and VSP erbium YAG laser treated side. All these patients had mature lesions (striae distensae alba). Three subjects had a moderate response on both sides; these patients' striae were immature (striae distensae rubra). Histologically, elastic fibers were slightly increased in post-treatment samples compared with pretreatment skin biopsies. CONCLUSION: We observed no satisfactory clinical improvement in striae distensae alba lesions although histopathological changes were seen. We suggest that variable square pulse Er: YAG and long pulse Nd: YAG lasers are not useful in the treatment of striae distensae alba.