A Clinical, Dermoscopic, and Histopathological Study of Follicular Psoriasis.

Introduction: Follicular psoriasis is one of the underdiagnosed clinical types of psoriasis. Literature is grossly limited to anecdotal case reports and series. Clinical and investigational aspects are not studied in depth. Materials and Methods: A study was conducted to determine the frequency of follicular psoriasis, which includes cases with an exclusive or substantial number of follicular lesions. We analyzed the clinical, dermoscopic, and histopathological features of follicular psoriasis in a descriptive study. Results: A total of 117 patients with psoriasis were screened. An exclusive or substantial number of follicular lesions were found in 22 patients. Four patients had exclusively follicular lesions and others were psoriasis vulgaris with follicular psoriasis. Dermoscopy revealed perifollicular scaling and white homogeneous area with normal terminal hair in all cases. Vascular features were visible in 14 cases and all had dotted vessels, with four having additional globules. Twenty patients revealed one or more features suggestive of follicular psoriasis on histopathology. Conclusion: Follicular lesions can appear exclusively or can coexist with plaque type of lesions in psoriasis. They may indicate early psoriasis lesions. Dermoscopy is a useful and rapid tool to confirm the diagnosis of follicular psoriasis. Histopathology, though confirmatory, demands an astute interpretational skill. Diagnosis of follicular psoriasis can have therapeutic implications.

Onycho-mucocutaneous syndrome secondary to human immunodeficiency virus disease.

Cutaneous, mucosal, and nail examination is the key to unveiling a plethora of systemic diseases. Mucocutaneous lesions directly related to human immunodeficiency virus (HIV) infection usually present as initial manifestations of immune deficiency, of which few lesions act as predictors of an immunocompromised state. Here, we report two cases who presented with onycho-mucocutaneous symptoms which raised the suspicion of and invariably led to the diagnosis of an underlying immunosuppression secondary to HIV infection.

A cross-sectional study on clinico-dermoscopic features of periorbital melanosis in a tertiary care hospital.

INTRODUCTION: Periorbital melanosis (POM) is an esthetic facial concern on increasing trend and has a severe emotional impact on patients. We aimed to study the clinical and dermoscopic patterns of periorbital melanosis to aid in the classification and strategize therapy. METHODS: A cross-sectional, observational study was conducted on one hundred patients with POM in a tertiary care center in India from January 2020-March 2020. Dermoscopic assessment of POM was done using video dermatoscope- FotoFinder Medicam 1000s (magnification up to 140x). RESULTS: The mean age of participants was 32.8 ± 9 years. It was more prevalent among females (78%). The constitutional type (43%) of POM was the most common followed by shadow-effect type (32%). The various dermoscopic pigmentary patterns seen were scattered pigmented dots (56%), exaggerated pigment network (31%), globules (30%), and blotches (27%). Dilated veins and telangiectasia were seen in 50% and 32% of subjects, respectively. Exaggerated skin markings were seen in 43% of participants. Scattered pigmented dots were most commonly seen in constitutional, vascular, and shadow types but were significantly associated with vascular type. Exaggerated pigment network was the most frequent pigmentary pattern in post-inflammatory type of POM. Globules were significantly associated with constitutional as well as shadow type of POM and blotches with shadow type of POM. CONCLUSIONS: Periorbital melanosis presents as multifactorial entity with constitutional type being the most common. The dermoscopic patterns of POM may provide a clue to the underlying etiology, thereby helping to plan appropriate treatment.

Role of Tinea Unguium and Other Factors in Chronic and Recurrent Dermatophytosis: A Case Control Study.

CONTEXT: There is an alarming rise in the incidence of chronic and recurrent dermatophytosis (CRD) in India. Many factors including tinea unguium may be responsible for it. AIMS: To evaluate various epidemiological and clinical factors including the presence of tinea unguium as a risk factor for CRD. SETTINGS AND DESIGN: This was a case-control study in which patients attending the dermatology outpatient department of a tertiary care hospital in February-March 2019 were recruited. A total of 80 consecutive clinically diagnosed patients with CRD as per the case definition (cases) were selected. Another 80 consecutive patients with dermatophytosis other than CRD (controls) were also selected. Patients were clinically evaluated with special attention for the presence of tinea unguium. RESULTS: Among the total of 80 cases, 44 (55%) and 36 (45%) were diagnosed to have chronic dermatophytosis and recurrent dermatophytosis respectively. CRD was relatively uncommon in patients younger than 20 years. Sharing of linen, family history, and topical corticosteroid abuse were also frequent among patients with CRD. Tinea unguium was present in six cases (7.5%) and two controls (2.5%) which was not statistically significant (P = 0.27). CONCLUSIONS: The current epidemic of CRD may be primarily due to a pathogen with certain specific epidemiological and clinical determinants. It may be primarily a skin pathogen with less or no affinity toward the hair and nail.

Pruritic Periumbilical Plaque as a Presentation of a Rare Perforating Dermatosis.

Perforating dermatoses are characterized by transepidermal elimination of altered dermal components or foreign particles. Owing to their common clinical presentation as umbilicated papules with a keratotic plug, histopathology and special staining play a very crucial role in the diagnosis. Perforating calcific elastosis, (periumbilical perforating pseudoxanthoma elasticum), an uncommon acquired localized cutaneous dermatoses, is characterized by transepidermal elimination of modified elastic fibres. It is usually seen in middle-aged obese multiparous women as well-defined periumbilical hyperpigmented atrophic plaques. We report a case of a 66-year-old female who presented with a mildly pruritic hyperpigmented periumbilical plaque of 2 years duration. Histopathology studies revealed multiple fragmented, thick, short, and curly eosinophilic fibers; along with granular basophilic material in the dermis, which stained positive for calcium and elastin, thus clinching the diagnosis of perforating calcific elastosis. There were no features of hereditary pseudoxanthoma elasticum. We report this case for its rarity.

An Observational Cross-Sectional Study of Varied Clinical Manifestations of Connective Tissue Disorders and their Association with Antinuclear Antibodies in a Tertiary Care Center.

CONTEXT: Connective tissue disorders (CTD) occur in 3-5% of the population. The advent of antibodies to extractable nuclear antigens (ENA) has become a reliable predictor to establish the diagnosis of CTD, subclassify patients into prognostic groups, and monitor disease activity. AIMS: The aim of this study was to (a) study the frequency of cutaneous manifestations, systemic manifestations, and anti-ENA antibodies in CTD; (b) determine the association between systemic manifestations and ENAs; and (c) determine the association between cutaneous and systemic manifestations of CTD. SUBJECTS AND MATERIALS: An observational cross- sectional study was conducted on 50 patients diagnosed to have CTD. The clinical profile and antibodies to ENA (ANA Profile) reports were retrieved and studied. RESULTS: The major dermatological manifestations were skin tightness (36%), salt and pepper pigmentation (30%), Raynaud's phenomenon (28%), and malar rash (28%). The common antibodies seen were anti SS-A (36%), anti-UI-ribonucleoprotein (U1-RNP) (34%), anti-dsDNA (32%), and anti-Sm (24%). Patients with anti-Sm and anti-dsDNA antibodies had increased frequency of renal manifestations. A strong association with significant P values was seen between neurological manifestations and anti-Sm antibody, and cardiovascular manifestations and anti-RNP antibody. An association between gastrointestinal manifestations and malar rash as well as neurological manifestations and photosensitivity was also seen. CONCLUSIONS: ENA panel predicts systemic involvement, thus helping in the multidisciplinary management. Cutaneous manifestations of CTD can be an early predictor in giving a clue to impending systemic manifestations.

Dermoscopic Features of Distal Lateral Subungual Onychomycosis.

BACKGROUND: Onychomycosis is a very common disease and accounts for upto 50% of the diseases affecting the nail apparatus. Diagnosis of onychomycosis is usually confirmed with the help of a potassium hydroxide (KOH) mount and fungal culture. Onychoscopy can be a handy and additional tool for the diagnosis. AIMS AND OBJECTIVES: To determine the dermoscopic findings in distal lateral subungual onychomycosis (DLSO). MATERIALS AND METHODS: A prospective study of 60 nails with a clinical and mycological diagnosis (KOH with Chicago sky blue positive) of DLSO. Dermoscopic examination was performed using a Heine delta 20 plus dermatoscope and the features were recorded. RESULTS: Longitudinal striae and jagged proximal edges seen in all 60 (100%) patients. Intermittent spiked pattern was seen in 47 nails (78.3%). Chromonychia and distal irregular termination were noticed in 23 (38.3%) and 7 (11.7%) nails, respectively. CONCLUSIONS: Onychoscopy can be used as an important diagnostic tool while evaluating nail disease, especially in DLSO. LIMITATIONS: Small study sample and lack of comparison with other nail diseases that manifests with distal onycholysis.

Atypical cases of Dowling-Degos disease.

Dowling-Degos disease (DDD) is a rare autosomal dominant condition characterized by multiple, small, round pigmented macules usually arranged in reticular pattern, chiefly distributed in axillae and groins. Here we are reporting three atypical cases of DDD in a family. They had hypopigmented macules with typical features of DDD indicating generalized DDD. Histopathology confirmed the diagnosis. We present these three cases to stress the existence of generalized DDD phenotype in the Indian population.

Livedo reticularis in type 2 lepra reaction: A rare presentation.

Type 2 lepra reaction or erythema nodosum leprosum (ENL) is an immune complex syndrome that occurs mostly in lepromatous leprosy and sometimes in borderline lepromatous leprosy patients. We present an untreated case of lepromatous leprosy, who presented with type 2 lepra reaction and livedo reticularis. Livedo reticularis, though seen in lucio phenomenon, is not a part of type 2 lepra reaction. The case is being reported for its rarity.

Clinical and dermatoscopic patterns of alopecia areata: a tertiary care centre experience.

BACKGROUND: Dermatoscopy is a new noninvasive tool for the diagnosis of various skin and hair disorders. Dermatoscopy of alopecia areata (AA) shows various specific features, which may aid in confirming the diagnosis. AIMS: The aim of this study was to determine the various clinical patterns and the dermatoscopic features of AA. MATERIALS AND METHODS: A total of 75 patients of AA were evaluated with a dermatoscope (magnification ×25 and ×60). RESULTS: The mean age of onset of AA was 23.58 years. Males were more commonly affected. Scalp was most commonly involved. Patchy alopecia was the most common pattern observed. 10 patients showed concomitant nail changes. The dermatoscopic features included yellow dots (YDs) in 43 (57.33%) patients, black dots (BDs) in 63 (84%) cases, broken hairs (BHs) in 28 (37.33%) cases, short vellus hair (SVH) in 51 (68%) patients and tapering hair (TH) in 14 (18.67%) cases. CONCLUSION: The most common dermatoscopic finding observed was BDs, followed by SVHs, YDs, BH and TH.