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   Table of Contents - Current issue
Coverpage
January-April 2022
Volume 9 | Issue 1
Page Nos. 1-66

Online since Monday, May 16, 2022

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EDITORIAL  

Pigmentary disorders: paradigms in a multicultural society p. 1
Monisha Gupta, Brent J Doolan
DOI:10.4103/pigmentinternational.pigmentinternational_47_21  
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REVIEW ARTICLES Top

Dermoscopy of disorders of hypopigmentation p. 4
Yasmeen Jabeen Bhat, Soumil Khare, Nahida Nabi
DOI:10.4103/pigmentinternational.pigmentinternational_13_22  
Dermoscopy has traditionally been used to diagnose neoplasms and, more recently, to evaluate inflammatory conditions. Recent observational studies have suggested a role for dermoscopy in identifying and differentiating various hypopigmentary disorders. This comprehensive review will summarize the growing literature on the use of dermoscopy for hypopigmentary disorders.
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Management of childhood vitiligo − a brief review p. 14
Sahana P Raju, Sumit Kaur, Eswari Loganathan
DOI:10.4103/pigmentinternational.pigmentinternational_66_21  
Vitiligo comprises of one of the commonest reasons for a dermatology consultation in the pediatric age group, worldwide. The incidence of childhood vitiligo varies from 1% to 8%, making it a significant pediatric condition. Various theories have been put forward to explain the occurrence of depigmentation in vitiligo, of which genetic factors play a predominant role in childhood vitiligo. The various modalities of treatment of childhood vitiligo are reviewed in this article. The management of vitiligo is extremely challenging, more so in the pediatric age group, as it can lead to significant psychologic trauma and dysregulation of social development in a child. The goals of management of childhood vitiligo should be aimed at addressing all these issues and achieving an optimum result out of the available modalities.
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ORIGINAL ARTICLES Top

Dermoscopy in Vitiligo: An emerging armamentarium in diagnosis and activity assessment p. 25
Guneet Awal, Jasleen Kaur, Komalpreet Kaur
DOI:10.4103/pigmentinternational.pigmentinternational_4_21  
Context: Vitiligo is an autoimmune depigmentary disorder characterized by loss of epidermal melanocytes. It can be diagnosed clinically, however, dermoscopy aids in its differentiation from other hypopigmentary and depigmentary conditions and also helps in evaluating disease activity. Aims: To study the dermoscopic patterns of vitiligo and evaluate their correlation with disease activity. Settings and Design: This is a cross-sectional and observational study conducted in the outpatient department of dermatology of a tertiary care hospital at Sri Amritsar. Methods and Materials: Fifty patients complaining of depigmented lesions were diagnosed clinically for vitiligo. Histopathological confirmation was done in difficult to diagnose cases. Patients with clinically stable vitiligo, unstable vitiligo, and vitiligo under treatment were included. A dermoscopic examination was done with a Dermlite DL4 dermoscope. The photographs were taken using a standard phone and the dermoscopic findings were documented.Statistical Analysis Used: The results were tabulated and expressed as percentages. The Pearson correlation coefficient was calculated between dermoscopic patterns of vitiligo and disease activity. Results: On examination with the dermoscope, pigmentary patterns observed were marginal hyperpigmentation, perifollicular pigmentation, reticulate hyperpigmentation, and altered pigment network. Morphological patterns seen on dermoscopy included leukotrichia, micro-Koebner phenomena, polka dots, and starburst appearance. Conclusions: Marginal hyperpigmentation, perifollicular pigmentation, and reticulate pigmentation were the markers of disease stability. Leukotrichia was seen in patients of stable vitiligo majority being treatment refractory. Altered pigment network, micro-Koebner phenomena, starburst appearance, and polka dots indicated unstable vitiligo. Presence of erythema and telangiectasias indicated response to treatment. Hence, dermoscopy can be used as an effective tool for the diagnosis of vitiligo and evaluation of disease activity.
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Role of oral corticosteroids, methotrexate, and azathioprine in patients with unstable vitiligo: A comparative study p. 33
Niharika Mittal, Tejinder Kaur
DOI:10.4103/Pigmentinternational.Pigmentinternational_2_20  

Background: There are several medical and surgical interventions for vitiligo but still the search for a definite cure is going on. The first goal of the therapy is to make the disease stable by preventing the appearance of new lesions. Drugs like oral corticosteroids, methotrexate, and azathioprine have been found effective in this phase. Objective: To compare the efficacy of oral corticosteroids, methotrexate, and azathioprine in patients with unstable vitiligo. Materials and Methods: It was a retrospective data analysis of 319 vitiligo patients, out of which 52 patients with unstable vitiligo who have received treatment in the form of 0.5 mg/kg oral corticosteroids on 2 consecutive days per week, 0.3 mg/kg methotrexate per week, and 1 to 1.5 mg/kg azathioprine daily were selected and were evaluated for the effect of drug for 12weeks. Results: There was no statistically significant difference in the appearance of new lesions in all 3 groups; however, methotrexate showed the early effect which plateaus after a few weeks whereas steroids as well as azathioprine showed a gradual and consistent effect. Conclusion: Methotrexate, steroids, and azathioprine all arrest the disease activity in vitiligo. Methotrexate can be used to arrest disease activity in fast-spreading vitiligo. Azathioprine can be used in patients with active vitiligo, wherever steroids are contraindicated.

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A split-face study to evaluate the efficacy of Nd:YAG laser versus radiofrequency cauterization for the treatment of ephelides on face p. 39
Ambuj Singh, Tarang Goyal, Pooja Singh
DOI:10.4103/Pigmentinternational.Pigmentinternational_54_20  
Background: Until recently, the removal of ephelides on face was predominantly carried out by using dermabrasion, chemical peeling, and radiofrequency cauterization. As these treatment modalities caused undesirable side effects such as scarring, this study is being performed to compare the effect of ND:YAG laser and radiofrequency to remove ephelides with laser showing better result and fewer side effects. Materials and methods: The present study was conducted in the department of dermatology, venerology, and leprology during the period 2017 to 2019 after obtaining clearance from Board of Studies and Ethical committee. Patient was thoroughly examined on the basis of history and examination for a confirm diagnosis. After confirming the diagnosis, the patient’s face was divided into left and right sides. On to the right-sided freckles of the face, radiofrequency cauterization was carried out and on left part, Nd:YAG was performed. The objective parameters were estimated at the end of 1 month using global improvement scale and also by evaluating patient’s satisfaction score. Photographs of both sides of the face were taken at 0, 1 week, and at 1 month under consistent background, position, and lighting and compared with the pretreatment images. Results: The study population consisted of 9 (18%) males and 41 (82%) females. Distribution of global improvement scores 3 and 4 was significantly more among Nd:YAG laser (65.0% and 10.0%, respectively) compared to radiofrequency ablation (2.5% and 0.0%, respectively). Mean freckle area severity index (FASI) score post-treatment and reduction in score were significantly more among Nd:YAG laser compared to radiofrequency ablation. Erythema, hyperpigmentation, and hypopigmentation were significantly more among radiofrequency ablation. Conclusion: Nd:YAG laser showed satisfactory result in removing freckles in comparison to radiofrequency ablation.
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Comparative study of efficacy of intradermal tranexamic acid microinjections versus intradermal glutathione microinjections for treatment of facial melasma Highly accessed article p. 46
Kanchan Kumawat, Kailash Bhatia, Jushya Bhatia, Rajesh Kataria, Chaitanya Namdeo, Ankur Sarin
DOI:10.4103/Pigmentinternational.Pigmentinternational_13_20  
Background Melasma is a hypermelanotic disorder, which poses therapeutic challenge. Tranexamic acid (TA) and glutathione are novel therapies for the treatment of melasma. Aim To compare the therapeutic efficacy of localized intradermal microinjections (mesotherapy) of TA versus microinjections of glutathione for the treatment of melasma. Methods This prospective, comparative study was carried out to assess the therapeutic efficacy of TA and glutathione in 64 patients with dermal melasma after obtaining written informed consent, over a period of 12 weeks. Face of the patient was divided into two halves (split face); right cheek was injected with TA and the left with glutathione, at baseline (zero), 4th, 8th, and 12th weeks. The treatment response was assessed by using visual analog scale (VAS); photographs were taken to ascertain the improvement and its percentage was calculated. A parametric test, Student t test, and Z test were applied wherever applicable. P-value of <0.05 was considered statistically significant. Results Out of 64 enrolled, 50 patients completed the study and it was found that the reduction in VAS score from baseline to 8th week and baseline to 12th week was significant in both the groups (P < 0.05). However, the mean difference in improvement percentage between baseline and 8th week and baseline and 12th week with TA was found to be more significant than glutathione. Conclusion This study revealed that both TA and glutathione intradermal microinjections are effective in the treatment of melasma but TA is more effective.
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CASE REPORTS Top

Vitiligo: an uncommon cutaneous manifestation of graft versus host disease p. 51
Preema Sinha, Anwita Sinha, Subramaniyan Radhakrishnan, Jasvinder Kaur Bhatia
DOI:10.4103/Pigmentinternational.Pigmentinternational_30_20  
Graft versus host disease (GVHD) is the most serious complication of hematopoietic stem cell transplantation. Skin is the most commonly affected organ, in both acute and chronic GVHD with a variable clinical spectrum of presentation with the typical skin lesions being either lichenoid or sclerodermatous. Antibodies developing in chronic GVHD act as triggering factors in the development of autoimmune diseases and can manifest as vitiligo that is an autoimmune disease resulting in melanocyte destruction. Vitiligo as sequelae and manifestation of GVHD is infrequently reported in the literature. Herein, we report the case of a lady who developed vitiligo post hematopoietic stem cell transplant.
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Dyschromatosis universalis hereditaria with keratoacanthoma: a rare presentation p. 55
Veena
DOI:10.4103/Pigmentinternational.Pigmentinternational_51_20  
Dyschromatosis Universalis hereditaria is a rare pigmentary disorder presenting with dyschromia of skin involving trunk and extremities arranged in mottled manner lesions, usually present in the first few years of life. Herein, we report this extremely rare case of dyschromatosis universalis hereditaria in a middle-aged male with a family history of dyschromia in his younger sister, now presenting to us with a keratoacanthoma.
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LETTERS TO THE EDITOR Top

Premature graying of hair observed as the commonest cutaneous association in vitiligo in a comparative cross-sectional study: a component to be pondered p. 59
Nair Divya, Priya Prathap, Neelakandhan Asokan
DOI:10.4103/pigmentinternational.pigmentinternational_17_21  
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Turban Dermatitis p. 63
Vignesh Narayan R, Anuradha Bishnoi, Muthu Sendhil Kumaran
DOI:10.4103/pigmentinternational.pigmentinternational_27_21  
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CLINICAL PICTURE Top

Congenital hairy melanocytic nevus over eye p. 65
Sunil Kumar Gupta, Sushantika Kumari
DOI:10.4103/Pigmentinternational.Pigmentinternational_11_20  
A ten year old boy presented with black hairy nevus over left eyelid since birth.He did not have any complains of vision. The nevus was progressing in size encroaching over upper eyelid with minute papules in eyelid margin. It was diagnosed as congenital hairy melanocytic nevus clinically. His parents were advised laser therapy after he reaches maturity as a management option. The location of the nevus made it worth reporting.
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