Skin is an easily accessible source of various sub population of stem cells including epidermal stem cells, hair follicle stem cells (HFSCs) and dermal mesenchymal stem cells. The outer root sheath (ORS) of the hair follicle is a rich source of a type of HFSCs called the melanocytes stem cells (MelSCs). These HFSCs have a vast, unexplored potential in the treatment of vitiligo as initial re-pigmentation often occurs around the hair follicles. Common therapeutic modalities such as tacrolimus, phototherapy and dermabrasion acts through MelSCs. Newer cellular techniques have explored the use of ORS hair follicle suspension in surgical treatment of vitiligo. Advancement in melanocyte and stem cell research has identified various cytokines, growth factors and regulators involved in proliferation and differentiation of melanoblasts, which can be used for autologous in situ melanocyte regeneration. In this review, we briefly discuss the current position and future prospects of stem cells in vitiligo.

Pigmentary demarcation lines (PDLs) are areas of an abrupt transition from hyperpigmented to hypopigmented or normal skin color. They are seen on limbs, face, and sometimes trunk. They are common in the black race. There are eight groups of PDL A to H. Facial PDL should be differentiated from melasma and postinflammatory pigmentation over the face. PDL are common in black women during pregnancy and are considered to be normal variants of pigmentation. Etiology of PDL continues to be an enigma and needs further research. PDL in pregnancy may regress spontaneously after delivery and do not require treatment. Facial PDL have a persistent course posing cosmetic concern for the patient and a challenge for dermatologist.

Background: Exogenous ochronosis (EO) can be associated with the prolonged application of hydroquinone (HQ) used for the treatment of melasma. Histopathological examination is required for a definite diagnosis. Dermoscopy can be used to avoid unnecessary biopsies from the face. Aims and Objectives: The aim was to characterize the clinical profile of melasma, to elicit the dermoscopic features of melasma and EO if any, and to histopathologically confirm any suspected cases of EO. Materials and Methods: This was a descriptive study spanning October 2011 to June 2013. With informed consent, a detailed history and examination was carried out along with details of skin lightening creams used if any. This was followed by cutaneous examination and dermoscopic evaluation. In those who had lesions suspicious of EO, consent for 3 mm punch biopsy was obtained and the samples were studied using hematoxylin and eosin stain for banana-shaped ochre colored fibers. Results: In 104 (94 females, 10 males), the mean age at onset and duration of melasma was 36.6 and 4.14 years, respectively. Past history of treatment for melasma was present in 30.8% patients. The most common clinical type of melasma was malar (51.9%). EO was suspected in five patients. In suspected cases, brown-blue globules were noted in addition to melasma features dermoscopically. Telangiectasias were noted in 37.5% of patients. Histopathological confirmation of EO was obtained in only one out of four patients who gave consent for biopsy. Conclusion: The frequency of EO in our study was found to be 0.9%. The incidence of EO in Indian population appears to be quite low, which might be due to under reporting, lack of awareness, irregular and infrequent use of HQ or population based difference in prevalence.

Pigmentary demarcation lines (PDLs) are abrupt demarcation lines between the areas of light and dark pigmentation and also called as Futcher's or Voigt lines. These lines are most commonly seen in upper and lower limbs but can also be seen in other body parts. They occur almost in all races, but the incidence is more in Japanese, Caucasians and Negros. Treatment is not necessary because of transitory and asymptomatic nature of PDL. If at all required, it is due to cosmetic concerns only. We are reporting a rare case of type B PDL persisting even after 1 year postpartum.

A 61-year-old Indian male presented with gradually progressive generalized reticulate brownish pigmentation of the trunk, upper limbs, and lower limbs. The face and neck area were conspicuously spared. There was no oral, scalp or nail involvement. However, the soles showed bilaterally symmetrical well-demarcated erythematous hyperkeratotic plaques. There was no history of violaceous pruritic lesions over the body. Histopathological features of the trunk as well as sole lesions were consistent with findings of lichen planus (LP). LP pigmentosus is a variant of LP seen in Indian and other darker-skinned populations and most commonly presents as diffuse pigmentation over sun-exposed areas, mainly the face and neck. Our patient, however, presented with reticulate pattern of pigmentation, sparing the face and neck, along with lesions over both the soles. Such a manifestation in the absence of typical lesions of LP is very rare and to our knowledge this is the first such case reported from the Indian subcontinent.

Dermoscopy is a simple noninvasive technique that aids in the diagnosis of disorders of hyperpigmentation. However, its role in diagnosis of vitiligo is relatively infantile with only few published reports. We report the case of a young man who sought consultation for diffuse facial hyperpigmentation suggestive of photomelanosis. Dermoscopy from a pigmented forehead lesion revealed perifollicular depigmentation (PFD) without leukotrichia, in a background of reticular hyperpigmentation. There was no clinical evidence or past history of vitiligo. Family history of early-onset recalcitrant vitiligo was positive in mother. The patient developed rapidly progressive vitiligo with leukotrichia within the next 4 weeks. Dermoscopic re-evaluation from the same region revealed a reduction in hyperpigmentation, widening of PFD, leukotrichia of few hairs and rarefaction and pigment reduction of other hair shafts suggestive of impending leukotrichia. He developed the treatment-refractory disease over the next 6-8 months. Therefore, though perifollicular pigmentation is preserved in the lesional skin in most cases of vitiligo, PFD seen on dermoscopy may paradoxically indicate impending vitiligo especially in a high-risk case e.g. positive family history. This case has been documented to highlight the role of dermoscopy and the sign of PFD in early detection of vitiligo.