Penile ulcerative pyoderma gangrenosum: A rare entity.

Pyoderma gangrenosum (PG) is a rare, chronic, ulcerative, neutrophilic, and inflammatory skin disease. It most commonly affects the lower limb, may affect peristomal skin, and rarely involves mucosal and internal sites. Genital involvement has been rarely reported. Hereby, we report a case of penile PG in a 70-year-old male treated with oral steroids.

Plica Neuropathica: Bird's Nest under Dermatoscope.

Plica polonica is a rare condition presenting as a mass of scalp hair with irregular twists and irreversibly entangled plaits, which are firm to hard impenetrable mass of keratin cemented together with dirt and exudates. The exact etiopathogenesis of plica neuropathica is not known, but it can be due to longitudinal splitting or weathering of hair shaft due to vigorous friction and frequent use of harsh shampoos and cleansers or long hair with poor hair care Drug-induced hair matting due to chemotherapeutic drugs and due to neurotic illness like hysteria, anxiety, to psychotic illness have also been reported. Dermatoscopy showed interwining of hair shaft with matting and honey-colored concretions mimicking "wrangled mesh of wires" appearance. The treatment of plica neuropathica involves cutting the matted hair and evaluating underlying psychiatric illness to prevent recurrence.

An Observational Study of Cutaneous Manifestations in Internal Malignancy at Tertiary Care Centre.

Introduction: Skin is the largest organ in the human body and mirrors the changes in the organism it envelops. Internal malignancies can cause various specific and non-specific cutaneous manifestations along with hair, nail and oral mucosal changes. Some of the changes are detected early indicating a strong association with cancer, while some occur in later stage indicating dissemination or immunosuppression. The present study is an effort to know pattern of dermatosis associated with internal malignancies so that early diagnosis and interventions can be done. Aim: To determine the pattern of specific and non-specific dermatosis associated with internal malignancy. Methods and Material: Patients of internal malignancies with skin lesions attending dermatology and oncology department during July 2020 to June 2021 were recruited in the study after taking written informed consent. A detailed history of skin lesions and malignancies were taken. Clinical examination (skin/hair/nail) was carried out and photographs were taken. Relevant investigations were carried out. Frequency and percentage of dermographic data and dermatosis associated with internal malignancies were calculated. Results: The study included 150 patients with maximum number of patients 78 (52%) in 41-60 years of age group with female: male ratio of 1.2:1. Most common internal malignancy was breast carcinoma in 43 (28.67%) cases. Specific dermatosis were seen in 5 (3.33%) cases and non-specific dermatosis in 121 (80.66%) cases. Specific dermatosis were vasculitis, necrolytic migratory erythema, lymphocytoma cutis, growth and cutaneous metastasis with 1 (0.67%) patient each. Most common non-specific dermatosis was herpes zoster in 17 (11.33%) cases. Conclusion: The study was useful in understanding the various specific and non specific dermatosis associated with internal malignancies and thereby helping the physician to manage the conditions.

An Observational Study of Cutaneous Manifestations in Patients on Chemo and Radiation Therapy for Internal Malignancies at Tertiary Care Center.

Context: Chemotherapy and radiation therapy given to treat internal malignancies may cause cutaneous, hair, nail, and oral mucosal changes. The present study is an effort to know the pattern of cutaneous drug reactions with chemo and radiotherapy. Materials and Methods: Patients of internal malignancies with skin lesions attending the dermatology and oncology OPD/ward were recruited after taking their written consent in vernacular language. A detailed history of skin lesions, malignancies, and treatment was taken. Clinical examination was carried out. Relevant investigations and biopsy were carried out as and when required. Being a descriptive study, age group and gender-wise frequency and percentage were calculated for the treatment of malignancies and dermatosis. Results: The study included 150 patients with 28 different types of internal malignancies, of which 127 (84.66%) patients were treated, 45 (35.43%) treated exclusively with chemotherapy, 16 (12.59%) with exclusive radiation therapy, and 66 (51.96%) with combined chemo and radiation therapy. Total 111 (87.41%) patients received chemotherapy and 82 (64.56%) patients received radiation therapy. Most common internal malignancy was breast carcinoma in 43 (28.67%) cases. Most common chemotherapeutic agent given was paclitaxel to 33 (29.73%) patients. Most common dermatosis associated with exclusive chemotherapy was hand-foot syndrome in 7 (15.55%) cases and with exclusive radiation therapy was radiation dermatitis in 8 (50%) cases. Conclusions: The study was useful in understanding various chemo and radiation therapy-associated dermatosis so that early interventions can be done to prevent further treatment-related adverse effects. Limitation: Small sample size and inability of pinpointing a single drug as the side effect.

Atypical Presentation of Halo Nevus over Eyelid with Poliosis: A Dermatoscopic Perspective.

Halo nevus (HN) is benign skin condition with a central melanocytic nevus, surrounded by an area or halo of depigmentation. It is the result of immunological response of the body toward the nevus, which destroys the melanocytes in surrounding skin, leading to the depigmented halo. An increased frequency of HN in patients with vitiligo is observed. It is more commonly seen in children or young adults of either sex, particularly on the trunk, less commonly on the face, neck, and limbs. We present a rare case of HN which was present on the lower eyelid associated with poliosis, diagnosed with dermatoscopy.

Topical steroids: Awareness and misuse among patients, pharmacists and general medical practitioner.

AIMS AND OBJECTIVES: (1) To determine the level of awareness among patients, pharmacists and general practitioners about commonly available topical steroids and its combinations.(2) To determine the source of recommendation/prescription of topical steroids and its combination creams.(3) To know and create awareness about the side effects of topical steroids in all the study groups. METHODS: This was a prospective questionnaire-based study where three study groups, namely patients, pharmacists and general practitioners, were included. This study was approved by the institutional ethics committee. after ethical clearance. The patients who used topical steroids for dermatoses where it is an absolute contraindication, as well as those who developed side effects, were included in the study. ThoroughComplete cutaneous examination was done specifically to detect the side effects of steroids. Seminars were conducted and questionnaires were given to both the pharmacists and general practitioners of nearby areas. The questionnaire consisted of questions regarding their prescription and dispensing practices of topical steroids and its combinations. RESULTS: Out of 95 patients seen, the most commonly used steroid molecule was clobetasol propionate 0.05% in 44 (46.3%) patients, the common source of recommendation was general practitioners in 36 (37.8%), the common indication was superficial dermatophytosis in 85 (89%) and the most common adverse effect was recurrence/increase in the extent of the infection in 72 (75.78%) patients. Out of total 44 general practitioners enrolled in the study, 22 (50%) were qualified allopathic medical practitioners and22 (50%) were homeopathic/ayurvedic doctors. Superficial dermatophytosis [19 (43.18%)] was the common dermatosis seen by them. While 29 (65.90%) preferred prescribing topical steroids or its combination, rest of them preferred plain steroid creams. Out of 179 pharmacists, 74 (41.34%) did not have appropriate knowledge of topical steroids, 35 (19.55%) were not aware that steroids are isschedule "H" drugs. Commonest molecule sold over the counterwas clobetasol propionate 0.05% by 74 (41.89%). The limitations of our study were small study group and short duration. CONCLUSION: As dermatologists, it is our responsibility, to correctly educate the society, particularly the non-dermatologist medical fraternity, about ethical and rational use of topical steroids.

Epidermodysplasia verruciformis with plane warts over lower abdomen and genitals.

Epidermodysplasia verruciformis (EDV) may clinically vary from pityriasis versicolor-like macules to wart-like flat papules, psoriasiform red papules, or pigmented keratotic lesions resembling seborrheic keratosis. Sun-exposed areas are commonly affected with genital areas rarely involved. It is associated with more than 30 human papillomaviruses (HPVs). In 90% cases of squamous cell carcinomas, HPV5 and HPV8 is isolated. A case of EDV with plane warts involving the genital area in a 35-year-old male is reported here.

Congenital Triangular Alopecia - A Case Report.

Congenital triangular alopecia also known as temporal triangular alopecia or Brauer nevus may be present at birth or acquired during the first decade of life. It can present as triangular, oval, or lancet-shaped patch of alopecia. It may be misdiagnosed as alopecia areata, traction alopecia, trichotillomania, tinea capitis, and aplasia cutis congenita. Histopathological features and dermoscopic features help in its diagnosis. There is no effective treatment for it and, in most cases, there is no need for therapeutic intervention. Therapeutic modalities include topical minoxidil, surgical excision, and hair transplantation.

Prevalence and Pattern of Skin Diseases in Tribal Villages of Gujarat: A Teledermatology Approach.

BACKGROUND: The prevalence and pattern of skin diseases are influenced by the overall ecosystem of the region. There is a dearth of research about prevalence, health-care seeking, compliance, and treatment outcome in skin diseases among scheduled tribes. OBJECTIVES: The aim of this study is to understand the magnitude of skin diseases in tribal area of Dahod, Gujarat using a simple "Store and Forward" technique of teledermatology. MATERIALS AND METHODS: A cross-sectional study was conducted in 10 randomly selected villages of Dahod and Jhalod blocks of Dahod district of Gujarat during June-August 2017. Trained surveyors visited households randomly in different localities (called Faliya) of each village ensuring representativeness. Survey responses were captured on mobile-based MAGPI portal, and images of skin conditions were capture on smart phones, and de-identified images were transferred over WhatsApp. RESULTS: A total of 781 households were approached in 10 villages and 2214 participants consented. Among them, 549 were identified with suspected skin diseases, but 520 consented for photograph. The skin diseases were more prevalent among males, children, and elderly. Of 520, 44 (8.5%) could not be assess due to poor quality photograph and 35 (6.7%) did not have any clinically significant condition. Thus, of 2214 participants, 441 (20%) had skin diseases, and infections and eczema were major conditions constituting two-third of the skin diseases in the study population. The treatment-seeking behavior and compliance to treatment was poor. CONCLUSION: Considering the high prevalence of skin diseases in tribal villages of Dahod, Gujarat coupled with limited availability of trained dermatologist, new innovative avenues like teledermatology should be explored.

Dermoscopy in general dermatology (non-neoplastic dermatoses) of skin of colour: a comparative retrospective study by the International Dermoscopy Society.

BACKGROUND: Dermoscopy has been shown to be a useful supportive tool to assist the diagnosis of several non-neoplastic dermatoses (i.e. inflammatory, infiltrative and infectious skin diseases), yet data on skin of colour is still limited. OBJECTIVES: To characterize dermoscopic features of non-neoplastic dermatoses in dark-skinned patients in order to identify possible clues that may facilitate the differential diagnosis of clinically similar conditions. MATERIALS & METHODS: Members of the International Dermoscopy Society were invited to submit cases of any non-neoplastic dermatosis developing in patients with Fitzpatrick Phototypes V-VI whose diagnosis had been confirmed by the corresponding gold standard diagnostic test. A standardized assessment of the dermoscopic images and a comparative analysis according to clinical presentation were performed. Seven clinical categories were identified: (I) papulosquamous dermatoses; (II) facial hyperpigmented dermatoses; (III) extra-facial hyperpigmented dermatoses; (IV) hypopigmented dermatoses; (V) granulomatous dermatoses; (VI) sclerotic dermatoses; and (VII) facial inflammatory dermatoses. RESULTS: A total of 653 patients (541 and 112 with Phototype V and VI, respectively) were recruited for the analysis. Thirty-six statistically significant dermoscopic features were identified for papulosquamous dermatoses, 24 for facial hyperpigmented disorders, 12 for extra-facial hyperpigmented disorders, 17 for hypopigmented disorders, eight for granulomatous dermatoses, four for sclerotic dermatoses and 17 for facial inflammatory diseases. CONCLUSION: Our findings suggest that dermoscopy might be a useful tool in assisting the diagnosis of clinically similar non-neoplastic dermatoses in dark phototypes by revealing characteristic clues. Study limitations include the retrospective design, the lack of a direct dermoscopic-histological correlation analysis and the small sample size for less common diseases.

A Cross-Sectional Study on the Dermatoses in Postmenopausal Patients at a Rural-Based Tertiary Health Care Center.

CONTEXT: There is still a dearth of knowledge regarding the types of dermatoses occurring in postmenopausal women. The common disorders occurring in postmenopausal women and the probable effects of hormonal fluctuations on the skin have to be considered while treating postmenopausal women. AIMS: To study clinical patterns of dermatosis in menopausal women. SETTINGS AND DESIGN: It was a cross-sectional study conducted in the dermatology department from May 2017 to June 2018 after approval from ethical committee. MATERIALS AND METHODS: All postmenopausal patients having dermatoses were included in the study after taking their written consent in vernacular language. STATISTICAL ANALYSIS USED: All findings were analyzed using STATA (14.2). RESULTS: The study included 150 postmenopausal women. Most of the patients belonged to the age group of 61-70 years (38.67%) with a mean age of 61.52 years. The age of menopause was most commonly achieved between 40 and 50 years (57.33%). The genital dermatoses were found in 90 (60%) subjects and included atrophic vaginitis (21, 33.33%), lichen sclerosus et atrophicus (14, 15.55%), lichen simplex chronicus (14,15.55%) and tinea cruris (10,11.11%) among others. The extragenital dermatoses were found in 96 (64%) cases and common ones were dermatophytosis (16, 16.33%), lichen planus (11, 11.22%), psoriasis (9, 9.18%) and eczema (8,8.16%). CONCLUSION: This study is useful in understanding the various clinical patterns of postmenopausal dermatoses and thereby help the physician, dermatologist, and gynecologist to effectively manage the conditions.

Circle Hairs Involving the Extremities in a Young Girl.

Circle hairs (CHs) represent a body hair growth disorder which is characterized by asymptomatic presence of hairs in typical circular or spiraliform arrangement. It is not associated with follicular or inflammatory abnormalities. CHs are rarely reported, probably underestimated, as medical consultation for CH only is rare in practice. It needs to be differentiated from rolled hairs, which is a relatively common disorder of hair growth associated with follicular hyperkeratosis and keratin plugging. Trichoscopy is a noninvasive technique to confirm the diagnosis without biopsy. We present a 20-year-old female who presented with CHs over bilateral upper and lower limbs involving extensors.

Xanthelasma palpebrarum - a brief review.

Xanthelasma palpebrarum is the most common cutaneous xanthoma, characterized by yellowish plaques over eyelids - most commonly, over the inner canthus of the upper lid. It is triggered by hyperlipidemia, thyroid dysfunction, and diabetes mellitus. Xanthelasma results from perivascular infiltration of mono- and multinucleated foam cells within lipid-laden cytoplasmic vacuoles in the superficial reticular dermis. Different modalities of treatment, such as simple surgical excision, cryotherapy, chemical peeling with trichloroacetic acid, radiofrequency, and laser, are used in the treatment of xanthelasma palpebrarum. A brief review of current treatment strategies is presented here.

Impact of Palmoplantar Dermatoses on Quality of Life.

BACKGROUND: Palmoplantar dermatoses are commonly found in dermatological practice. Quality of life (QOL) is severely impaired if these areas are affected. Early and appropriate management of palmoplantar dermatoses help in improving patient's QOL. AIM: To assess the impact of palmoplantar dermatoses on QOL. MATERIALS AND METHODS: Patients with palmoplantar dermatoses with or without other body part involvement were enrolled in the study. QOL was assessed by Dermatology Life Quality Index (DLQI) questionnaire for >16 years of age and by Children's Dermatology Life Quality Index (CDLQI) questionnaire for 5-16 years of age. RESULTS: Two hundred and two patients participated, of which 108 (53.46%) were males and 94 (46.53%) were females. The commonest age group affected was 17-40 years (42.57%). Housewives 61 (30.2%) and laborers 53 (26.2%) were most common occupational group affected. The mean DLQI and CDLQI scores were 7.68 and 7.46, respectively. Fifty-seven (28.21%) patients had palmoplantar psoriasis (PPP), 35 (17.32%) had palmoplantar keratoderma (PPK), and 26 (12.87%) had hand eczema (HE) with mean DLQI scores 8.60, 8.53, 8.60, and CDLQI scores 8.40, 8.28, and 8.26, respectively. In both DLQI and CDLQI, questions on symptoms and feelings scored maximum. Gender, age, occupation, duration, progress, and type of dermatosis did not show statistically significant association with DLQI. However, chronic recalcitrant dermatoses such as PPP, PPK, and HE showed significant impairment in QOL in relation to occupation and duration of disease. LIMITATION: Severity of various palmoplantar dermatoses was not graded and therefore relation between severity of various dermatoses and QOL was not established. CONCLUSION: Majority of patients with palmoplantar dermatoses especially those having chronic course had significant impairment in their QOL.