Tranexamic acid (TXA), an antifibrinolytic drug, is now gaining popularity as a depigmenting agent. It is a synthetic lysine amino acid derivative which mainly blocks the conversion of plasminogen to plasmin by inhibiting plasminogen activator. This results in less free arachidonic acid production, and hence a reduction in the prostaglandin (PG) levels as well. Thus, by reducing PG production, TXA reduces the melanocyte tyrosinase activity and plays an important role in the treatment of melasma, ultraviolet-induced hyperpigmentation, and other postinflammatory hyperpigmentation. It has been tried topically, orally, and intradermally in the management of melasma with minimal adverse effects. However, more randomized trials are needed to fully elucidate the exact mechanism of action, ideal route, frequency, and duration of administration of the drug, along with its potential to treat other pigmentary disorders.

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Background: Disorders of increased facial pigmentation constitute a major group of disorders in all dermatology clinics. Apart from cosmetic disfigurement, these disorders could significantly affect patient psychology. Therefore, it becomes imperative on the part of clinician to arrive at a conclusive diagnosis so that appropriate therapy could be administered. Aim: To correlate the clinical and histology findings in 70 females 30–50 years of age with persistent facial hypermelanosis. Methods: Following a written, informed consent, a 2 mm punch biopsy was performed from the lesional skin, succeeded by microscopic evaluation and clinical correlation. Results: Out of the 70 patients studied, 31 had melasma, 14 with seborrhoeic melanosis (SM) and lichenoid dermatitis each, four with acanthosis nigricans (AN) and ashy dermatoses, and the remaining three with Riehl’s melanosis. Out of these patients studied, all patients with melasma and AN demonstrated 100% clinicopathologic concordance. Koilocytes were identified in two patients with persistent facial hypermelanosis, and in 17 patients, the histology findings were undecided. Conclusion: Melasma appears to be the most common cause of facial hypermelanosis in females and has demonstrated a 100% clinicopathologic correlation. Subclinical infection with human papilloma virus (HPV) could be a cause of increased facial pigmentation which, if not carefully evaluated, could go undetected. SM still remains a disputable entity. Majority of these disorders are chronic and highly recalcitrant to all conventional therapeutic modalities.

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Background: Vitiligo prevails to be a skin disease with endless possibilities but no promises. Despite substantial research in pathogenesis and therapeutic modalities, the literature is deplete with technologies to predict the probabilities for repigmentation with or without therapy in the common generalized vitiligo. Aim: To correlate pretreatment melanin index in skin patches of nonsegmental vitiligo to probable extent of repigmentation following 6 months of monotherapy with a topical corticosteroid. Methods: A prospective study was conducted including thirty patients of vitiligo and their melanin index (melanin value; pigmentation index) in representative skin lesion was determined using Mexameter^® MX 18. Patients were studied under three groups (A, B, and C) based on the obtained melanin indices. The extent of repigmentation following 6 months of topical therapy with mometasone furoate 0.1% cream was correlated with pretreatment melanin indices. Results: Repigmentation in Group C (mean melanin index >200) was significantly higher in terms of number of patients (P = 0.000) and area of patch coverage (P = 0.00) as against the other two groups with lower melanin indices. Conclusion: Melanin index in depigmented lesions is a useful indicator in the management of nonsegmental vitiligo to predict the repigmentation and to choose the appropriate treatment option. Mexameter is a simple, noninvasive, low cost staging, and monitoring device to estimate the melanin reservoir in vitiligo.

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Background: Vitiligo, an acquired disorder of the skin, is characterized by depigmented macules and patches. Three pathogenic mechanisms that is immunological, neural, and biochemical have been suggested. One of the newer theories in the pathogenesis of vitiligo is the role of oxidative stress. Aims: We compared the levels of malondialdehyde (MDA), superoxide dismutase (SOD), and its cofactor zinc between cases and controls and related it to body surface area (BSA) involved and stability of the disease. Methods: Sixty vitiligo patients and 60 healthy controls were selected, and their serum SOD, MDA, and zinc levels were compared. The cases were further classified on the basis of BSA involved and stability of the disease. Serum SOD, MDA, and zinc levels were then compared within these groups. Serum SOD and MDA levels were measured using enzymatic methods, and serum zinc levels were measured using a commercially available kit. Results: It was observed that SOD and MDA levels were significantly raised in vitiligo cases than in controls. There was no statistically significant difference in serum zinc levels among the cases and controls. Moreover, the values of SOD and MDA were higher in patients with progressive disease than in patients with stable disease. Conclusions: Our observations support the theory of oxidative stress playing role in the autoimmune pathogenesis of vitiligo and SOD and MDA levels may act as biochemical markers for stability in vitiligo.

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Background: Lichen planus (LP) is a unique inflammatory papulosquamous disorder that affects the skin, hair, nail and mucous membranes, and is associated with a relapsing and remitting course. Aim: To study the clinicopathological profile in patients diagnosed with LP. Methods: A cross-sectional prospective study of 100 freshly diagnosed cases of LP over a period of 1 year, wherein following patient enrolment, they underwent a thorough clinical evaluation followed by a biopsy, that was carefully studied and evaluated. Results: A male preponderance (60%) was observed. Majority of the patients were in the 21–40 years age group (60%). Pruritus was witnessed in 84% of the patients. The morphological types of cutaneous LP encountered were classical (58.9%), hypertrophic (28.4%), linear (4.2%), lichen planopilaris (LPP) (4.2%), bullous (2.1%) and LP pigmentosus (2.1%). Out of the 42 patients with oral LP, reticulate type was present in 85.7% patients and erosive variant in the remaining 14.3%. Spotted hypergranulosis was a finding seen in 100% of the cutaneous biopsies taken. Hyperkeratosis was identified in 92.6%, pigmentary incontinence in 93.7% and subepidermal band like lymphocytic infiltrate in 92.6%. In none of the patients of LPP were the characteristic microscopic findings identifiable. In oral mucosal biopsies, dysplastic changes were evident in 50% of the participants. Conclusion: LP is a disorder more common in males usually manifesting in the 3^rd to 4^th decade of life, with the classical type of cutaneous LP and reticular variant of oral LP being most commonly encountered. Dysplastic changes in oral LP demonstrated a value of 50% in our study, a value much higher when compared to previous reports, thus mandating vigilant identification of the same for appropriate patient management.

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Background: Melasma is a common acquired hypermelanosis, notorious for its recalcitrant nature. Though benign in nature, it could significantly affect the quality of life in some patients. Therefore, apart from pharmacologic management in cases of resistant melasma, the need for psychologic counseling would be imperative to improve the quality of life in such patients. Aim: To analyze the clinical patterns of melasma along with all other demographic parameters followed by Wood’s lamp (WL) examination, Melasma Area and Severity Index (MASI) scoring and assessment of Dermatology Life Quality Index (DLQI) in all the participants of our study. Methods: A prospective, observational and descriptive study done over a period of 7 months in 175 freshly diagnosed females with melasma above 18 years of age. Results: Majority of the patients with melasma were in the 31–40 year age group (44%), followed by 21–30 (26.9%) and 41–50 (16.6%) years. The duration of melasma in most of our patients was below 1 year. Sunlight (48.5%) appeared to be the major precipitating factor followed by cosmetics (22.2%). A significant association with hypothyroidism was demonstrated amongst our participants. A positive family history was noted in 54.85% of the study subjects. The dermal variant was the most common type of melasma that was observed. The mean MASI score observed was 5.3 and the mean DLQI seen in our study was 1.46. Conclusion: Melasma is common in middle-aged females. Solar radiation constitutes a major risk factor for melasma. Hypothyroidism appears to have a significant association with melasma. It is important to evaluate the DLQI in all patients with melasma to holistically manage these patients.

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Background: Neurofibromatosis (NF)-1 is an autosomal dominant genodermatoses affecting numerous body systems. Though many associations are known, new findings encountered continue to intrigue the medical fraternity. Aim: A clinical study of various manifestations of NF-1. Methods: An observational study that was conducted on 30 patients with NF-1 over a period of 1 year. Results: Café-au-lait macules were identified in 28 (93.3%) patients. A family history of NF-1 was demonstrated in 10 (33.3%) patients. In 4 (13.3%) patients, plexiform neurofibromas were identified. Axillary freckling was seen in 27 (90%) patients and inguinal freckling in 17 (56.1%) patients. Lisch nodules were detected in 28 (93.3%) patients, conjunctival neurofibromas in 2 (6.7%) and conjunctival freckles in 3 (10%) patients. Bone changes were demonstrable in 8 (26.7%) patients. Blood pressure was normal in all our study subjects. Conclusion: In our setting, no gender preponderance of NF-1 was noted. Conjunctival freckling, an ocular pigmentary observation, was a new observation detected in 10% of our study subjects. An association of conjunctival neurofibroma along with cutaneous neurofibromas was seen in 2 (6.7%) patients. Rare radiographic findings like lytic lesions over skull bones and ribboning of metatarsal bones and ribs were detected in 2 (6.7%), 1 (3.3%) and 3 (10%) patients, respectively.

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Becker’s nevus commonly presents as a unilateral hyperpigmented, irregular macule or patch or verrucous plaque with a variable hypertrichotic element located on the shoulder, anterior chest or scapula, and back, and rarely, on the face, neck, and extremities. A number of cutaneous associations were reported with Becker’s nevus. However, coexistence of vitiligo and Becker’s nevus is a rare finding. We report such a finding in a 15-year-old boy who presented with Becker’s nevus on the left side of chest and upper arm and had developed depigmented lesions on the same site over the past 5 months. Diagnosis of both the types of lesions was confirmed by histopathology. Role of cytokines may be proposed in the development of vitiligo and other immunologically mediated diseases on the existing Becker’s nevus on the basis of the concept of ‘Wolf’s isotopic response’ and ‘Ruocco’s immunocompromised district’.

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Dyschromatosis universalis hereditaria (DUH) is a rare genodermatosis, which has been reported most often from Japan. The etiology of this disorder is not yet known. DUH is characterized by mixtures of hyperpigmented- and hypopigmented macules all over the body. Skin lesions are usually present in the first years of life. The trunk and extremities are the dominant sites. We report this pigmentary disorder in three siblings, two females and one male. These siblings presented with hypo- and hyperpigmented macules arranged in a reticulate pattern over trunk, dorsal and ventral aspects of legs and arms, and dorsa of both hands and feet. The biopsy findings were also consistent with DUH. Autosomal dominant pattern of inheritance was seen as one of the parents was also affected. There was no systemic involvement.

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