Dermoscopic Perspective of Pityriasis Versicolor in a Cross-Sectional Study.

Background: Pityriasis versicolor is a common superficial fungal infection which is usually easily diagnosed with Wood's lamp examination and 10% potassium hydroxide mount. However, these modalities have varying sensitivity and specificity. Aims and Objectives: This study aimed to ascertain the dermoscopic features of pityriasis versicolor lesionally as well as perilesionally using dermoscopy, a non-invasive diagnostic tool. Materials and Methods: In this cross-sectional study, consecutive patients with pityriasis versicolor underwent dermoscopic examination of lesions and 2 cm around lesions, noting lesional and perilesional features. Semi-objective grading of pigmentation, scaling, and vascularity was done. The association between parameters was determined using heat maps and violin plots with Kolmogorov-Smirnov test. Lesional analysis was performed since lesions at different sides showed disparate features. Results: A total of 353 lesions from 233 patients (males = 150/233; 64.38% and females = 84/234; 36.05%) were studied. On lesional dermoscopy, pigmentary and scaling abnormalities were universal. 258/353 (73.1%) of lesions showed vascular abnormalities. Perilesionally, scaling (223/353; 63.17%) followed by pigmentation (205/353; 58.07%) and vascular changes (111/353; 31.44%) constituted the most common dermoscopic abnormalities and were noted in 294/353 (83.29%) of lesions overall. Increased disease duration corresponded with increased intensity of perilesional pigmentation alterations, perifollicular (P = 0.04), and follicular scales (P = 0.02). Conclusion: Awareness of dermoscopic features could improve the diagnostic accuracy in doubtful cases of pityriasis versicolor. Vascular findings are common and may point to an underlying inflammatory pathogenesis. Perilesional findings constitute early dermoscopic features of pityriasis versicolor and hint at the need for treatment beyond the confines of lesions. Larger follow-up studies and research into immunopathogenesis may be of further benefit.

Epidermolysis bullosa in a mother-infant dyad.

Epidermolysis Bullosa is an inherited mechanobullous disorder which presents in the neonatal period as blistering skin lesions. In this case report, we describe an uncommon presentation of Epidermolysis Bullosa Simplex in a term infant, weighing 2640 g, born to a mother who was also diagnosed with Epidermolysis Bullosa Pruriginosa during the course of the evaluation of her newborn. The clinical situation presented us with a unique dilemma with regard to routine newborn care practices including handling, skin and diaper care. Though the presentation was typically characteristic of EB, we illustrate with images the diagnostic modalities and challenges faced in the hospital while caring for this fragile skin in a low and middle-income country's neonatal intensive care unit. This is the first reported case of a neonate with Epidermolysis Bullosa Simplex born to a mother with Epidermolysis Bullosa Pruriginosa.

A Six-Year Retrospective Analysis of Skin Biopsies in the Pediatric and Adolescent Population Performed at a Tertiary Health Care Center in India.

Background: Hesitancy to perform skin biopsies in children or adolescents may lead to delayed diagnosis or misdiagnosis and relatively, few studies analyzing pediatric skin biopsies exist. Aim and Objectives: This study aims to analyze the spectrum of skin diseases biopsied and demographic data of pediatric patients underwent skin biopsies at a tertiary health care center in India. Materials and Methods: Biopsy records over six years were analyzed, noting demographic data, disease duration, clinical differential diagnoses (CDD), final diagnosis after histopathology, disease categorization, and agreement between clinical and final diagnosis. The mean, range, and statistical significance of differences between proportions were calculated. Results: A total of 1308 biopsy records were analyzed. A male preponderance was noted (males - 55.1%; n = 721, females - 44.9%; n = 587). Most biopsies were performed in adolescents (12-18 years; 55.2%) followed by school-age children (5-12 years; 31.4%). Preponderant disease groups biopsied comprised papulosquamous (17.7%; n = 231) and infectious diseases (14.1%; n = 184). Leprosy was the most common infectious disease (37.5%; n = 69) with most patients belonging to borderline tuberculoid spectrum. The overall diagnostic agreement was 74.7%. No correlation of final diagnosis was noted with the number of CDD offered. In more than a fifth of cases, biopsy averted misdiagnosis. Conclusions: This study highlights the importance of skin biopsies in pediatric patients and the relatively high clinico-histopathologic agreement. Leprosy and papulosquamous diseases were preponderant in the pediatric dermatopathology caseload.

Acral involvement in lichen scrofulosorum: A diagnostic oddity with distinctive features on dermoscopy.

A commonly underdiagnosed harbinger of visceral tuberculosis, lichen scrofulosorum classically manifests as centripetally located erythematous to violaceous cutaneous papules. Perifollicular and perieccrine tuberculoid granulomas constitute the histologic hallmark. We report a case of lichen scrofulosorum with involvement of the acral areas which is unusual. Also, dermoscopy, which has not yet been widely utilized in this condition gave a novel insights into histopathology in this case.

Oral Lymphangiomas: A Rare Presentation of Two Cases with Dermoscopic Findings.

Lymphangiomas are benign hamartomatous malformations, infrequently seen in the oral cavity. They can cause aesthetic issues and functional impairments if not treated in the initial stages, thus necessitating the need to diagnose early. Two presentations were observed: a 35-year-old male with classical frog-egg appearance involving lower buccal mucosa with macrocheilia for two years, which was diagnostic on mucoscopy and histopathology, confirming acquired capillary lymphatic malformation. The second case was of a 12-year-old girl with a gradual appearance of reddish lesions over the tongue and episodic history of bleeding, which was confirmed on mucoscopy, and histopathology is highlighted. Mucoscopy of both the cases showed yellowish-pink lacunae with a hypopyon-like feature and surrounding pale septa. We present two cases of oral lymphangiomas with different presentations and highlight the importance of dermoscopy of oral lesions to bypass invasive techniques such as biopsy.

Depression, body image and quality of life in acne scars.

Background: Acne scars commonly occur in almost 95% of adolescents having acne. Depression and the psychosocial impact of acne have been studied by previous researchers but there are few studies on acne scar patients. Objectives: To study the prevalence of depression, body image, and quality of life in patients with acne scars and the correlation of depression with body image and quality of life. Material and Methods: Around 81 patients above 18 years of age clinically diagnosed as having different grades of acne by a dermatologist were assessed for depression using Becks Depression Inventory, Body image concern inventory, and Dermatology Life Quality Index and included in the study after being informed consent. Results: The mean duration of acne was 6.03 ± 2.9 years, and acne scar was 2.88 ± 1.2 years. Nearly 93% of our sample had an equal preponderance of Grade 1 and Grade 2 acne scars. 31 (38.27%) patients had clinical depression with a total mean BDI score of 16.8 ± 9.7. 15 (18.5%) and 7 (8.6%) patients had moderate and severe depression respectively. Only 5 (6.17%) patients reported significant body image disturbances. All patients reported a very large effect on the quality of life due to flaws in facial appearance leading to feelings of embarrassment and impairment in sexual activities. Depression was significantly associated with grade 1 and 2 scars, body image disturbances, and quality of life. Conclusions: There is a high prevalence of depression in patients with acne scarring which needs to be detected and treated. Liaison with a psychiatrist would improve the outcome.

Neutrophilic Pustular Eruption with Behcet's Like Illness Post Covid-19 Vaccination.

The COVID-19 pandemic has deeply impacted the lives of many. In such unprecedent times, mass vaccination has been the cornerstone in decreasing morbidity and mortality. However, various adverse events (AEs) to COVID-19 vaccines including cutaneous AEs have been reported worldwide. We report a case of neutrophilic pustular eruption with a Behcet's disease-like illness following COVID-19 vaccination with no history of known allergies or prior severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection.

Dermoscopic Evaluation of Extragenital Lichen Sclerosus et Atrophicus.

Introduction: Lichen sclerosus (LS), is an uncommon inflammatory dermatosis with preferential involvement of anogenital region. Diagnosis of LS is mainly clinical, but clinical differentiation from conditions like vitiligo, morphea may be a difficult task at times that often requires histological analysis. Dermoscopy is one such non-invasive tool which can help diagnose the disease. There is paucity of Indian data on dermoscopy of LS. Objectives: To evaluate clinical, dermatoscopic patterns of LS and correlate them with histopathology. Methods: The study was conducted in a tertiary hospital after obtaining consent from 20 patients. OITEZ e-scope digital microscope was used to evaluate the lesions. Both polarized and nonpolarized mode were used and skin biopsy was done to confirm diagnosis. Results: Based on morphology, LS was classified as scleroatrophic lesions (61.5%), guttate lesions (30.8%) and hyperkeratotic lesions (7.7%). Dermoscopic analysis revealed structureless white to yellow areas as most common finding (100%) followed by chrysalis like structure (80.8%). Linear irregular vessels were seen in 61.5% lesions and perifollicular scaling in 50.0% lesions. Keratotic plugs were seen in 50.0% lesions. A new characteristic finding, "rosettes" was seen in 38.5% lesions has never been reported with LS before. Non polarized mode was particularly useful for identifying texture changes, keratotic plugs and minute scales which were not visible otherwise. Conclusions: Dermoscopy is a simple diagnostic tool that helps in the early diagnosis of LS with specific pattern which can avoid invasive procedure like biopsy. Both non-polarised and polarized dermoscopy must be done to visualize the changes of LS well.

Cutaneous Features, Autoantibody Profile, and Nailfold Capillaroscopy of Systemic Sclerosis: A Study of 60 Cases.

BACKGROUND: Systemic sclerosis (SSc) is an autoimmune chronic multisystem disorder with a plethora of cutaneous manifestations. These manifestations often may be the only presenting complaint. Early identification of these help in diagnosing grievous systemic manifestations and their prompt and appropriate treatment. AIMS: To study the clinical profile of SSc, modified Rodnan's skin scoring (mRSS), nailfold capillaroscopy (NFC) patterns, antibody profile in the western India population, and their association with cutaneous manifestations. METHODS: Patients of SSc fulfilling the European League Against Rheumatism (EULAR) 2013 classification of SSc criteria, who attended dermatology outpatient department (OPD) between January 2017 and September 2018 were included in the study. The demographic data, cutaneous features, autoantibody profile, mRSS, and NFC pattern were noted Results: A total of 60 patients (57 females and 3 males; mean age years) of SSc were evaluated. Clinical subtypes were 40 diffuse cutaneous SSc and 20 limited cutaneous SSc. The most common presenting symptoms were Raynaud's phenomenon (RP) (95%) and skin tightening (90%). The common cutaneous findings were sclerodactyly (86.7%), stellate scars (78.3%), parrot-beaked nose (76.7%), mask-like facies (75%), microstomia (56.7%), salt and pepper pigmentation (55%), puffy finger (46.7%), telangiectasia (46.7%), digital ulcer (38.3%), fixed flexion deformity (33.3%), and calcinosis cutis (8.33%). Limited cutaneous systemic sclerosis (lcSSc) had mRSS score of 8.3 ± 4.1 and diffuse cutaneous systemic sclerosis (dcSSc) subset had a score of 28 ± 10.4. Antinuclear antibody (ANA), Anti-topoisomerase antibody (ATA), and anti-centromere antibody (ACA) were positive in 59, 49, and 7 patients, respectively. The NFC patterns were early (23.3%), active (45%), and late (18.3%). LIMITATION: The sample size of the study was small. We were not able to determine the significance of other less common autoantibodies with scleroderma. CONCLUSION: The study highlights the importance of identifying early cutaneous findings and the role of a useful diagnostic and prognostic reproducible scoring system (mRSS) and NFC.

Unusual presentation of crusted scabies with osteolysis in immunocompetent.

BACKGROUND: Crusted scabies results from a failure of the host immune response to control the proliferation of the scabies mite in the skin, with resulting hyperinfestation and a concomitant inflammatory and hyper-keratotic reaction. However, it has also been recognised in people with no evident immunological deficit. CASE HISTORY: We present a case report of apparently immunocompetent 16-year-old female presenting with multiple hyperkeratotic vegetating plaques over limbs, excoriated papules over trunk with minimal itching since 2 years without any positive family history. The microscopic examination of the skin scales with potassium hydroxide demonstrated numerous scabies mites and eggs. Histopathology showed hyperkeratosis with multiple mites in stratum corneum. Numerous mites were seen on biopsy of lesion. X-ray showed osteolysis of distal phalanges secondary to chronic pressure. Repeated topical treatments with permethrin and oral ivermectin led to the considerable resolution of her lesions. CONCLUSION: We present a rare case of crusted scabies with osteolysis in an immunocompetent female.

Granulomatous Variant of Giant Centrifugal Miliaria Profunda in a Hypothyroid Infant: A Case Report.

The miliarias are a clinically heterogeneous group of diseases which occur when the free flow of eccrine sweat to the skin surface is impeded. Miliaria profunda is a variant with obstruction of the duct at or below the level of dermoepidermal junction. The giant centrifugal variant of miliaria profunda has been described in the past at the sites of occlusive tapes and in febrile patients. Thyroid hormone has a regulatory effect on the skin and its appendages and an association of hypothyroidism with this variant of miliaria profunda has not been described in the past. We report a case of giant centrifugal miliaria profunda in an infant with congenital hypothyroidism.

Schopf-Schulz-Passarge Syndrome.

Schopf-Schulz-Passarge syndrome (SSPS) is a rare type of ectodermal dysplasia that has autosomal recessive inheritance. It is characterized by palmoplantar keratoderma, hypodontia, hypotrichosis, nail dystrophy, and multiple periocular and eyelid apocrine hidrocystomas. A 36-year-old male presented with multiple eyelid and periocular apocrine hidrocystomas, ichthyosis, palmoplantar keratoderma, hypodontia, nail dystrophy, and thin scalp hair. Skin biopsy from a periocular lesion revealed cyst lined with smooth, thin epithelium, and few areas revealed foci of decapitation secretion consistent with apocrine hidrocystoma. The patient was diagnosed with SSPS.