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   Table of Contents - Current issue
January-April 2023
Volume 10 | Issue 1
Page Nos. 1-75

Online since Thursday, March 23, 2023

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Pigmentation in chikungunya: An enigma to unravel Highly accessed article p. 1
Ajit B Janagond, Arun C Inamadar
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Primary localized cutaneous amyloidosis − a review Highly accessed article p. 4
Vijay K Somani, Anirudh Somani, Rashmi Sarkar
Amyloidosis describes a group of diseases characterized by abnormal extracellular deposition of a fibrillar protein in tissues. It comprises of a spectrum of diseases ranging from a mild asymptomatic cutaneous involvement to a progressive life-threatening multisystem disorder. Primary localized cutaneous amyloidosis (PLCA) is characterized by pruritus, hyperpigmentation, and lichenification. Demonstration of amyloid in dermal papillae by various techniques confirms the diagnosis. Three types are described, macular, lichen/papular, and nodular. Majority of cases of PLCA are sporadic but an autosomal dominant family history may be present in up to 10% of cases. Exact pathogenesis is not elucidated yet, but several factors like friction, sunlight, genetics, atopy, immune dysregulation have been implicated. Pathogenic mutations in oncostatin M receptor and the interleukin (IL)-31 receptor A gene (IL31RA) have an important role to play in the pathogenesis of both familial and sporadic PLCA. Nodular amyloidosis, the rarest type of PLCA, is known to progress to systemic amyloidosis in 7% to 15% of cases, hence a long-term follow up is recommended. The plethora of treatment options reported to be beneficial in cutaneous amyloidosis underscores the fact that none of the modality is universally effective.
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Cosmeceuticals in hyperpigmentary disorders Highly accessed article p. 14
Subburaj Kiruthika, Jain Sejal, Vinay Keshavmurthy
Cosmeceuticals are hybrids between cosmetics and pharmaceuticals containing ingredients that modify the skin’s functions and enhance its appearance. They are a bridge between drugs and cosmetics for minor skin ailments. The lack of proper regulatory standards for cosmeceuticals makes it very important for the dermatologists to educate the patient regarding their safety, or consequences of lack of knowledge thereof. In hyperpigmentation disorders, cosmeceuticals specifically target melanocytes and block the important regulatory steps in melanin synthesis, especially tyrosinase. The various agents include arbutin, bakuchiol, ferulic acid, kojic acid, licorice root extract, nicotinamide, plant extracts, resorcinol, retinol, sunscreens, thiamidol, and vitamin C. Plant extracts have minimal side-effects and are gaining popularity. They include aloe vera extract, cinnamic acid, coffeeberry, flavonoids, grape seed extract, green tea extracts, marine algae extract, mulberry extract, N-acetyl glucosamine, orchid extract, pycnogel, soy and umbelliferone. There is a requirement for large randomised controlled trials to establish their efficacy and adverse effects. Patient follow-up and compliance are the cornerstones of any skin therapy as any cosmeceutical use can produce gradual results when compared to conventional therapies. The PubMed database was searched using ‘hyperpigmentation disorders’ OR ‘melasma’ AND ‘cosmeceuticals’ as keywords. Abstracts were screened to include studies in the English language and those pertaining to the use of cosmeceuticals in hyperpigmentary disorders. In this review, we summarise the existing literature on the utility of cosmeceuticals in the treatment of hyperpigmentary diseases.
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Clinico-histopathological and dermoscopic features of Becker nevus: an analytical observational study from southwestern India p. 24
Ankita Patil, Ajay Kumar, Kalyan Dalave, Mahendra S Deora, Devayani Pol
Background: Becker nevus (BN), a common nevoid hamartoma, presents as a hypermelanotic often hypertrichotic plaque localized to the chest, shoulder, or back in the first two decades of life. Aims: The aim of the study was to evaluate clinicohistopathological and dermoscopic findings of BN in the Indian population. Methods: Thirty-five clinically diagnosed cases of BN were enrolled. Sample characteristics, clinicohistopathological findings, dermoscopic findings, and developmental abnormalities were noted and an observational analytical study was carried out. Results: The mean age of the patients was 18.9 years and 28 (80%) were Males. BN was present since birth in 12 (34.3%), developed in the first decade in 5 (14.3%), and in the second decade in 18 (51.4%). Common sites included the chest in 10 (28.6%), the face in 8 (22.9%), and the upper limb in 7 (20%). Hypertrichosis was observed in 24 (68.6%) and acneiform lesions in 2 (5.7%). Twenty-two (62.9%) patients had right-sided lesions. No developmental abnormalities were detected. Skin biopsy findings included hyperkeratosis in 25 (71.4%), acanthosis in 32 (91.4%), elongation of rete ridges in 32 (91.4%), basal layer pigmentation in 35 (100%), and smooth muscle hyperplasia in 4 (11.1%) patients. Dermoscopic findings included reticular brown lines (pigmentation network) in 32 (91.4%), perifollicular white color (perifollicular hypopigmentation) in 27 (77.1%), skin furrow hypopigmentation in 17 (48.6%), and focal hypopigmentation in 15 (48.6%) cases. Conclusions: Onset at birth and facial lesions are common in those of Indian ethnicity, while developmental abnormalities associated with BN are infrequent.
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Childhood onset vitiligo − clinical profile and impact on quality of life of family members p. 30
Mary Augustine, Vimal John
Background: Vitiligo, a chronic disease, is distressing for patients and family. There are only a few studies on childhood onset vitiligo that describe its prognosis. Aim: To study the clinical and epidemiologic features of childhood onset vitiligo and to assess its impact on quality of life (QoL) of family members. Methods: A cross-sectional study was carried out on patients with vitiligo, with onset before 12 years of age. Clinicoepidemiologic profile was recorded. QoL of family members was assessed using family dermatology life quality index (FDLQI). Results: Fifty-four patients with age ranging from 1.2 to 41 years were included. Mean age of onset was 6.68 ± 3.43 years. Generalized vitiligo was most common (33.33%), followed by segmental (31.48%), acrofacial (24.07%), mucosal (7.40%), universal (1.85%), and focal (1.85%) types. About 42% had mucosal involvement, oral mucosa in 27.78%, and genital mucosa in 14.81%. Leukotrichia was significantly more common in segmental vitiligo (SV) than nonsegmental vitiligo (NSV) (P = 0.000046). Of the 9 adult NSV patients, progressive disease was reported in 6 with 10 years duration and 2 with 20 years duration. Mean FDLQI was 7.02 ± 3.64; emotional distress having maximum score (1.09). There was no significant association between total FDLQI and age (P = 0.69), gender (P = 0.528), clinical type (P = 0.874), vitiligo disease activity (VIDA) score (P = 0.105), or site of involvement (P = 0.07). Conclusion: NSV can be progressive for many years; a fact to be kept in mind while planning management of childhood onset vitiligo. QoL of family is affected regardless of the clinicoepidemiologic profile.
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Cross-sectional study on clinical profile and quality of life of individuals with occulocutaneous albinism in Lagos, Nigeria p. 37
Olusola O Ayanlowo, Ayesha O Akinkugbe, Adeola Onakoya, Erere Otrofanowei, Ogogho A Odiase, Yetunde M Olumide
Introduction: Albinism is a genetic disorder of pigmentation with variable phenotypic presentations. Albinism occurs all over the world, with highest prevalence in sub-Saharan Africa. The most common type is oculocutaneous albinism (OCA), an autosomal recessive disorder. Albinism is associated with morbidity and mortality in Africans. This study aims to describe the epidemiology of OCA, clinical expressions, and effect on the quality of life (QoL). Methods: Individuals with albinism were invited through the albino foundations and dermatology clinic of Lagos University Teaching Hospital. Structured questionnaires were used to document demographic and clinical data: occupational history, sun exposure, sun protective behavior, knowledge of adverse effects of sun exposure, and QoL and features of photodamage. Results: A total of 142 Nigerians with albinism were recruited. The male to female ratio was 1:1.25. The median age was 22.5 and interquartile range 10.25 to 34. Knowledge of need for sun protection was found in 129 (90.8%): 81 (57%) had daily sun exposure and 61 (43%) had work exposure to sun. Use of sun protection was noted in 103 (72.5%). Overall, photodamage was found in 136 subjects (95.8%). Mean effect of albinism and photodamage on QoL was 6.34 ± 4.47 (standard deviation) corresponding to moderate effect on QoL and domain of “symptoms and feelings” was most affected. Conclusion: The prevalence of photodamage among people with albinism is high despite knowledge of sun protection. There is need for efforts on photoprotection by individuals with albinism and public health interventions.
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A 4-year follow-up study of 20 cases of stable localized childhood vitiligo treated by autologous, noncultured melanocyte–keratinocyte cell transplantation p. 46
Ettappurath N Abdul Latheef, S. Rahima, K. Muhammed, Najeeba Riyaz
Background: Vitiligo is a common skin disease affecting 1% to 2% of general population. Even though different modalities of treatment available, it remains as a difficult disease to treat. Many cases remain stable after a period of medical therapy without any further response. For treating pediatric vitiligo, currently available and result providing therapies are limited. Surgical techniques are the only hope in such patients. Only limited studies are available regarding surgical interventions in childhood vitiligo. Aim: To evaluate the response of autologous, noncultured melanocyte–keratinocyte cell transplantation in childhood stable vitiligo. Methods: A retrospective analysis was conducted in 20 cases of stable localized childhood vitiligo (10 segmental and 10 focal) treated by autologous, noncultured melanocyte–keratinocyte cell transplantation. Serial photographs were taken from the first visit onwards. The patients were followed for a period of 4 years. The results were analyzed on a visual analog scale. Results: Out of total 20 cases, 11 had excellent (90–100%) response, 4 had good (60–89%), 2 had fair (25–59%), and 3 had poor response (0–24%). Age and sex of the patients and size and duration of lesions did not show significant influence on results of transplantation. Conclusion: This is a simple, safe, and effective surgical therapy for replenishing the missing melanocytes even in resistant cases of vitiligo. Only limited studies are there in childhood vitiligo. In spite of its invasive nature, it can be used to treat localized stable vitiligo in children.
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Role of chemical exposure in induction and evolution of vitiligo: a retrospective cross-sectional study from tertiary care center, North India p. 52
Tanreet Kaur, Tejinder Kaur, Jaspreet Kaur
Background: Vitiligo in general is a disease of multiple hypotheses. Some forms of vitiligo vulgaris are in fact caused by household/occupational exposure to certain chemicals which may simply accelerate oxidative stress pathways in melanocytes resulting in their destruction in genetically predisposed individuals. Aims: The basic objectives of this retrospective cohort study were to determine the role of chemical exposure in induction and evolution of vitiligo, to find any association between the duration of chemical exposure and the duration of the disease and to observe the outcome of the disease upon avoidance of suspected chemicals. Methods: In this retrospective study, the records of 81 patients with vitiligo at Government Medical College, Amritsar were evaluated. The primary data were obtained from the performa containing elaborative details regarding demographic and clinical profile of the patients including type of chemical, site, and duration of chemical exposure. Statistical analysis to detect correlation coefficient (R-value) between duration of chemical exposure and duration of disease was performed using SPSS 22.0 version software. Outcome of the disease upon avoidance of chemicals was also documented. Results: In a total of 81 patients of vitiligo, 41.97% were employed in leather industry, 12.34% patients were laborer involved in cement work, 35.41% of females were exposed to household chemicals present in detergents, etc., and 27.7% of the males were farmer by occupation. Acrofacial pattern was observed in 56.79% patients followed by generalized type (29.62% patients). Only 28.39% patients reported symptoms such as pruritus, burning sensation, and erythema at the site of exposure. About 69.13% patients (n = 56) showed positive correlation between site of chemical exposure and site of onset of vitiligo. The mean duration of vitiligo was 6.20 ± 2.51 years and mean duration of chemical exposure was 11.20 ± 4.51 years. The duration of disease and duration of chemical exposure showed no correlation (R = +0.134 and P = 0.490). There was significant reduction in mean percentage of body surface area involved with vitiligo in fully compliant patients (P = 0.01) versus noncompliant patients (P = 0.07). Conclusion: It was observed that several chemical compounds, most of which containing phenol groups in their structure, have role in triggering vitiligo. Complete avoidance of exposure has definite role in haulting the progression of the disease. However, more prospective cohort studies are needed in future to determine the causality.
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Mysterious discoloration of nails in both hands, particularly thumbs alone: a curious case of varied pigmentation in both hands p. 57
Akshay Kumar Jain, Shivani Saini
Preterm babies have immature immunity and skin barrier functions. To cope up with these, many times they are kept under observation in neonatal care unit (NICU) for months until they attain their normal physiological age, weight, and immune functions along with other vital capacities. We are reporting such a curious case of 1-month-old preterm child who presented with the sequence of blackish blue to yellowish discoloration of thumb nails in both the hands.
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Dermoscopy of classic Dowling–Degos disease with review of literature p. 60
Veena Kharayat, Preema Sinha, Manoj Gopal Madakshira, Vinod Sharma
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Lichen planus pigmentosus masquerading as seborrheic melanosis: A case report p. 64
Jayati Shailesh Dave, Atul Dongre, Sunanda Arun Mahajan
Lichen planus pigmentosus is a macular variant of lichen planus commonly affecting photo-exposed areas. A 45-year-old female presented with asymptomatic blackish pigmentation on the both naso-labial folds, alar grooves, angle of mouth, lower lip, medial canthus, and eyelids since 8 years. Dermoscopy of these pigmented lesions revealed non-uniform accentuation of pseudoreticular pattern with dark brown dots and globules in arcuate and incomplete reticular fashion suggestive of lichen planus pigmentosus. Biopsy from the lesion showed perivascular infiltrate with heavily pigmented melanophages in the upper dermis. Based on clinico-pathological correlation and dermoscopic features, diagnosis of lichen planus pigmentosus was made.
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Eyelid lichen planus: diagnosis of a rare entity made easy with a dermoscope p. 68
Preema Sinha, Mahashweta Dash, K. Lekshmipriya, Vinod Sharma
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Hair patch leukoderma p. 70
Sujata R Mehta-Ambalal
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Eccrine poroma p. 73
Gurman Singh Bhasin, Swapna S Khatu, Nitin Chaudhari
Poromas designate a group of benign adnexal neoplasms with poroid (terminal duct) differentiation. The great majority of these lesions are found on the palms and soles and present as moist exophytic lesions. Herein we report a patient who presented with a slow growing nodular lesion over the left palm which was later histopathologically confirmed to be case of Eccrine Poroma.
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