Salient nail unit changes serve as pointers toward systemic disease. On similar lines, salient nail changes are associated with pigmentary disorders, and can help toward diagnosis. Nail changes form a part of various physiologic pigmentary changes including racial pigmentation, pregnancy, or neonatal period. At the same time, a number of nail changes can be valuable clues toward disorders of pigmentation associated with genetic syndromes (Laugier–Hunziker syndrome, incontinentia pigmenti, and tuberous sclerosis), endocrine disorders, disorders of metabolism (alkaptonuria), infections (HIV-AIDS), internal malignancies, etc. Nail changes are especially useful if cutaneous pigmentary changes are suspected to be drug-induced based or associated mucosal and/or cutaneous hyperpigmentation. Various drugs that can cause cutaneous pigmentary alterations along with nail changes include cyclophosphamide, adriamycin, vincristine, docetaxel, paclitaxel, carboplatin, psoralens, hydroxyurea, bleomycin, etc. Nail changes are also associated with disorders of hypomelanosis, for example, vitiligo. Pigmentary changes due to endogenous and exogenous pigments are again diagnosable based on the nail changes they induce. This narrative review highlights the importance of nail changes in suspecting and diagnosing various disorders of pigmentation. It also points toward areas which need future research.

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The mast cell is a critical mediator of the inflammatory response by secreting histamine. While histamine is currently not regarded as a melanogen, recent studies have shown histamine release to induce melanogenesis, melanocyte proliferation and migration. Herein, we discuss the current evidence of the complex relationship between the mast cell and melanocyte, and its impact in pigmentation disorders.

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Pigmented spots on the skin are caused by burrowing bugs of family Cydnidae. These are commonly seen in monsoon, and the pigmentation is due to secretion by the insect. Here we report a case of Cydnidae pigmentation with characteristic dermoscopic features. Dermoscopic features included dark brown pigmentation over the dermatoglyphics with enhanced pigmentation around the sweat pores. The pigmentation which is seen commonly over the acral areas may be mistaken for lentigines or melanoma. Identifying the classical features on dermoscopy prevents the patient from undergoing unwanted investigations.

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Introduction: Melasma is a relatively common hypermelanotic disorder characterized by symmetrical light to gray-brown macules and patches involving photoexposed areas. Multiple factors have been implicated in the etiopathogenesis, including genetic factors, UV radiation, pregnancy, oral contraceptive pills (OCPs), thyroid dysfunction, and cosmetics. However, the role of cosmetics has not been well studied in melasma patients. The present study was designed to study the contact sensitivity to cosmetic allergens in patients with melasma. Material and Methods: Thirty patients with and thirty without melasma who visited Dermatology OPD between October 2015 and March 2017 were recruited according to selection criteria and were sequentially patch and photopatched with Indian cosmetic and fragrance series. Results: The mean age of melasma patients was 32.10 ± 6.62 years with female to male ratio of 1.72:1. Sixteen (53%) patients were found to show positive reactions on patch and photopatch testing with Indian cosmetic and fragrance series. Among 32 allergens tested, 15 allergens were found eliciting positive reaction. Thiomersol was the most common contact sensitizer eliciting positive reaction in six (38%) patients, followed by cetrimide, hexamine, and sorbitan each in three patients (19%). In the control group, only one (3.3%) subject showed positive contact allergy pattern. The results were significant (P < 0.001). Conclusion: A possible consideration of the pigmented cosmetic dermatitis and cosmetic contact sensitivity is recommended in the etiologic factors of melasma especially, in nonpregnancy/lactation induced melasma or when it is not associated with hormone therapy. Contact sensitizers might also have a role in melasma that is recalcitrant to all standard therapies.

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Milian ear sign is a specific clinical finding that aides in differentiating erysipelas from facial cellulitis. The anatomical absence of subcutaneous tissue in pinna brings about this clinical distinction. Although bilateral Milian ear sign is rare, erysipelas should be considered when encountering patients presenting with red ears, among other differentials such as Ramsay-Hunt syndrome, relapsing polychondritis, auricular perichondritis, and red ear syndrome.

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Context: Amyloidosis is group of rare diseases that are characterized by extracellular deposition of abnormal amyloid proteins either involving multiple organ systems (systemic amyloidosis) or restricted to a single-tissue site, such as skin (localized amyloidosis). In primary cutaneous amyloidosis, there is deposition of amyloid in apparently normal skin. The hyperpigmentation in all the lesions of primary cutaneous macular amyloidosis gives us an insight of a possibility of a connection between amyloid fibrils and melanogenesis. Aims: To compare the melanin content from the lesional skin of upper back and surrounding non-lesional skin of macular amyloidosis. Settings and Design: A hospital based, cross-sectional study conducted over a period of 6 months. Methods and Materials: Forty-two patients (30 females and 12 males) clinically and histopathologically diagnosed as macular amyloidosis were enrolled in the study. A Mexameter MX18 was used to measure the melanin index of the lesions of Macular amyloidosis over upper back and non-affected similar areas (control). Results: The melanin index of the lesional skin of female patients ranged from 552 to 823 (mean = 705.1). The melanin index of the lesional skin of male patients ranged from 621 to 792 (mean = 697.41). In the non-affected surrounding skin of females, the mean melanin index was 357.66, whereas in males, the melanin index of the surrounding normal skin was 296.75. The P value came out to be significant, that is, <0.05 in both males and females. Conclusions: There is a possible connection between amyloid fibrils and melanin synthesis. Amyloid protein in primary macular cutaneous amyloidosis may act as the precursors for melanogenesis.

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Background: Lichen planus (LP) is a papulosquamous skin disorder characterized by violaceous polygonal papules and plaques associated with itching. Dermoscopy in LP shows variable forms of whitish structures that correlate with Wickham striae (WS), vascular structures, and pigmentary changes that aid in its diagnosis. Aim: To study the correlation between clinical and dermatoscopic features in cutaneous variants of LP in Indian skin. Method: Patients with LP presenting over a period of 1 year were included. Dermoscopy of the lesions in polarized mode was done using video dermatoscope − Dino-Lite Premier AM4113ZT model. Both clinical and dermoscopy findings were photographed, recorded, and studied. Result: Fifty-six percent patients (39/70) had classical LP (CLP), 14% patients (10/70) had hypertrophic LP which were the most common clinical variants. Reticulate pattern of WS was the most common pattern observed in 40% (28/70) cases and a new rosette pattern of WS was observed in 13% (9/70) cases. Nonvascular findings such as WS, comedo-like openings, and grey blue dots showed statistically significant association with CLP. Among the pigmentary findings, pepper-like pigmentation was seen in 64% (25/39) CLP and reticulate pattern of pigmentation in 85% (6/7) cases of LP pigmentosus. Perifollicular pigmentation showed statistical significance in 100% cases of lichen planopilaris. Conclusion: In view of consistent dermoscopic features observed in LP, it aids as a valuable noninvasive diagnostic tool, many a times obviating the need for skin biopsy. Limitations: Small sample size and the exclusion of lesions of LP over the nails, genitals, and oral mucosa.

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Serpentine supravenous hyperpigmentation is a rare, cutaneous sequela of intravenous chemotherapeutic agents, collagen vascular diseases (systemic sclerosis, systemic lupus erythematosus, and rheumatoid arthritis), and infections like leprosy and HIV. The condition manifests clinically as a peculiar, patterned eruption characterized by hyperpigmented streaks following the superficial venous network on the skin. Here, we report a case of a middle-aged lady with breast carcinoma, who developed serpentine supravenous hyperpigmentation after intravenous docetaxel.

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Toxic erythema of chemotherapy (TEC) is a term used to describe the presence of erythema with or without edema often affecting the hands and feet, intertriginous areas such as axillary and inguinal areas and less frequently elbows, knees, and postauricular areas. Sometimes the lesions can be petechial or with sterile blisters. They are generally self-limiting and resolve with post-inflammatory hyperpigmentation. Here we describe one such rare case of Methotrexate-induced TEC involving uncommon sites like hairline, postauricular areas, and neck.

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Giant congenital melanocytic naevus is a naevus measuring more than 20 cm in adulthood. Its incidence is 1:20,000 and is more common in girls. Bathing trunk naevus, a specific form of giant congenital melanocytic naevus is even rarer with incidence of 1:500,000. Giant congenital melanocytic naevus usually presents as a brown lesion, with flat or mamillated surface, well-defined borders and hypertrichosis. Dermoscopic examination of melanocytic naevi shows brown-blackish background, globules, reticular network and vascular structures. Although giant congenital melanocytic naevus is often diagnosed clinically, dermoscopy aids in detecting early changes of complications such as malignant melanoma. We report a case of bathing trunk naevus with multiple satellite lesions in a brown child with dermoscopic findings.

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