Long-Term Utility of Follicular Unit Excision in Lichen Planopilaris-Correlation of Graft Survival With Histopathological and Ultrasound Biomicroscopic Parameters.

BACKGROUND: Hair transplantation in scarring alopecia is challenging and transplant surgeons are hesitant due to fear of poor graft survival apart from the risk of reactivating the disease. OBJECTIVE: Survival rate of hair follicles transplanted in cases of lichen planopilaris (LPP). To correlate histopathological and ultrasonography findings and their impact on graft survival. METHODS: In 32 patients of inactive LPP included, a 5-cm2 recipient area was tattooed. The follicular unit density of the transplanted area was 20 to 25 FU/cm2. Postoperative follow-up was conducted at 6, 12, and 24 months. The recipient area density and ultrasound biomicroscopic parameters were assessed at each follow-up visit. RESULTS: The survival of grafts was 78.62% at 12 months, and 79.96% at 24 months. Histopathology variables studied at the time of transplantation such as epidermal atrophy, fibrosis, and inflammatory infiltrate were not found to have any effect on the graft survival. Ultrasonography parameters of the involved scalp skin were found to be markedly improved on follow-up. This suggests that the overall health of the scalp improved after hair transplantation. CONCLUSION: Follicular unit excision is a ray of hope for cases of primary cicatricial alopecia such as LPP because the result is satisfying to both the patient as well as the doctor.

Reversal of steroid-induced lipoatrophy with serial injections of isotonic saline in a child.

The problem of side-effects of injectable corticosteroids has gradually become more acute with rampant and unlimited misuse of the drug, particularly by non-dermatologists. Serial saline injections at the site of steroid-induced lipoatrophy in a child served as a safe, relatively rapid, and cost-effective solution.

Monozygotic twins with atrophia maculosa varioliformis cutis.

Atrophia maculosa varioliformis cutis (AMVC) is a sporadic or inherited childhood disorder, signified by the occurrence of pitted scars, usually over the face. We report two cases of AMVC occurring in monozygotic twins.

Unknown: Multiple painful nodules - what is the diagnosis? Chronic tophaceous gout.

Gout is a common rheumatologic condition of recurrent polyarticular involvement. Tophi may be the first sign of the disease. We report a 55-year-old hypertensive, chronic alcoholic and diabetic male with a three-year history of multiple painful skin-colored nodules on the forearms, elbows, feet, posterior thighs, and popliteal fossa associated with discharging sinuses. Serum uric acid was 8.1 mg/dL (normal: 2-7.4 mg/dL). Fine needle aspiration cytology showed monosodium urate crystals, which are pathognomonic for gout, confirmed histopathalogically.

Tinea Capitis Presenting as Diffuse Hair Loss and Significance of Trichoscopy: Four Case Reports.

Tinea capitis is a common fungal infection in children but is less frequently encountered in adults. Tinea capitis presenting as diffuse hair loss is a rare presentation. When patient presents with a diffuse hair loss, tinea capitis is not commonly thought of as differential diagnosis. Low clinical suspicion can lead to inappropriate empiric treatments that delay diagnosis. Trichoscopy in tinea capitis obviates the need for lengthy and invasive procedure or even KOH examinations in the absence of a side lab for diagnosing this common scalp disorder and also avoids misdiagnosis. Trichoscopy not only differentiates tinea capitis from female patterned hair loss but also aids in differentiating ectothrix from endothrix. Here, we present case reports of tinea capitis masquerading as female pattern hair loss with trichoscopy aiding in diagnosis of endothrix infection.

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.

Lichen Simplex Chronicus on the Scalp: Broom Fibers on Dermoscopy; Gear Wheel Sign and Hamburger Sign on Histopathology.

Lichen simplex chronicus (LSC) is characterized by lichenification of the skin because of primary excessive scratching. Herein, we present two cases of scalp LSC with a patch showing localized hair loss and paroxysmal severely itching on that area. Dermoscopy examined the presence of broom hair fibers while histopathological examination revealed gear wheel sign, hair shafts split in two (the hamburger sign), and decrease in the size of the sebaceous glands.

Early Diagnosis and Prompt Treatment Improves Quality of Life in Patients with Frontal Fibrosing Alopecia.

Frontal fibrosing alopecia (FFA) is a slowly progressive cicatricial alopecia. FFA patients typically present with hair loss in the frontal, temporal, or frontotemporal scalp and eyebrows. It can also involve facial and body hair. It has an early inflammatory stage, which slowly progresses to the stage of fibrosis. In this article, we report a case of FFA in the early inflammatory stage who responded well to intralesional steroid.

Distinguishing Lipedematous Scalp, Lipedematous Alopecia, and Diffuse Alopecia Areata.

Soft, spongy or doughy consistency of the scalp resulting from thickening of the subcutaneous layer is termed as lipedematous scalp (LS). When such soft, boggy scalp is associated with hair loss, where the scalp hair is no longer than a few centimeters, it is referred as lipedematous alopecia (LA). There have been coincidental reports of androgenetic alopecia, psoriasis, mucinosis, and discoid lupus erythematosus with LS. We report a case of LS and alopecia areata whose characteristic histopathological feature showed a "swarm of bees" appearance and thickening of subcutaneous tissue. The diagnosis of alopecia areata was further confirmed by immunohistochemistry staining of the tissue showing CD3+ T-lymphocytes around the bulb. The aim of this case report is to make readers understand that LA and LS are not different diseases and one needs to rule out other causes of alopecia in order to pick up conditions which are essentially reversible and treatable.

Pedunculated poroma on forearm: A rare clinical presentation.

Eccrine poroma (EP) is an adnexal tumor that commonly occurs on soles as a soft sessile flesh colored nodule. We report here a case of 54-year-old man who presented with a pedunculated red colored nodule on the right forearm. Histopathological examination was consistent with EP. This presentation of EP on the forearm as a pedunculated nodule is rare.

Case Report: Solitary mastocytoma treated successfully with topical tacrolimus.

Solitary mastocytoma, a rare dermatological entity accounts for 10-15% of cutaneous mastocytosis. We report a rare case of solitary mastocytoma presenting at birth, treated successfully with topical tacrolimus. Along with reassurance and strict avoidance of triggering factors, no recurrence was reported within the one year follow-up period.

Perianal pseudoverrucous papules and nodules.

Perianal pseudoverrucous papules and nodules (PPPN) is a rare entity attributed to chronic irritation. We came across this entity in a case of spina bifida. A 14 year old girl having spina bifida at L3 presented with complaints of multiple asymptomatic whitish lesions on the inner aspect of thighs and labia majora since early childhood. She had incontinence of stool and urine since birth. Cutaneous examination revealed multiple 3-12 mm flat topped moist papules, few verrucous nodules, some of these lesions coalesced to form plaques at the perianal area extending upto the labia majora. On histology marked epidermal hyperplasia and pale keratinocytes in the epidermis was seen. This confirmed the diagnosis of PPPN. This rare condition can be mistaken with sexually transmitted diseases leading to unnecessary investigations and treatment.

Adenoid type of Basal cell carcinoma: rare histopathological variant at an unusual location.

Basal Cell Carcinoma (BCC) is almost exclusively seen in head-neck region with rare involvement of trunk and extremities. The tumour is commonly seen on nose, eyelids, at the inner canthus of eyes and behind the ears. Adenoid type of BCC is one of the rare histopathological types of BCC which has not found to have any site predilection. We report two cases of BCC occurring at an unusual site i.e., lower back and both of them showed adenoid type of BCC on histopathology. Morphologically they were pigmented and ulcerative type of BCC respectively.

Papulonecrotic tuberculid of glans penis: A common disease at an uncommon site.

A 65-year-old man presented with multiple asymptomatic papulo-pustules and ulcers over glans penis since last 1 year. The lesions used to resolve spontaneously in a few days with scarring. The clinical features and histopathology were suggestive of papulonecrotic tuberculids of the glans penis.