Dermatoscopy of Urticaria Pigmentosa with and without Darier's Sign in Skin of Colour.

Urticaria pigmentosa is the most common form of mastocytosis that often develops in infancy or early childhood. We report two male children- first, a 7-month-old child with a history of asymptomatic multiple dark colored skin lesions macules with wheals on gentle rubbing (Darier's sign) and second, a 2-year-old child with similar clinical presentation without Darier's sign. Dermoscopy showed dark brown lines in a reticulate pattern which is an exaggeration of the pigment network seen in the normal skin. The reticulate pigment network was darker and thicker in the child with positive Darier's sign. This is the first case report of dermoscopy of urticarial pigmentosa with and without Darier's sign reported in skin of colour.

Cross-Sectional Study of Dermatoscopic Findings in Relation to Activity in Vitiligo: BPLeFoSK Criteria for Stability.

BACKGROUND: Stability in vitiligo is an important concept in guiding patient management and a vital prerequisite before vitiligo surgery. Disease activity of vitiligo based on patient's history is imprecise. It is practically impossible to perform biopsy from all lesions of vitiligo to ascertain stability. Dermatoscopy can be used to examine all clinical lesions in a patient of vitiligo. There is a need to validate many reported dermatoscopic findings for universal use. AIMS: To analyze the significance of dermatoscopic findings in the activity of vitiligo and to devise a cutoff score for stable vitiligo. MATERIALS AND METHODS: Dermatoscopic examination was performed in 85 patients clinically diagnosed with vitiligo. Six dermatoscopic parameters, namely, border, pigment network, perilesional hyperpigmentation, perifollicular pigmentation, satellite lesions, and micro-Koebner phenomenon (acronym: BPLeFoSK) were evaluated against Wood's lamp findings as standard. Chi-square test was used to test association between categorical variables. Cutoff values for stability for these six parameters were plotted in receiver operating curve. RESULTS: A total of 131 vitiligo lesions were analyzed with dermatoscopy. Absence of satellite lesions and absence of micro-Koebner phenomenon were the most sensitive parameters (96.7% and 100%, respectively). Sharp border and absent or reticulate pigment network within the vitiligo patch were the most specific findings (100% and 91.5%, respectively). CONCLUSION: A cutoff score of more than or equal to 1.5 using the "BPLeFoSK criteria" indicates stability in the vitiligo lesion.

Polymorphous Cutaneous Sarcoidosis Associated with Peripheral Vascular Disease and its Dermatoscopic Findings.

Sarcoidosis is a multisystem disorder with cutaneous involvement with myriad of morphological presentations, often leading to diagnostic dilemma. We report a case of 31-year-old male with peripheral arterial disease who presented with three morphological forms of sarcoidosis simultaneously, namely, papular, psoriasiform, and pigmented purpuric dermatosis-like lesions. Dermatoscopy of cutaneous lesions showed yellow-orange globules, red dots, linear vessels, and white crystalline structures depending on the clinical forms. Histopathology of all three morphological types of skin lesions demonstrated sarcoidal naked granulomas. Sarcoid specific lesions of more than one morphological type presenting in a same patient is rare. Association of peripheral vascular disease with sarcoidosis is also seen rarely.

Multispectral Dermatoscopic Features of Chemical Leucoderma with Pigmented Contact Dermatitis.

Chemical leukoderma is characterized by pigment loss on constant exposure to chemical agents. Its association with pigmented contact dermatitis is rare. Here, we report a 40-year-old female presenting with depigmented macule with surrounding hyperpigmentation over the upper forehead. We used a multispectral dermatoscope by which decreased pigment network was better visualized with blue light, and gray granular dots were better appreciated with yellow light. Shorter wavelengths delineate epidermal features better whereas longer wavelengths highlight dermal features in multispectral dermatoscopy.

Evidence-based Review, Grade of Recommendation, and Suggested Treatment Recommendations for Melasma.

Treatment of melasma is known to be less satisfactory, often incomplete, and relapse is frequent. Although many treatment options are available, they are either known to be unsafe on long-term use or their long-term safety profile is unknown. Patients often use various drugs, even topical steroid-based preparation without any medical supervision for long period of time, making the skin unsuitable for many of the drugs available. Thus, there has been gross disparity among the treating physician about what drugs and what regimen are best suitable for various categories of melasma patients and in different situations. With this background, numerous newer drugs, mostly combinations of some proprietary molecules or even unknown plant extracts, have flooded the market for the management of melasma. Information on efficacy or safety of these products are almost unknown. Studies on Asian people, especially Indian population, are far less commonly available. Therapeutic guideline for use on Indian patients with melasma is almost missing. Extrapolation of data from Caucasian people for use on Asian people may not be scientifically justifiable because Caucasian and Asian people are known to have inherent difference in their response as well as tolerance to the drugs used for melasma. With this background, we have extensively evaluated, following a strict, scientifically designed protocol, all the available studies on melasma management till May 2016 and prepared this document on level of evidence, grade of recommendation and suggested therapeutic guideline for melasma as per the method proposed by Oxford Centre of Evidence-Based Medicine. Various ethical, social, logical, regional, and economic issues in the context of Indian and similar populations were given due importance while preparing the suggested therapeutic recommendation.

Invisible Lichen Planopilaris Unmasked by Dermatoscopy.

Lichen planopilaris is a form of lymphocyte-mediated primary cicatricial alopecia characterized by perifollicular scaling progressing to patches of alopecia depending on the clinical variant. The course is relentlessly progressive and chronic. Hence, early diagnosis and institution of therapy are imperative to halt the disease progress. Although definitive diagnosis is made by scalp biopsy, the detection is usually delayed. Dermatoscopy helps in early recognition of this condition which at that stage is clinically invisible. We report a 23-year-old female who presented with hair loss and scalp scaling without clinically obvious patches of alopecia.

Finger-shaped Red Light Emitting Diode to Ascertain the Depth of Periungual Wart.

Management of periungual wart is a great challenge, especially when there is subungual extension. The major cause of recurrence of wart is improper clinical assessment of its extent and not directing therapy against the entire wart. This difficulty of ascertaining its extent could be overcome with this finger-shaped red light emitting diode device. Red light in the device penetrates the thick palmar skin and dark constitutive skin colour due to its longer wavelength.