A Cross-Sectional Study of Epidemiological and Clinical Aspects of Pityriasis Rosea along with Dermoscopic Analysis and Histopathology Correlation.

Background: Pityriasis Rosea (PR) is a common, yet enigmatic, dermatological condition characterized by a distinctive clinical presentation. Despite its prevalence, the aetiology and pathogenesis of PR remain elusive. Aims: To study the epidemiological and clinical aspects of patients with PR. To study dermoscopic findings and carry out histopathological correlation. Methods: A cross-sectional study of 50 patients was conducted. A detailed clinical history was taken and an examination was done followed by a dermoscopy. Quantitative data like age and duration of disease are presented with the help of standard deviation. Qualitative risk factors, like gender, age groups, symptomatology, site of lesion, findings or cutaneous examination, dermoscopy findings, and histopathology findings, are presented with the help of frequency and percentages. Results: PR shows male preponderance and mean age of occurrence being 30.8 ± 15.7 years. Forty per cent of patients had an atypical clinical presentation. The most frequently seen dermoscopy findings were diffuse red background (58%), peripheral collarette scale (62%), and peripheral dotted vessels (50%). On histopathology, the most common findings were spongiosis (44%), parakeratosis (38%), irregular acanthosis (34%), perivascular lymphocytic infiltrate (56%), and red blood cell extravasation (36%). Limitations: Sample size was less due to COVID. As this was a corss-sectional study follow up of patients could not be done. Conclusion: While the diagnosis of PR is clinical, it is difficult in atypical cases where dermoscopy comes to the aid. It also helps identify the age of lesions, thus helping decide the treatment strategy for patients. Biopsy remains the gold standard in ruling out other differentials of PR.

Efficacy and Safety of Topical Tofacitinib for the Treatment of Alopecia Areata.

Background: Alopecia areata (AA) is an autoimmune disease of the hair follicles. Although some cases resolve spontaneously, many patients require some form of treatment, including corticosteroids and vitamin D analogues, among others. Cytokine signaling in autoimmune disorders and their inhibition have been the prime objective in therapeutic research over the past few years. Janus kinase inhibitors such as tofacitinib have shown efficacy in the treatment of AA. The present study aimed to evaluate the efficacy of a novel formulation of topical tofacitinib compared to vehicle in patients with AA. Materials and Methods: A prospective, non-blinded, intrasubject vehicle-controlled study was conducted in patients with AA for a total duration of 6 months. A 2% tofacitinib citrate ointment was compounded in the pharmacy. Tofacitinib tablets (5 mg) were crushed and mixed in white soft paraffin to produce 2% ointment. A thin layer of this ointment was applied to the treatment patch, while the control patches received the application of the vehicle twice daily. Both patches in each patient were evaluated for percentage change in severity of alopecia tool [SALT] score after 24 weeks as the primary outcome. This was graded as excellent response (>50% improvement), intermediate response (25-50%), mild response (5-25%), and no response (<5% improvement). Trichoscopy and hair pull test were evaluated as secondary outcomes. Results: The present study included 30 patients with AA having a median age of 27 years. Among 30 patients, 40% achieved excellent response (>50% change in the SALT score) over six months of treatment. The mean SALT score was significantly reduced from baseline to six months of treatment (mean [95% CI]: 4.3 [1.9-6.3]; P = 0.001). The control patch had substantially higher positive results in the final hair pull test, indicating disease activity (Treatment: 10% vs. Control: 86.7%, P < 0.001). Compared to the control patch, the prevalence of upright hair (10.0% vs. 80.0%) and terminal hair (3.3% vs. 70.0%) were significantly higher in the treatment patch (P < 0.001). No serious adverse effects were reported during the study duration. Limitations: Sample size was small and the followup was not long enough to study the full effects of tofacitinib, as well as maintenance of remission or relapse after discontinuation. Conclusion: Topical tofacitinib proved to be an efficacious and well-tolerated treatment modality for AA with no adverse effects reported during this study.

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.

Comparison of Dermoscopic Patterns at the Center and Periphery of Alopecia Areata Patch - A Cross-sectional Study in 100 Patients.

BACKGROUND: Dermoscopy is a noninvasive tool for the diagnosis of various dermatological disorders. Dermoscopy of alopecia areata (AA) aids in confirming the diagnosis and severity of the disease. MATERIALS AND METHODS: A total of 100 patients of AA were evaluated with a dermoscope (×20 and × 200) to determine the dermoscopic features at the center and periphery of patches of AA. RESULTS: Black dots were the most common dermoscopic finding at the periphery of AA patch among the study population, followed by yellow dots, vellus hair, broken hair, tapering/exclamation mark hair, kinking at the point of emergence of a hair shaft, piggy tail hair, and depressed follicular opening. At the center of the patch, yellow dots were the most common dermoscopic findings among the study population, followed by black dots, vellus hair, broken hair, and piggy tail hair. CONCLUSION: Black dots were the most common dermoscopic findings at the periphery of the patch. Yellow dots were the most common dermoscopic findings at the center of patch among the study population. Kinking at the point of emergence of the hair shaft was a new sign in this study seen at the periphery of the patches in 19 patients. It is the latest finding which requires further elaboration with larger sample size studies.

Use of Topical Steroids in Dermatology: A Questionnaire Based Study.

CONTEXT: Topical steroids, the most widely prescribed drugs in dermatology are being increasingly misused. AIMS: This study was conducted to assess knowledge and practices regarding the use of topical steroids and to analyze prescriptions containing topical steroids. SUBJECTS AND METHODS: Following approval from the institutional ethics committee, participants were recruited as per the selection criteria and divided into those treated in the institution and those having outside prescription. They were administered a pre-validated questionnaire to assess knowledge and practices regarding the use of topical steroids. STATISTICAL ANALYSIS USED: Comparison of awareness between two patient categories was done using Chi-square test. Prescription variables were analyzed using descriptive statistics. Significance of P value was set at 0.05. RESULTS: Out of 400 patients, 167 had external prescriptions whereas 233 were institutional patients. Only 5.5% of all patients knew about the type of drug prescribed whereas 31.25% were aware of the indication. A total of 33.75% of the patients knew topical steroids required a prescription and 5.6% said they were aware that topical steroid use was associated with side effects. Side effects were reported by 96 patients. Awareness regarding knowledge, indication, and need for prescription were significantly better in institutional patients whereas knowledge about side effects was lacking in both groups. Psoriasis was the most common indication overall whereas tinea was the most common indication (51.5%) among externally prescribed. CONCLUSIONS: Although this study showed that institutional patients had comparatively better knowledge than community-treated patients, there is a need to create more awareness among patients overall and implement measures to stop irrational prescribing practices in the community.

"Pink glow": A new sign for the diagnosis of glomus tumor on ultraviolet light dermoscopy.

Glomus tumors are usually benign hamartomas, which are painful, small, and uncommon. They are usually subungal in location but may occur at other sites. A female patient presented to the outpatient department with painful swelling over the nail matrix of her right index finger. Here, we describe the use of a videodermosope having white light, polarized light, and ultraviolet (UV) light in the localization of glomus tumors that revealed a pinkish glow on UV light examination suggesting the vascular nature of the tumor. Thus, videodermoscopy can be used as an outpatient department procedure to confirm the diagnosis of glomus tumors.