Lichen planus pigmentosus (LPP) is a condition characterized by persistent and asymptomatic slaty-gray pigmentation, predominantly in the face. Classically, the pattern is “actinic” with symmetric and diffuse pigmentation in sun-exposed areas, commonly in dark-skinned individuals. It can also rarely present as macular pigmentation of the flexures in the lighter-skinned. LPP is a disease of the middle-aged, with onset in the third to fourth decades of life and few studies show as slightly greater incidence in females. The photo-distributed or actinic pattern, which is more common, is a disease of tropics and Type IV–Type V skin types. Reports are mainly from India, the Middle East, and South America. The inversus type is relatively rare, predominantly occurring in Caucasians. LPP is thought to be a type hypersensitivity IV reaction to unknown antigen with lichenoid inflammation, leading to melanin incontinence and superficial dermal pigmentation. The natural course of the disease is not clear with some cases showing spontaneous resolution, and some cases with persistence of pigmentation for years. In addition, LPP may have marked overlap clinically and histologically with conditions such as pigmented contact dermatitis, differentiation of which may not be possible in routine practice. Because of these issues, as well as the relative rarity of the condition, there is not much evidence on the efficacy of the various treatment options. Currently, none of the available treatment options show consistent responses or a clear superiority to other modalities, the evidence on efficacy being restricted to a few case series.

Background: Vitiligo is the most common depigmenting disorder. It is more significant in the dark-skinned population, with a major impact on the quality of life of patients. Phototherapy has been the mainstay of treatment for a long time. Both psoralens with ultraviolet A (PUVA) and narrow-band ultraviolet B (NB-UVB) therapy have shown satisfactory results. Aims: To study the efficacy of phototherapy (PUVA and NB-UVB) in patients with vitiligo and to compare the response to phototherapy (PUVA vs. NB-UVB) in vitiligo. Methods: This is a prospective study of 60 patients recruited from the patients attending the dermatology outpatient department of KEM Hospital, Pune. Thirty patients each were randomly allotted to either PUVA or NB-UVB group. Therapy was given thrice a week for PUVA and twice a week for NB-UVB on nonconsecutive days. Patients were followed-up every month for 1 year. Two primary parameters, repigmentation and arrest of progression of disease activity, were considered. Results: Our study showed that both PUVA and NB-UVB are effective in the treatment of vitiligo. Both treatment methods showed a good repigmentation especially over the face, with a poor response on the feet and hands. The overall grade of repigmentation was better with NB-UVB than PUVA. The adverse effects were marginally more with PUVA therapy. Conclusion: Thus, it was proven in our study that both PUVA and NB-UVB are effective for the treatment of vitiligo. However, NB-UVB has proved to have a distinct edge over PUVA in terms of better efficacy and lesser adverse effects.

Background: Primary cutaneous amyloidosis (PCA) is quite a common disorder seen in Southeast Asia. It is characterized by amorphous eosinophilic deposits of a fibrillar protein in the dermis without any systemic involvement. However, the etiology for this disease still remains elusive without much satisfying outcomes with the currently available treatments. Aim: To study the clinical and demographic patterns of PCA and correlate it with histopathological findings along with polarized microscopy examination. Methods: A cross-sectional study done over a 1½ years period wherein after patient enrollment, they underwent a thorough clinical evaluation followed by a skin biopsy and complemented by polarized microscopy. Results: A prevalence of 0.04% and a female preponderance (61.76%) was observed. Lichen amyloidosis (LA) was more common than macular amyloidosis (MA). Majority of patients presented between 41 and 50 years. There was a significant association of pruritus and friction with PCA. The most common sites involved were shins for LA and interscapular area for MA. On histology, epidermal changes were not so significant for MA. However, hyperkeratosis and acanthosis were major epidermal findings for LA. Lymphohistiocytic infiltrates were common dermal changes for both variants of amyloidosis. Amyloid deposits appeared as eosinophilic fissured masses under light microscopy on hematoxylin and eosin staining. Conclusion: PCA is a disorder of middle age seen more commonly in females. Pruritus and friction demonstrate significant contribution in the development of PCA. Whether there is an association of PCA with diabetes mellitus, hypertension, bronchial asthma, and hypothyroidism needs further consideration.

Background: Premature canities is largely an unexplored zone. Its onset in adolescence may have a significant effect on the developing psyche of an individual sufferer, especially in Indian patients with skin of color. Thus far, the impact of premature canities on quality of life (QoL) has not been documented. Aim: To objectively evaluate the impact of premature canities on QoL. Methods: The impact on QoL was calculated with the help of a modified and validated questionnaire on 52 patients with onset of canities before the age of 20 years. Results: The mean modified Dermatology Life Quality Index score recorded was 16.42 ± 5.93. Almost 85% patients were found to have a very large to extremely large effect on the QoL. Embarrassment, need for treatment and guilt were reported most frequently. The less severely affected domains were those pertaining to interpersonal relationship and work or studies. The limitation of the study was small sample size and lack of control group. Conclusion: Patients of premature canities were found to have an adverse impact on their QoL, attributable to the disease, seen most prominently to affect their psychology or emotional well-being and the felt need of medical care. Considering the age group affected, it could have a long-term detrimental effect on their psychological wellbeing.

The gingival melanin hyperpigmentation may represent an esthetic problem for some patients. Among the alternative treatments, the epithelial abrasion or scrapping is a simple and effective technique. The aim of this report is to present a clinical treatment of gingival melanin hyperpigmentation treated by the technique of epithelial scrapping. The result of the employed technique proved to be effective in the removal of melanin pigment, restoring the patient's esthetic, and self-esteem.

Amyloidosis cutis dyschromica (ACD) is a very rare and distinctive variant of primary cutaneous amyloidosis, clinically characterized by the appearance of hyperpigmented and hypopigmented or depigmented macules on normal looking skin before puberty in generalized distribution. We herein report a 30-year-old male with ACD involving whole body except hands, feet, palm, soles, genitalia, and mucosa since 10 years of age and positive family history. His 25-year-old younger sister also had the similar mottled pigmentary lesions since 8 years of age. On histopathological examination (HPE) of the hyperpigmented macules, increased melanin in the basal layer, pigmentary incontinence, and amorphous eosinophilic deposits were seen in the papillary dermis. HPE of depigmented lesions demonstrated a significant decrease in the number of melanocytes and melanin in the basal layer along with deposition of eosinophilic amyloids in papillary dermis. Based on these HP findings, diagnosis of ACD was made.

Becker's nevus or melanosis is an acquired pigmented hairy nevus with both epidermal and dermal components, commonly seen in males. Herein, we report a case of giant bilateral Becker's nevus involving shoulder, scapular region, anterior chest and both the arms. Bilaterally, symmetrical presentation and large area of involvement make it a rare case.

Bleomycin is a commonly used chemotherapeutic agent for lymphomas, germ cell tumors, and malignant pleural effusions. Although the pulmonary toxicity of bleomycin is well reported; the cutaneous side effects are relatively uncommon, ranging from generalized hyperpigmentation, sclerodermoid changes, erythema multiforme, and gangrene to flagellate dermatosis. Here, we report a characteristic but relatively rare side effect of flagellate dermatitis, which developed secondary to bleomycin in a 28-year-old gentleman suffering from Hodgkin's lymphoma after two cycles of treatment with adriamycin, bleomycin, vinblastine, dacarbazine regimen.

Lichen planus (LP) is relatively common papulosquamous condition characterized by purple, polygonal, pruritic, papules of unknown etiology affecting skin, mucous membranes, and the nails. It can range from the generalized to much localized form. Zosteriform LP is an uncommon variant with dermatomal or zonal distribution and may arise either de novo, at sites of trauma (koebnerization) or as Wolf's isotopic response at the site of healed zoster. Linear distribution of the disease has been described in less than 1% of patients and needs to be differentiated from other linear dermatoses. Treatment includes topical corticosteroids and systemic antihistamines. A 30-year-old male diagnosed with LP involving C7 (Cervical) dermatome over left side of the body in a zosteriform pattern is presented here.

Hypopigmented macules or guttate leukoderma is a rarely reported association of Darier's disease largely reported in dark colored individuals. So far, the pathogenesis of hypopigmented macules has been only partially explained by varying hypotheses such as post inflammatory phenomenon, an early or subclinical variant of disease, and genetic mosaicism. We describe a case of a 32-year-old male of Indian origin suffering from multigenerational Darier's disease associated with hypopigmented macules over the trunk. Classical warty papules and plaques were present in three generations thus highlighting autosomal dominant inheritance of the disease. The hypopigmented macules were found only in the proband thereby signifying its nonfamilial manner of inheritance.

Alkaptonuria (AKU) is a rare inherited autosomal recessive metabolic disorder, caused by the deficiency of homogentisic acid oxidase enzyme. Herein, we are reporting a case of AKU with bilaterally symmetrical palmar pigmentation and skeletal involvement. Histopathological examination revealed ochre colored pigment in the dermis whereas roentgenogram of the lumbar spine showed typical calcification of the intervertebral discs.