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.

Cross-sectional study to evaluate the utility of elastic tissue staining in primary cicatricial alopecia.

BACKGROUND AND AIMS: Diagnosing end-stage primary cicatricial alopecia (PCA) on routine histology is challenging since the major diagnostic feature (inflammatory infiltrate) may be minimal or absent. This study aimed to assess various staining patterns and diagnostic utility of elastic tissue staining by Verhoeff-Van Gieson (VVG) method and trichoscopy in PCA. STUDY DESIGN: Cross-sectional study. METHODS: Fifty-three patients clinically diagnosed with PCA underwent biopsy and trichoscopy in this cross-sectional study. Clinically active edge, if present, was biopsied. Twenty serial tissue sections were stained using H&E and VVG stain. Clinicopathological diagnoses were lichen planopilaris (LPP), discoid lupus erythematosus (DLE), folliculitis decalvans and unclassified PCA (UPCA) in 30 (56.6%), 11 (20.75%), 1 (1.9%) and 11 (20.75%) patients, respectively. Utility of VVG stain was ascertained considering clincopathological correlation (CPC) as the reference standard. Association of characteristic trichoscopic and VVG staining patterns was ascertained. RESULTS: Diagnostic definition was achieved on VVG staining in 19/30 sections of LPP (wedge-shaped pattern) with 63.33% sensitivity; 7/11 cases of DLE (absent upper and mid dermal elastic fibres) with 63.64% sensitivity and 7/11 cases of UPCA (wedge-shaped pattern-3/7; recoil pattern-4/7). Routine histology suggested diagnosis only in 13/53 sections (24.52%). However, diagnosis on VVG staining corresponded with diagnosis on CPC in 33/53 cases (62.3%). Comparison of H&E versus VVG stain both overall and in the LPP and UPCA cohorts proved utility of VVG staining using Fisher's exact test (p<0.05). Statistical significance was also noted when trichoscopy was correlated with patterns on VVG staining (p<0.05). CONCLUSION: Increased diagnostic yield is noted with trichoscopy and VVG stain in PCA especially when routine histopathology is non-diagnostic.

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.

Koebnerization of Lichen Sclerosus Et Atrophicus at Insulin Injection Sites - A Rare Case with Dermoscopic Features.

Lichen sclerosus et atrophicus (LSEA), also known as lichen sclerosus (LS), is a disabling, cosmetically disfiguring condition predominantly affecting the anogenital region of pre- and postmenopausal females. Extragenital LS is relatively less common and occurs predominantly on the trunk and neck. Koebnerization or isomorphic phenomenon is reported occasionally in LS after trauma like radiotherapy. A few case reports describe koebnerization of LS at injection sites. We describe the first such case in India of LS koebnerizing at insulin injection sites with dermoscopic features.

Scrotal Lymphangiectasia with Penile Elephantiasis in Underlying Lymphatic Filariasis-Challenging the Diagnostic Mind! A Case Report.

BACKGROUND: A plethora of diseases manifest as acquired genital lymphangiectasias which clinically manifest as superficial vesicles. They range from infections such as tuberculosis to connective tissue diseases such as scleroderma and even malignancy. Amongst infectious etiologies, lymphatic filariasis leads as the cause for lymphatic obstruction. Despite this, acquired lymphangiectasias due to this cause are not commonly reported. An unusual case of acquired scrotal lymphangiectasia secondary to filariasis is detailed in this paper with dermoscopic and histologic findings. METHODS: A 65-year-old male farmer presented with multiple, asymptomatic vesicles over the scrotum with thickened scrotal and penile skin that had occurred for six years. He gave past history of intermittent fever and milky urine, was diagnosed with filariasis and treated with diethylcarbamazine for a year, four years previously. Systemic complaints abated but the peno-scrotal lesions did not. RESULTS: Polarized dermoscopy revealed multiple skin-colored nodules and translucent pale blue lacunae over the scrotum. A few radially arranged linear irregular vessels were noted over the nodules. On histopathology, multiple ectatic lymphatics were noted in the mid and upper dermis with acanthosis and superficial perivascular lymphocytes. Peripheral smear revealed eosinophils; however, microfilariae could not be detected despite repeated diethylcarbamazine provocation and night smears being taken. The findings were compatible with acquired scrotal lymphangiectasia secondary to treated lymphatic filariasis. Local hygiene was advised; however, procedural treatments were refused by the patient. CONCLUSION: Herein, we report an unusual case of acquired scrotal lymphangiectasia of the scrotum secondary to treated lymphatic filariasis. Very few similar reports exist. To the best of our knowledge, dermoscopic features of this condition have not been elucidated before. This case, detailing an uncommon manifestation of a common disease (filariasis), demonstrates the importance of careful history taking and examination. This was especially so in the present case since only circumstantial evidence of filariasis was noted in investigations. There is a need to heighten awareness of this unusual condition amongst physicians especially if the patient hails from an area endemic for filariasis.

Parameatal Median Raphe Cyst: A Case Report of a Midline Developmental Defect of True Urogenital Origin.

Median raphe cyst (MRC) is an uncommon, asymptomatic benign lesion, that may present anywhere on the midline ridge between the external urethral meatus and the anus. Although they are developmental in origin, they often present in the postpubertal age, aggravated by trauma, and are frequently infected secondarily. MRCs are often misdiagnosed as epidermal cysts, steatocystoma multiplex, and eccrine cystadenomas. They are underrecognized and less than ten case reports exist from the Indian subcontinent. We, herein report a male with an immunohistochemically proven parameatal MRC.