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Pigmentary changes in skin can act as an interface to diagnose and monitor various systemic diseases. Endocrine and metabolic disorders can directly or indirectly affect melanin synthesis pathway, thus affecting melanogenesis and skin color. Moreover, these disorders can affect the vascularity of skin and the amount of endogenous nonmelanin pigments that are responsible for skin color. Pigmentary changes can also occur in mucosa, hair, and nails and provide a clue to underlying disease. In this review, we discuss the clinical features, pathogenesis, and treatment of pigmentary changes associated with various endocrine and metabolic disorders. It is imperative for the dermatologists to be aware of these cutaneous manifestations, recognition of which can help in diagnosis and management of underlying condition.

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Glutathione is a thiol-containing tripeptide which is considered as a master antioxidant. Found naturally in fresh leafy vegetables, fruits, and nuts, commercially available preparations of glutathione have been found to be useful in number of medical conditions such as central nervous system disorders, autism, cardiovascular system disorders, peripheral vascular disorders, diabetes and its complications, liver disease, acquired immunodeficiency syndrome/human immunodeficiency virus, and chronic obstructive pulmonary diseases. With regards to the dermatologic disorders, some studies have highlighted the role of glutathione as a skin-lightening agent. The studies on use in other diseases such as psoriasis, pemphigus vulgaris, acne vulgaris, rosacea, etc., are limited and need to be explored more. Glutathione is available as oral preparations (pills, sublingual tablets, solutions, syrups, and sprays), parenteral forms (intravenous [IV] preparations), topical formulations (creams, soaps, and facewashes). The major drawback of oral form of glutathione is its low bioavailability in humans. To overcome this drawback, sublingual tablets and oral liposomal glutathione have been made available. However, the number of studies evaluating its efficacy and safety are less in number. This review article has been written to highlight the role of glutathione in various dermatologic disorders apart from skin-lightening agent.

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Background: Paucity of literature and non consensus on clinicohistopathological features amongst the nonmelasma facial melanosis for example lichen planus pigmentosus (LPP), pigmented contact dermatitis (PCD), macular amyloidosis, acanthosis nigricans, pigmented demarcation line, post inflammatory hyperpigmentation, etc., make them difficult to diagnose and equally challenging to treat. Materials and Methods: It was a prospective, uncontrolled study, conducted at tertiary hospital at eastern India in 100 patients presenting with facial hyperpigmentation who agreed to undergo 3 mm skin biopsy during Jan 2014 to Jun 2015. Cases of melasma were excluded by clinical, Woods lamp examination and if required dermoscopy. Details of history, physical examination, histopathological examination, and Immunohistochemical studies were recorded. Melan A was used as melanocytic differentiation marker while CD4, CD8 were used as inflammatory markers. Mean ± SD, chi-square test or Fisher’s exact test, degree of agreement by Cohen’s Kappa were calculated. P-value was considered significant if ≤0.05. Results: 44 males and 56 females (56%) (M: F=1:1.24) with mean age of 45.98 years and median duration of illness of 28 months (5 months-13 years) were studied. Out of 43 confirmed cases of PCD, 16 had associated hypothyroidism (chi square 6.11, P-value 0.0134). Maximum patients belonged PCD (n = 47) followed by LPP (n = 27). Maximum concordance of clinical and histopathological diagnosis was present in PCD and LPP (Cohen kappa more than 0.9). Epidermal atrophy and band like inflammatory infiltrate were statistically significant features in LPP (P < 0.001). There was no histopathological and immunohistochemical correlation. Overall, clinical histopathological concordance rate was 77%. Conclusion: Subset of nonmelasma facial melanosis is difficult to diagnose clinically which require further confirmation by histopathological examination. Small number of patients in other groups apart from PCD and LPP and uncontrolled study were major limitations of this study.

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Background: Periorbital dark circles are common in all races. Proposed causes include increased vasculature, tear-trough deformity, pigmentary demarcation lines, spongiotic dermatitis, lichenoid dermatitis, acanthosis nigricans, post-inflammatory hyperpigmentation, and heredity. Aims: To evaluate the clinical features and histopathological features of dark circles compared to nearby unaffected skin in South Asians. Methods: Clinical evaluation, skin biopsies, and narrow-band reflectance spectrophotometry of periorbital dark circles and nearby unaffected skin were performed on all subjects. Results: There was a positive correlation between the clinical severity of dark circles and increased melanin based on spectrophotometry. Histological evaluation showed increased dermal melanin content in dark circles compared to normal skin. Limitations: Single-center pilot study. Conclusion: Dark circles in this cohort of South Asians are associated with increased dermal melanin. Other contributing factors may include exaggerated tear trough depression, translucency of eyelid skin, and pigmentary demarcation lines.

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Background: Cosmetic camouflage, used to temporarily normalize appearance, has been shown to improve quality of life in patients with visible disfiguring skin disorders. Its integration into the daily dermatology practice is affected by many hurdles, including dermatologists’ perception about it. Knowledge gained during residency teaching likely affects future practices. Aims: This questionnaire-based survey study was planned to assess the knowledge, attitude, and practice about cosmetic camouflage among dermatology residents. Methods: Dermatology residents in four tertiary care hospitals were contacted for voluntary participation by anonymously filling out a questionnaire devised to assess the awareness of cosmetic camouflage among dermatology residents, various indications of recommendation, any inhibitions in recommending camouflage, problems faced while recommending, and so on. Results: Nearly all (30 of 31; 96.8%) of the dermatology residents in the survey were aware of cosmetic camouflage, but translation of this into practice was low as only about half (17 out of 31, 54.8%) had recommended it. Commonest indication known to the residents was vitiligo (27; 87.1%). The most frequent situation for recommendation felt by 20 (64.5%) respondents was in patients with significant disease related psychological morbidity. Most (18; 58.1%) respondents felt one or the other inhibition in recommending camouflage. The respondents felt that the commonest problem faced while recommending camouflage was availability of the camouflage products (21; 67.7%). Majority (13; 41.9%) thought it only had a “somewhat” role in dermatology. Conclusion: This study highlights the need to improve early education in residency regarding the option of cosmetic camouflage to address the cosmetic concerns of patients. Setting up of camouflage clinics in teaching hospitals may help in this.

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Progressive cribriform and zosteriform hyperpigmentation (PCZH) is an uncommon disorder of pigmentation that is believed to be a result of pigmentary mosaicism. In this report, we describe a child with congenital nevus depigmentosus and low intelligence who later developed PCZH by the age of 5 years.

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Nevus of Ota (NOO) is a dermal melanocytoses characterized by bluish-brown macules along the distribution of trigeminal nerve. Ocular involvement is observed in most of the patients in the form of scleral pigmentation. Also reported associations in this condition are iris/ciliary body pigmentation/glaucoma, ocular melanoma, etc. Hence, the terms nevus fusco-ceruleus ophthalmo-maxillaris and oculodermal melanocytosis are used to refer to this condition. Bilateral NOO is a rarely encountered condition, with only few scattered case reports in the literature. In this study, we report a rare presentation of bilateral NOO in four patients. The condition is important to recognize due to cosmetic concern it poses and limited treatment options.

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Bilateral segmental neurofibromatosis is a nonfamilial variant of neurofibromatosis without any systemic involvement. Speckled lentiginous nevus (SLN) is a pigmented, light brown to tan patch of varied diameter, speckled with smaller, darker colored macules or papules. SLN has been reported in association with bilateral nevus of Ito, blue nevus, centrofacial lentiginosis, and nevus sebaceous. Its association with bilateral segmental neurofibromatosis has been rarely reported in the literature. We report a rare co-existence of zosteriform nevus spilus with bilateral segmental neurofibromatosis, diagnosed on the basis of clinico-dermoscopic-histopathological features, in a 25-year-old female.

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